Potty training considerations

 

Potty training tidbits

If you look at parenting as a journey, consider that every single one of us has to pass through the ‘toilet training’ station. Some kids do it very easily, but they are the minority. There are tons of differing opinions on how best to tackle this. Regardless of which method appeals to you, the key is recognizing that kids all will present their own unique way of achieving the ‘big kid/no more diapers’ status. Watch your child's cues. If you start too soon, more often than not, you can expect several months of aggravation. My kids were no exception to this and I learned some valuable lessons along the way. My first daughter, Lauren, mastered most of the milestones on the early side. Seriously, she was singing show tunes at 18 months. She was interested in the potty and was mostly trained well before she was 2. But it wasn’t completely smooth sailing. She went through a period of horrible constipation.  Constipation is very common during this phase. I am defining constipation as when they have hard or pellet-like stools. I see this happen ALL the time. Toddlers are now physiologically able to hold their poop. If they hold it too long, it will be uncomfortable coming out; this will make them want to hold it even more. Even one painful poop is going to make them more reluctant to go. This is the proverbial vicious cycle. Keep track I don’t think it is necessary to track every pee and poop (sneeze, yawn, ounces of milk etc) when you have an infant. However, once you have a child who is on the brink of leaving diapers behind, it is very important to pay attention to their poops. This is especially critical if there are multiple caregivers. It is easy to lose track. Kids might skip several days before anyone notices. If they miss a few days and the stools are still mushy, that is just fine. However, more often than not, the infrequent stools are harder than we want them to be. I would suggest starting a shared document or using a tracking app such as Huckleberry. This is to make sure that whoever is on duty when the poops make an appearance, marks it down. Make note of the consistency as well. This would include daycare providers, grandparents and anyone who is part of the team. All the caregivers should not only help keep track, but it is really important that everyone is on the same page and giving consistent messages during this process.  Pay attention to diet Be proactive. Make sure they are getting lots of fluids and fiber. Make some healthy muffins with ingredients like oats, flax seeds and molasses. Kids tend to eat things that they have helped with. Or make smoothies with lots of veggies. Let them add things to the blender, be in charge of turning it on and have a special cup that they drink it out of. All the kids will manage to get out of diapers sooner or later.  If you wait until they seem ready, they can have success within a week. My younger daughter, Alana took her time with all of the milestones. Having Lauren do everything so quickly made it feel even slower. She was slow to walk, slow to talk and not in the least bit interested in getting rid of the diaper.  Be careful how you ask the questions! Me: " Hey Lani, don't you want to be a big girl? Do you want to wear these wonderful big girl undies?" Alana: " Nope. I like being a baby. I like my diapers." Hmmm, for some reason, that wasn't the response that I was expecting and I didn't have a follow up. Just when I was figuring that this 'big for her age' almost 3 year old would need to start wearing "depends" all of a sudden she was magically ready. She asked for underwear and barely had an accident after that. As with everything, Alana waited until she was good 'n ready before doing anything and then simply mastered it. (her first poop in the potty was 5/31/93 How can I possibly know this???? Check out the "keep a journal post!" ) For anyone who is worried, Alana is a local therapist who has given her blessings to me sharing this. Books, songs and Potties As soon as they show the slightest signs of being interested, I suggest getting a selection of the children's books and videos about potty training. Let them get familiar with the concept that some day, big kids pee and poop in the potty or toilet.  Regardless of which method you choose, books can be a fun part of the learning process. A simple search on Amazon will show you that there are tons of cute ones out there. My grandson, Elliot likes the Elmo book P is for Potty, and he also likes the song “Go Potty Go” by Daniel Tiger. My old friend and ex-boss Dr. Schwanke’s favorite is an old book called Toilet Learning, by Allison Mack. This one is especially good for boys. He likes that the title helps parents recognize that it is learning, not training.  Everyone poops is another classic So many options There are also all sorts of potty seats. Some have steps and fit over the toilet. Others play music. Talk to your child about the choices that exist. Which one would they like to try?  Lauren and Adam inherited an Elmo potty that makes noise and Elmo laughter, which they have quickly come to resent.  Monkey see. Monkey do Let them watch you do your business. Although most kids start out by sitting down, little boys and dads...go play the ‘sink the cheerio game’ (I don't really need to spell that one out, do I?) If they are in daycare, exposure to some little friends who have made the transition makes a difference. Elliot has a bunch of little friends that occasionally do some facetime from the potty to show off a successful pee or poop. If you have siblings, cousins or friends who are willing to demonstrate, kids can be motivated by watching their peers. It is okay if they master Pee before the ‘daunting poop’ You may opt to allow this to happen in stages. For some reason most kids are way more comfortable tackling the pee issue but are much more reluctant to poop out of the comfort of their diapers.  