There are so many different factors to consider when facing most of the common parenting issues. The Nurse Judy approach is a combination of many years of medical experience, a desire to treat things as naturally as possible, a large dollop of common sense. email nursejudysf@gmail.com to be added to my weekly email list
Friday, September 15, 2017
Friday, August 18, 2017
What should you have in your first aid/emergency kit?
What should you have in your first aid/emergency kit?
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A new mom recently asked me if she needed to purchase a first aid kit to have in the house in preparation for the new baby. There are indeed lots of commercially available kits out there, but it is pretty simple and less expensive to put together your own.
Last week my post was all about being mentally prepared for a variety of situations. This seemed like a logical follow up.
Having some items on hand is wise. Take time to make sure these things are organized and easily accessible so that you don’t waste time scurrying around if you need something quickly.
Home:
The following link is to my December post about having an appropriately stocked medicine cabinet.
That post gives you a hefty list for things you should keep available at home.
Here are a few additions
Every family with a young child should have a nasal aspirator: The hospital will send you home with a bulb aspirator, but many people find those awkward.
I really advise that every new parent have a NoseFrida:
or NeilMed Naspira:
If the baby has a stuffy nose, or has secretions blocking their nasal passages, these snot suckers are a simple way to clear them. Have you ever had milk come out of your nose when you are laughing, sneezing or coughing? That can happen to your baby as well. An aspirator near by can make things less chaotic.
Make sure you are prepared and own infant nail clippers or scissors. Some babies are born with very long nails and can end up really scratching themselves if you don’t clip or file them :
I asked Dr Katherine Morioka of City Optometry what folks should have on hand in case of an eye injury. She suggests that a first aid kit should include artificial tears, an eye wash kit, gauze and first aid tape.
Away from home:
CAR: Every car that you drive should have its own emergency kit in the trunk.
Some of the items I am going to add are NOT typically found on general lists.
Have a change of clothes, extra diapers, clean socks, extra layers (for every family member.) In San Francisco, the fog can come in quickly; don’t end up looking like a shivering tourist and resort to having to buy another Alcatraz sweatshirt.
A baggy with basic first aid supplies:
Have some durable snacks, pouches or bars and some water. If you are on a road trip double down on this and make sure you have provisions in case you get stuck.
Okay, here are some things that are not on the general lists:
Get in the habit of checking this stash thoroughly, several times a year. Perhaps do it with the clock change when you check your smoke detector batteries. Check expiration dates, diaper sizes, battery life, phone number accuracy,... etc.
Diaper bag:
As long as you are close to the car, you don’t need to carry too much with you.
Keep a small baggie with some gauze/ antiseptic wipes/ small packet of neosporin. If you more than 30 minutes from the car, have tylenol/ibuprofen, and benedryl/zyrtec with you. If there are medications in your diaper bag, pay attention that young children don’t have easy access to them.
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Friday, August 11, 2017
Problem solving skills 2017
- Assess for injury; call 911 if needed
- If you are on a highway, wait for assistance. Getting out of the car is often dangerous!
- Do you have an AAA membership? Know where the card is.
- Know where your insurance info is kept (make sure you have a copy accessible)
- Take a photo of any damage
- Take a photo of the other driver's insurance card and driver's license...etc.
- Always have a charger in your car for your cell phone so that a low battery is never an issue.
Friday, August 4, 2017
Food Heroes and Villains
Up until just recently coconut oil was considered heaven sent. It cured all sorts of things. When I saw the recent news putting it back on the list of terrible foods, I groaned out loud. I feel the need for a little rant. I hope you will bear with me!
Everyday we have different foods take turns getting a blast of media attention. We see lists of the world's healthiest foods and list of foods that should be avoided at all costs. Some things that are on the ‘wonder food’ list one day might be on the ‘avoid at all costs’ list the next. Take red wine for instance, one minute it is the best thing to help you avoid heart disease...oops but it might increase the risk of some cancers.
Of course some of these headlines are often followed by frantic calls to the advice nurse. When the organic rice was found to have measurable amounts of arsenic the phones practically exploded. In fact arsenic is pretty hard to completely avoid and is found in other foods as well.
The list goes on…..
You get the idea. Navigating through all of this info is so challenging when you are trying to feed your family a healthy diet.
The food pyramid has been turned upside down and there are so many fads that come and go. I asked Nurse Lainey and her internet savvy sister Katie to do a little poking around for me and within a short period of time they came up with an extensive list of dietary trends, including something that sounds particularly alarming called ‘souping’.
I am not about to sort through all of the fads (the posts are often too long as it is.) Rather I am going to give you the message, "take a deep breath and do the best you can. Everything in moderation!"
If you are lucky and you have a child who will eat plenty of different foods, make a valiant effort to give variety and not to binge on any one thing.
Below is my take on some obvious current heroes and villains.
Organic and Non GMO: Hero
We probably can’t really count on any labels to be completely accurate anymore, but if you can afford it, I prefer organic produce if it is available:
Sugar: Bad Guy! Try to minimize added sugar. You might be shocked by how much sugar is added to things. Be a good label reader. Agave, which used to be considered a healthier alternative is no longer on the “good guy” list. If you are looking for a natural sweetener, current consensus would put honey at the top of the list for healthiest option. Remember that this is NOT a good choice for any baby under one year. No honey for them!