Go ahead and work on peeing in the potty first. Some parents have their kids wear undies but tell them when they need to poop and then put a diaper or pull-up on for that. Potty training is the second (hunger cues are the first) big developmental transition where our children learn to listen to their bodies. And as you well know, some are better at listening than others. Having them recognize that they need to pee or poop is such an important first step and a big win. Rewards may or may not be helpful Sometimes a simple star chart is all you need. Other parents have success offering limited use of the ipad or phone for potty sitting.  Some kids are motivated by the lure of ‘big kids’ undies. There are so many fun choices. Princess, dinosaur, super hero, let your little one decide what they would want to wear. Watch out for reward backfires. With Lauren we were offering some little M&M for each poop in the toilet. She proudly squeezed out a pea size piece of poop, pointed to the ‘no longer clean’ potty. She received her treat and a round of applause...."but wait Mom and Dad...look there's more!" Like a gumball machine, she had figured out how to dispense a small piece of poop at a time. After washing out the potty multiple times, we had to do a recalculation (much to her displeasure). And suddenly they are over 3 Aside from reading a few books, unless a deadline is forced on you, such as acceptance to a preschool that only accepts kids who are potty trained. I usually leave the more recalcitrant kids alone until they are 3-ish. Once that birthday is on the horizon, I think it is now time to take some action. There are popular methods available that some folks swear by. The premise is that disposable diapers are very absorbent and make it very comfortable for kids to hang out with a dirty one. Most kids are not inclined to just pee anywhere when the diaper is off. Drawing a firm line in the sand and just getting rid of the diapers is the fastest way to do this. Here are some of the more popular ones Oh Crap potty training guide This is probably the best known Three Day Potty Training This is the one that Lauren’s friend Arielle used with her son Makai and it worked really well. Potty training made simple. This one was created by Big Little Feelings These systems typically help you make a step by step plan. Most involve finding a several day stretch of being home with no diaper. Make sure that you pick a convenient time where you can carve out several days at home where you don't need to be anywhere and can focus a good bit of attention on this. Kids may cry for their diapers, but these method usually works pretty well. I share these because using a program or formal method is great for people who crave firm guidelines and handholding. The costs are variable. For everyone else, remember that generations of parents successfully potty trained their children without fancy apps or prescribed ‘methods’ . It is fine to just wing it!! Here is a consideration/incentive for your older kids. Take them to the store with you when you buy the diapers. (Amazon will survive). Use cash. Singles if you have them. (Remember what actual currency looks like?) Show them the money that you give to the store every time you buy some diapers. Then, look at some toys and see how much they cost. Plant the seed, so that when they are ready, instead of a box of diapers, you can perhaps use some of the money to buy that toy instead. Obviously this tactic works better when the kids are old enough to understand the concept. Recipe for success Give some nice positive attention for any attempt at sitting on the potty and making a real effort.  Ariell shared that the sustained and also specific enthusiastic praise was SO key to their success. Now Makai gives her a hip hip hooray every time she goes to the bathroom and she has never felt so celebrated for such a routine part of the day! Set a timer and have them sit on the potty or toilet for five minutes when they are working on a poop.  Just like squatty potties are great for adults, helping your child be in the right position can facilitate easier pooping. Give them a little place for their feet so that the knees are bent a little.  Make sure that they are wearing outfits that they can pull up and down easily so that when they do remember on their own they are not hampered by difficult buttons. Kids get involved in playing and often don't pay much attention to their body's cues. Get in the habit of taking them to the potty every hour or so. The adults who are watching them need to be consistent. Oops/accidents happen There should be no shame or punishment, but once they are three, they can have a little ‘skin in the game’ They need to help clean up and know where the dirty clothes get deposited. As you are cleaning it is fine to mention how nice it would be if the poop went right into the toilet. Have them be part of the problem solving team  Pay attention to your language “What can we do to keep your new undies dry” Consider having a ‘poop agreement’ so that everyone is clear on any rewards and /or consequences that have been discussed Leaving the diaper phase has its challenges Being out and about with a newly potty trained child is an adventure. You will quickly learn which friendly merchants have clean and accessible toilets that you can run in and use. You will learn to watch out for the telltale signals. The hand down at the crotch and the jiggling up and down usually mean you have a minute or less to find a bathroom.  An inner tube and a large kitchen garbage bag make for an excellent makeshift potty. I used to have those in my trunk and this came in handy on many occasions when my kids were little. Some toilets are scarier than others You actually never know what is going on inside their little heads. When my nephew was 5, he started having some accidents because he refused to pee in his upstairs toilet. I asked him what that was all about? He showed me that there was a towel rack that was crooked. His mom fixed it and he no longer had an issue with that bathroom. Sometimes it is indeed a simple fix I have had some little patients absolutely terrorized when a public toilet automatically flushed while they were still sitting on it. Perhaps you go first and show them how it works. Arielle did the very wise move of getting her guy comfortable with public bathrooms well before they started the toilet training process. They explored the automatic faucets, noisy hand dryers, different toilet flushes and it made him much more comfortable. In fact recently they went to a show and he wanted to spend more time in the bathroom flushing the toilet instead of seeing the show because he was so intrigued by the sounds. If the toilet happens to go rogue and flush while someone is still on it, make it funny. “Silly toilet, I wasn’t finished yet” Or you can use this brilliant ‘post it note’ hack If you put a post it note over the sensor, it should eliminate the toilet from flushing until you are ready!  I have other patients who are really struggling with their aversion to the toilets at school or daycare. It is worth meeting and problem solving with the staff to see if you can come up with a workable solution. Blink and they are 3 ½ Do not shame or yell at a child who isn't quite ready. If your child is over 3 ½ and you don't feel that you are making progress, it might be time to talk to the pediatrician to see if they can help you move forward. Night time is a whole different issue.  I suggest working on the toilet training during the day and using pull ups at night. Don’t even think about tackling night time peeing until your child is waking up dry or asking to get rid of the night time pull ups  Extra Pearls of Wisdom from some experts Julie King, parent educator and coauthor of How To Talk So LITTLE Kids Will Listen shares: I learned from my own child not to ask certain questions. "Do you have to use the toilet?" always got me a "No!" My toddler was probably thinking, "No, I don't have to go. I'm sure I can hold it for at least another ten seconds. I'll keep playing." (Ten seconds later, of course....) I know a mom who asks her little one to "check in with your bladder and your colon. Do you have any pee or poop in there?" Her daughter will stop and try to feel what's going on in her body.  You can also model for your potty learner by checking in with your own body, and reporting out, to help them make the connection. "My bladder is getting full. I better go empty it." When I wanted my little one to empty his bladder before we went out, it worked better for me to say, "Let's see if you can get three drops of pee in the potty." Turns out that once you open the spigot, the pee flows freely! I'm also in favor of being playful. When my daughter was learning to use the potty, she was resistant to "trying" on command. But she was delighted when I used the toilet, and then told her, "My pee wants to say hi to your pee!"  (If you come up with other playful ideas, please share them with me julie@julieking.org! We might as well have some fun while we're spending so much time thinking about pee and poop!) It's not unusual for kids to resist using the potty, especially when it means they have to interrupt their play. (Raise your hand if you have ever sat somewhere for a tad longer than you probably should have, so you could finish an email or a video ... and then had to race to the bathroom? My hand is raised.) Our kids have less experience -- and smaller bladders -- than we do, so the problem is not uncommon. It can help to sit down and problem solve with your child -- come up with a plan for reminders or potty breaks. We have a pretty hilarious example of using problem solving to address this issue with a child, which is on page 110 of our book How To Talk So Little Kids Will Listen. It's called Miss Liberty Pitches In, and it's a true story from my co-author Joanna's family.  And just a reminder that kids with sensory processing differences or developmental delays can take longer to figure out all the steps of potty learning. One of my kids didn't have a good sense of what was going on in his own body, and he didn't feel it when his pants were soaking wet. It took him longer than what is considered typical, but he did eventually figure it all out. If you think you might have one of these kids, it can help to adjust your expectations so you don't get frustrated and impatient with the process, which can affect their ability to make progress. I know, easier said than done! It may help to remember that, for most kids, it will happen.  Mona Singhal of Sparks wonder, and Oath’s behavioral specialist adds: What to Wear: This is always a hot topic. Some experts say wear nothing, go commando! I am not a fan of that. Firstly, that isn’t always the best option depending on where you live. Secondly, we are a society that does wear clothes (most of the time) so that is what we should be teaching our children.   My preference is to have your little ones in underwear and loose sweatpants. You want them to feel wet because that will make them want to change and eventually not want to wet themselves. If they are naked it may not be that bothersome to pee everywhere. Remember to be casual when they have accidents. “Let’s go clean up! You can always tell us when you have to use the bathroom. What color pants do you want now? Can you put your pants in the laundry please?” Drop in the reminder to tell you but don’t focus on it.   Thanks to Julie, Mona, Lauren and Arielle for their valuable time,wisdom and feedback.