My preference would be that sugar and dessert not be used as a reward on a regular basis. If our body has had enough “growing food”, an occasional sweet treat is fine.
Gluten: Mixed. I get aggravated when folks dismiss this. More and more people can really not tolerate gluten, regardless of what testing shows. Both of my kids ate plenty of bread their entire lives but developed fairly severe gluten reactions as young adults. I have had many patients do an elimination diet and find that they feel much better when they cut it out of their diets. Not everyone suffers the same symptoms. It makes no sense to get rid of gluten if you show no signs of being impacted by it. That being said, in general white flours, breads and pastas are pretty low on the nutrition scale.
Rice/arsenic: just don’t overdo! There are in fact measurable levels of arsenic in rice. There is more found in the brown rice than white. Rinsing the rice well prior to cooking it might reduce some of the levels. I would not recommend more than a couple of servings of rice per week. We are fortunate that there are plenty of other options. Most other grains out there that don’t have this issue:
Trendy food Pouches: Read the labels!
Just because something is organic, doesn’t mean it is good for you. I know all the pouch foods are quite popular. The are convenient and the kids generally like them, but some are loaded with ingredients that you really don’t need.
They are also a nightmare for the landfill.
Wise words from Nurse Lainey. If you want to do some creative eating for yourself, please keep in mind that your children have different nutritional needs. They are not just little adults!
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Saturday, June 24, 2017
Water safety/Secondary and Dry Drowning
When frightening stories make the news, I know that I can anticipate some calls about whatever the issue is. There were some recent stories in the media about secondary drowning. Several parents have reached out and asked me to address the topic in a blog post. Next week I will continue the swimming theme. I had it all rolled into one but it was way too long. You would be surprised how many different body parts we get calls about that are swimming related. You can read all about those next week.
Let’s get the scary stuff out of the way first. Drowning is the second most common cause of death in children in the United States. Prevention is key. A person who is drowning may 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.
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. If you do have pool access, there are lots of pool alarms and safety monitors on the market. Hotels or apartments with fountains need to be treated with caution as well.
We had a scare with one of our families a few summers ago. 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. Dr. Karen Makely, one of the wonderful urgent care physicians over at St. Lukes, says that sometimes having a lot of adults around lends a false sense of security. Consider having each adult take turns being on a shift as the designated lifeguard.
Drowning is horrible, but the recent stories that scared the bejesus out of my families were about delayed drowning. You may have heard of dry drowning as well. They are not the same thing.
The primary difference between dry drowning and secondary (or delayed) drowning is the presence or absence of water in the victim’s lungs.
Dry drowning is something that can be brought on in several different ways. The first theory is that a sudden rush of water into the throat causes the airway to go into spasm. During this event, although no water enters the lungs, no air enters either, so the victim dies of asphyxiation. Another explanation is that the shock of a swimmer’s suddenly entering extremely cold water causes the heart to stop.
Distinct from “Dry Drowning” is secondary or delayed drowning. This is also very rare, but is something that parents need to know about. Symptoms usually develop within 6-24 after an incident. If someone had a near drowning or accidentally swallowed a lot of water, they are at risk for pulmonary edema from the fluid imbalance to the lungs. They may seem fine initially but then present with cough and increased labored breathing. This usually shows up within 24 hours of the event.
Caregivers of young swimmers should try to head off some of these issues by training their kids to keep their mouths closed when jumping into water and to enter very cold water slowly. This should help avoid aspirating large amounts of water. There is a big difference between water in the lungs and water in the belly. If your child swallows a lot of water they may end up with a tummy ache but it is rarely dangerous. The recent tragic news story about a child who died in Texas with this diagnosis is a bit of a puzzle. He had days of vomiting and diarrhea. Every physician that I spoke to says that it is respiratory, NOT tummy symptoms, that they would be on the lookout for. There is likely more to that story than is getting reported. It is the outliers that make the news.
Here is the takeaway message. It is important to closely monitor any child who has come out of the water coughing and sputtering. Especially keep an eye out for any further difficulties in breathing, extreme tiredness, or marked changes in behavior, all of which are signs that a swimmer may have inhaled a dangerous amount of fluid. If there is any concern, an emergency room or immediate medical intervention is needed. The first 24 hours are probably the most critical period. It is important to know what to look for, but to reiterate, in over 30 years with a practice full of swimmers, I am not aware of any of our patients having any serious complications from a mouthful of water.
I spoke to Dr. Tamariz from the CPMC ER. He reiterates how extremely rare this is, but stresses that if any CPR or resuscitation was needed, a follow up emergency room visit is essential regardless of how well they may appear. For the majority of swimmers that accidentally get a mouthful of water, observation at home is fine unless they are showing the obvious symptoms that are listed above. If you are concerned, go the the emergency room. They will check the oxygen level, listen to the lungs, and keep an eye on things until everyone feels comfortable. If clinically indicated they might do an x-ray but it is not automatic.
I am going to close with a little tidbit of common sense. Labored respirations should ALWAYS prompt you to seek medical attention, even if there is no concern about recent swimming.
Next week I will continue the swimming theme, sharing all the possible swimming related call that the advice nurse team receives!