Gun Safety 2023

 

Gun Safety

I don’t pretend that I am neutral when it comes to discussions about guns. I am a pediatric nurse who lives in San Francisco, California; it's easy to figure out my view on guns in general. But if you are a gun lover, please keep reading. I am really hoping that we can find something here that we can stand together on. It is inexplicable to me how so many issues these days have become partisan, but there MUST be some common ground. If you are a parent, regardless of how you feel about firearms, I am hoping that we can all agree that we want to keep our children safe. I actually consulted with my brother-in-law who tends to be on the opposite side of the aisle from me when it comes to many politically hot topics. I wanted to make sure that this post can speak to folks on both sides. Year ago I was approached by Krystal, a mom in my old practice, who was involved in a program called Be Smart For Kids. This group is tackling the gun safety issue. I was startled by the statistics. The Centers for Disease Control has stated that firearm-related deaths from homicide, suicide or unintentional injury remain one of the top three causes of death for American children. Every year, hundreds of children in this country gain access to a firearm and unintentionally shoot themselves or someone else. This happens every 34 hours! The vast majority of these shootings happened with a gun that the child found in their own home or car. These accidents are tragic. What is also sadly happening is that every day, at least one child takes their own life with a gun. Almost 500 American children die by gun suicide every year and the rate is climbing. More than 80% of the children who commit suicide use a gun that they found at home. Suicide attempts are often spur of the moment, feeling overwhelmed with despair, situations, but those who attempt suicide with a gun more often than not, don’t get a second chance. Most of the gun suicide attempts end in death. If you hate statistics, feel free to ignore them. One accidental death is too many. Be SMART's goal is to prevent children's access to firearms. o Secure guns in homes and vehicles. o Model responsible behavior. o Ask about unsecured guns in other homes. o Recognize the risks of teen suicide. o Tell your peers to be SMART. I am including some of the Be Smart strategies along with other information that I gathered while researching for this post. Secure the guns Research shows that nearly 4.6 million children live in homes with guns that are not properly stored. The American Academy of Pediatrics defines responsible gun storage as locked, unloaded and stored separate from the ammunition. Hiding a gun is not a good solution. Kids find things. They know how to poke around in closets and drawers. Guns simply must be locked up. If your gun is used for hunting, this should be a no brainer. If the gun is used for protection, I can understand the concern with anything that limits quick access. There is a solution! If Nurse Judy and the NRA are both in agreement with something, it must be good. There are biometric safe options. You can access the guns within several seconds with a fingerprint. They can be programmed to open with more than one person’s fingerprints for the adults in the family. Sentry Safe - Quick Access Pistol Safe has videos on their website showing access in as little as 2-3 seconds. Barska Mini Biometric Safe also claims 2.5 second access. The parents of the six year old who took a gun to school and shot his teacher recently, were stunned that their child was able to get ahold of their gun.  That gun was reported to be in a locked box on the top of a closet. Kids are smart. They know where the keys are. They can climb. They can figure out a combination. A fingerprint is a safer solution. Perfect would be a biometric box, but don’t let perfect get in the way of good. At the very least ammunition should be locked away in a different location. Model responsible behavior If you own a gun, of course teach your children all of the safety rules. Don't be lulled into a false sense of security because you think your child knows what to do if they come across a gun. The thing to remember is that kids will be kids. Study after study has found that even though kids have been taught never to touch a gun that they found, and that they should instead run to tell a grown up, most are unable to resist the temptation to handle it. Trusting your kids to do the right thing in this case is not the answer. The responsibility rests 100% on the grown ups. 20/20 has done some stories on this. 20/20 Gun Safety Clip As one wise person says in the above clip, “You can’t educate the curiosity out of the child.” It doesn’t help that so many of our kids are exposed to guns on television, movies and video games where people almost seem to be bulletproof. Ask about guns I have to confess that this never occurred to me before meeting with Krystal. I have taught a safety class for years. The topics are numerous - how to deal with a strange dog on the sidewalk, how to avoid burns, how to remove an edamame from a nostril, how to rescue your child if they are choking; discussion about guns wasn’t on the agenda. It will be from now on. When you allow your child to leave your protective orbit and entrust them into the care of someone else, it is quite reasonable to have a routine safety list. Is there a pool? Are any pets safe with kids? Is there a safe car and appropriate car seats for any driving? Are medications childproofed? Does anybody smoke? Are there any unsecured guns in the house? If so, can they be safely locked away, separate from ammunition while your child is visiting? Even a BB gun can cause an injury if not used properly. This is not only for a short play date. It is also an important checklist if your family is traveling and staying with relatives. You might be surprised at the answer to the gun question. Many people might even have guns that they inherited, or used to collect and don’t think much about it. Some households don’t have young children so this isn’t an issue until you point it out. If this conversation feels awkward, perhaps do it via email or text. Feel free to blame me. ”Nurse Judy asks all of her parents to go through this safety list”…. If someone is entrusting their child to your care for a visit, feel free to front load your own safety info. They will likely appreciate it. “Just so you know...in our house there is no smoking. We do have a cat, but she will likely make herself scarce and has always been gentle. There are no guns. Are there any food allergies that I should know about?” Recognize the risk of teen suicide It is essential for family members and friends of teens to be on the lookout for change in mood and behavior or increased aggression. Any talk about killing themselves or statements such as “you would be better off without me” need to be taken very seriously. Contact the Suicide Prevention center for more guidance. In children under 16 the presence of a gun in the house is a more significant risk factor than psychiatric illness. This is likely because suicidal behavior in children and adolescents of this age can be a spur of the moment choice. We don’t always know. Some of the kids who on the outside seem to have it all together are quite troubled. Knowing the impulsiveness of teens, let’s get the gun option off the table. When children and teens can’t get access to a gun in their moment of crisis, they are much less likely to die, even if they attempt suicide by another method. In the US, children are 11 times more likely than their peers in other nations to die by gun suicide, while they are no more likely to die by other suicide method. Tell your friends and family to be smart Many people, like me, hadn't really thought about this. I never recall asking anyone if they had a firearm before sending my children into someone's home. Sharing this info with your friends can help get this message out there. For readers in San Francisco, the Be SMART campaign has trained volunteers who can give presentations to parents' groups, PTAs/school groups, and any other interested community groups about simple strategies to help keep children safe from the risk of unsecured firearms. Please contact BeSMARTforKids@gmail.com if you would like to schedule a presentation or invite Be SMART to be part of your community safety fair or other events. A month before I first put out this post back in 2018, I was in Vietnam where there are NO guns. Even law enforcement doesn’t carry weapons with live ammunition. There are limited situations when a special swat team has access to them, but that’s it. I know that is never going to happen here. I dream of a day when sensible, common sense conversations can take place to figure out a way to slow down the relentless violence here in our nation. Some issues feel so big and impossible to tackle. The inability to have calm discussion about guns in this country is one of them. The Be SMART program shows that there is something measurable that YOU can do. It won’t get rid of gun violence, but it can tilt the odds for your child We need to start somewhere. Let’s keep all of our kids safe from OUR guns. Thanks Very much to my B-I-L Jeff for his thoughtful feedback.

Homage to Uncle Bert

 

For those of you who have been reading these posts for all of these years, I appreciate that you put up with the random assortment of topics. They bounce between health related issues, responses to relevant headlines, and updates of old posts. Some are more personal musings. This is one of those. An Homage to our Uncle Bert Uncle Bert was born in NY in 1929. He was an optometrist. I remember going to his office under the shadow of the old World Trade Center. He moved to Florida in the 80s. He was fiercely independent, never married, but ended up being the ultimate caregiver to many of his family members. He lived alone until he was 90, but moved into a wonderful assisted living facility right before Covid changed the world as we knew it. Our Uncle Bert had the travel bug. Not only did he go all over the world, but he had the lofty goal of visiting all 50 states in the US. He had made it to every state except North Dakota. Several years ago, I got a good laugh when he told me that he had used some frequent flyer miles to book a flight to Fargo. He left the airport, rented a car, drove around a little bit, returned to the airport and then got back on a plane and went home. Mission accomplished. When he traveled he would take hundreds of photos. This was before the age of digital cameras. He would develop them as slides, pick a handful of the best shots and simply discard the rest. I don’t think any of his North Dakota photos made the cut. There is a good lesson there. He didn’t weigh himself down with things that weren’t worthy or important. His favorites were some candid shots of kids and animals that were absolutely magical. To this day, if I catch sight of an endearing moment, I think “that would be an Uncle Bert shot!” Uncle Bert didn’t sweat the small stuff. This became apparent in one of my very first interactions with him.  He generously allowed 19 year old Sandy to borrow his old stick shift Toyota. We hadn’t driven very far when we realized that if there were any brakes left, they weren’t working very well. That was one scary ride. When we returned the car with a, “Hey Uncle Bert, thank you so much for lending us the car, BUT, uh….you need new brakes!” The response was, “yeah, probably true. I just down shift and go slow” He may have gone slowly in his car, but until his last year or so, I could barely keep up with him on foot. I remember waiting for him to exit security at the airport on his last visit to San Francisco. I waited and waited, I got a call from baggage claim where Sandy had gathered both Uncle Bert and his small suitcase. He had zoomed by so fast that I missed him. I guess I had been waiting for an ambling elderly fellow.  During that same visit, we surprised him with front row seats to a Giants game. It turns out that he had bought some bleacher tickets in advance. This almost 90 year old had a grand time scalping his ticket outside the stadium before joining us inside the park. Sadly, Uncle Bert died last week. He was the last relative of Sandy's from that generation. Due to the pandemic, we hadn’t been able to see him in person. We were all set for a visit this spring. Sigh, I am so sad that we didn’t make it in time. Here is something my sister-in-law (Sandy's sister) wrote about him: Bert was our mother's oldest brother and the last of the four siblings to survive. He was a few weeks short of 94, and we can truly say that he lived until he died. He walked on a treadmill daily; did the New York Times crossword puzzle daily - in ink; listened to Ella Fitzgerald, Nat King Cole, Dinah Washington, and his favorite, the Mills Brothers, on the computer; watched every sport on tv and could tell you who the superstars were. He loved playing tennis in his younger days and was looking forward to this week's Australian Open, when due to the time difference, he would get up in the middle of the night to watch it live. He also watched every episode of Big Bang Theory over and over again because, as he put it, "I never remembered what happened so each time was like it was the first time." He was unique. We loved him and will miss him. I am grateful I was part of his life for 45 year! We spoke on the phone regularly. His refrigerator was covered with photos of his great-great-nephew Elliot. Especially the ones where we captured an “Uncle Bert” moment. I am grateful that he lived well and passed relatively easily. Because it is in my nature for most of these posts to have a ‘takeaway’, here it is. If you are still fortunate enough to have older relatives, try to make it a habit to call them on a regular basis. A week passes, a month passes before you realize it has been a long gap in between your calls. Something as simple as a calendar reminder can help you make then happen on a more regular cadence. Enjoy your loved ones while you have them. If you have the opportunity, look at their photos and have them help you identify the people in them and tell you their stories. Once the final generation is gone, so many stories and family information is gone with them.

Managing the Tylenol and Motrin shortages/Winter 2022

 

Tylenol and Motrin shortages

My grandson Elliot isn’t feeling well. It turns out that he has croup. He flew with his family during the holidays and came down with a fever the day after they got home. Lauren asked me to pick up some children’s Motrin for him. I had seen the news stories about the shortage of children's pain and fever relievers, but I still wasn’t quite prepared for the impact that the empty shelves had on me. Fortunately, as a planner, I had snared a bottle of children's Motrin several weeks ago when I first heard about the shortage. We couldn't find any liquid, but had been able to get the chewable, but that was fine. He turns two next week, so he is old enough that this wasn't an issue. No one who knows me will be at all surprised that Elliot is familiar with chewables. He has been taking the Sambucol lozenges for quite a while. Having a child who is sick with a fever is stressful. I imagine that not being able to get medication is adding to anxiety. The lack of these medications is not dangerous! While I am quick to suggest the use of acetaminophen and Ibuprofen as needed, they are mostly about comfort. In fact, it is important to keep in mind that fevers are doing an important job. Fevers turn on the body immune system. They are one of our body's protective mechanisms   Many fevers can actually help the body fight infection.   Fevers that are associated with most viral syndromes and infections don't cause brain damage. Our normal brain's thermostat will not allow a fever to go over 105 or 106.   Only body temperatures higher than 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car.) As Dr. Ted shares in the fever post, He doesn’t actually worry about a fever unless it is higher than 105. But we still would like to have the medication on hand. The big chains may be out, but some parents have success at small health food grocery stores or convenience stores. The ‘natural’ or generic brands are fine. If you aren't finding what you want, consider getting suppositories if those are available A Compounding pharmacy may be another option. Check in with your local one to see if they have access to what you need. Laws vary by state, but in California they can only ship to addresses here in CA. My favorite compounder Eddie Lau from Feel Good Pharmacy says: The taste is probably not the best as the commercial item uses many syrups, sweeteners, etc. to make it palatable. But generally speaking, this is exactly the situation where a compounder can step in to help address drug shortages of commercially available products. If your child is young and you can get your hands on the chewable version, you can try your own hand at compounding. Take the chewable, grind it up and sprinkle on applesauce or yogurt. When Elliot decided he was too tired to cooperate with the chewable last night, my son-in-law Adam ground it to a powder and added it to a little fizzy water with a bit of simple syrup. The fizzy ‘medicine soda’ was a big hit. Turning it into a little game got every drop down (dilute it in as small an amount as possible). For older kids, it might be worth seeing if you can get them to actually learn how to swallow pills. Start with a little piece of candy. A Tic Tac works well for this. See if they can swallow one either with water, or by putting it in a spoonful of yogurt or jelly. If they have success, you can then try with a small caplet of the appropriate dose of medicine Even if you are able to procure medication, that doesn’t necessarily need to be plan A. Here are some natural ways to reduce fevers. Tepid baths cool compresses - back of neck, forehead, inside of elbows Popsicles. Keep hydrated. Pedialyte is better than plain water, but sips are sips so any fluids can be considered a win. Dress lightly; don’t over bundle Dr. Den has some more excellent tips in this link: https://theacupunctureden.com/index.php/2020/10/09/fever-tips-from-den/ Preparation for future situations This supply shortage will likely pass before too long. If you got caught without some basics on hand, don’t beat yourself up. Just try to do some basic planning so that it doesn’t happen again. A fine New Year's Resolution is to stock up. Here is a post on stocking your medicine chest . And don’t hoard!

What's the deal with Santa? Having the 'talk' with your child

 

Talking to your kids about Santa

Let me preface this post by saying that I think it is essential to be honest with people in your lives. You don’t need to knock them over the head with the truth, but if they ask a question and press for an answer, please don’t lie. Over the years several parents have asked me to weigh in on the ‘Santa discussion.’ What is the best way to keep the magic alive while not endangering the trust that is so important in any relationship? Covid has added an extra layer to the conversation. Some kids are worried that he will either have issues with social distancing or have trouble taking the time to wash his hands in between the houses that he visits. For this general discussion about Santa, we can put him into the fine company of the Tooth Fairy and the Easter Bunny, but it is safe to say that Santa is usually the member of this trio that has the most emotional connection. For the young kids who ask if the mythical creature is real, you might deflect the questions fairly easily without telling a falsehood if you want to extend the magic for another year. A simple,“What do you think?” works pretty well. Or, “It is fun to believe in magic sometimes and Santa is part of the holiday magic.” Keep in mind that once your child gets to kindergarten, believing that Santa is actually going to try to fit down your chimney, rather than the ‘spirit of the holiday magic,' may result in a shocking disappointment for them when they learn the truth. There are lots of kids at school, even virtually, who are eager to share the cold hard facts with your innocent child. It is much better if this discussion comes from you before your kids find out a harder way. I spoke to several people who recounted that they believed in Santa with all of their hearts and were completely devastated when they learned the truth.They felt deceived. One person told me that finding the truth was the moment they stopped believing in all magic. How sad! Letting them know the truth gently doesn’t have to be a negative experience. For older kids, I love a good story. Perhaps this one has an element of historical truth: “Once upon a time in a far off country there was a man named Nicholas. He loved to do good things for other people. What was special about him is that when he gave people presents or did nice things, he didn’t do it because he wanted something in return. He simply wanted to do good things. Lots of times he did it in secret and no one even knew who did something nice for them. Maybe this Nicholas was big and jolly and had a white beard. He became known as Santa Claus. Santa is a symbol of love and magic and hope and happiness. He teaches children how to believe in something that they can’t see or touch. I am on his holiday kindness team and now you can be too. Really little children might believe that there is one Santa who manages to be everywhere at once. Big kids like you get to know the secret. Team Santa is all the big kids and grown ups who want to help make other people happy. “ Perhaps take the opportunity to help your child be an active member of this awesome team; an initiation of sorts. Is there someone in your life that seems like they need a little kindness? What could you do for them? Is there a little gift that might make a difference? Plotting a secret kindness is the thing that wonderful lasting holiday memories are made of. Every kid and family are unique. There are families that make the choice to protect the ‘Santa is real’ narrative as long as it is possible. Make whatever choices feel right for you, but if your child asks a direct question, my advice is to find a gentle way to be honest. One more piece of Santa advice. The photo on Santa's Lap should be voluntary. If your child isn't eager to go sit on a stranger's lap, please don't force them.

The Magic of a Great Big Box

 

The Magic of a Great Big Box

We are heading into the holiday season. Lots of people are busy making lists of what to buy for their friends and family. It’s time to think outside of the box. Or actually IN the box! For young kids, a great big box can be magical. If you have any large purchases that come in a box, pause before breaking it down and automatically putting it in the recycle bin. Any large box can be hours of entertainment, but a really giant box, like the one from an appliance, is a treasure. (If you spot any neighbors getting anything huge delivered, ask them if you can have the box.) These can be turned into a clubhouse or a rocket ship. The possibilities are limitless. There are great ideas all over the internet with just a little bit of searching. https://www.pinterest.com/ClassroomDirect/cardboard-box-ideas-for-kids/ But even a moderately big box can be a way to foster creativity and imagination. You can make it a unique art project. Do this in a garage or someplace where you are not afraid of mess. Cover it with stickers or painted hand prints. Cut out pictures from a magazine and glue them on. Cover it with a layer of mod podge which will seal it. Make sure everything is dry before moving back into your living space. I would avoid anything with glitter (my niece Rose calls glitter ‘the herpes of the art world’!) A mid sized box is just big enough to sit in there with grandma and pretend it’s a car. Take turns driving of course. Or add a blanket and a stuffed animal and make a sweet little nest. You could also flip it over and make it the perfect table for a pretend tea party. Or a hiding place for the toddler! Get the imaginations in gear.  “I am inviting the zebra queen. She has purple stripes and is wearing a giant hat that is covered in strawberries. Who are you going to invite?” Smaller boxes can be turned into instruments. Rubber bands wrapped around them can be plucked. Tapping on the box with a spoon can make it a drum. Is it a box with a lid? Those are great for storing little toys. Take a picture of the items that will live there, print it and stick it on along with any other fun decorations. The task of cleaning up after playing is much easier if it is clear where things belong. Have fun!