Keep your kids safe from toxic plants

Poisonous Plants

There have been warnings on the news lately about the dangers of Easter Lilies being toxic to cats. Lilies can be toxic for young kids as well. It is not uncommon for me to get calls from parents whose young kids decided to nibble on some house plants, so those news stories are a good reminder for all of us that we need to be in the know about plants that our kids come into contact with. In most of the cases of these plant eaters, the kids aren’t showing any obvious signs that there was an issue. Typically if someone eats something that is toxic, and there is cause for concern, you would expect vomiting, diarrhea, a rash or fussing. To be on the safe side, the best course of action if you know your child has eaten something you aren’t sure about is to check in with the poison control center. In California that number is 1-800-222-1222 The Poison Control Centers here in the United States report that they get over 100,000 annual calls about plant or mushroom exposure annually. Knowing what plant your child actually came in contact with is very helpful to them. Unfortunately most of the time all we know is that it has leaves and is green. I would place a bet that many of us can't actually identify the plants we have in our homes and yards, and therefore have no idea about whether or not they are a potential hazard. It is a good idea to become familiar with the plants you have in and around your house and garden. Different plants will cause a variety of symptoms. Just like a sensitivity to food, not all kids will be equally reactive to an exposure. Reactions can range from mild vomiting and stomach cramps to more severe seizures and heart irregularities.Some plants can be deadly. Mushrooms are the biggest culprits Some plants will cause irritation just by coming in contact with them. Locally the most common culprit for that is poison oak. Some succulents and cacti aren’t poisonous but can cause a wicked scratch from getting too close to their spikes Step one is to teach your children not to put any part of a plant in the mouth (yeah, good luck with that…..) This means leaves, stems, bark, seeds, nuts, berries, and bulbs. Do not allow children to suck nectar from flowers or make "tea" from the leaves. Never chew, or let children chew on jewelry made from seeds or beans. Unfortunately kids will chew or eat things regardless of how they taste or the level of disgustingness. Depending on the plant, eating a tiny amount might not be an issue, but large or repeated doses can be harmful. I know it just about impossible to watch them every second, so it is important for you to be able to recognize plants that are more hazardous. If you have small children or curious pets, consider removing toxic plants. If you are attached to a plant that is on the list, perhaps lend it to a friend or neighbor until your little one is out of the "everything in the mouth" stage. In general, toxic or not, house plants should be placed out of reach of the very young. You also need to pay attention to falling leaves. If there are other houses or places that you frequent with your kids, make sure those plants are safe as well. If you are a gardener, make sure you store labeled bulbs and seeds in a safe place where your kids and pets don’t have access to them. Below is a list of some of the common house and garden plants with poisonous parts. Plants causing severe or fatal poisoning are marked *. Plants causing rashes are marked with°. Plants                                    Poisonous Parts African violet                                      Leaves Amaryllis-garden                                 Bulbs Azalea *                                              Leaves Castor bean                                        All parts Cherries *                                          Seeds and leaves Citrus fruits                                          Leaves Crown of thorns°                                 Milky sap Cyclamen*                                         Tuber Daffodil*                                            Bulbs Delphinium                                         Young plant, seeds Elephant ear*                                     All parts Figs°                                                  Milky sap Four o'clock*                                    Root, seeds Foxglove*                                         Leaves Holly-English                                     Berries Hyacinth*                                          Bulbs Hydrangea                                         Leaves Impatiens                                         Young stems, leaves Iris°                                                 Rhizomes Ivy-English, German, ground         Leaves, stems, berries Larkspur*                                         Young plants, seeds Laurel-Australian mountain                 All leaves Lily-of-the-Valley                                Leaves, flowers Lilies                                                  Bulbs Lupines                                             Leaves, pods, seeds Mistletoe*                                          Berries Narcissus*                                          Bulbs Oaks                                                  Acorns, foliage Oleander*                                         All parts Peaches                                             Seeds, leaves Philodendron                                     Stems, leaves Plums                                               Seeds, leaves Poinsettia*                                        Milky sap Potato-Irish                                     Green skin on tubers Primrose                                         Leaves, stem Rhododendron*                               Leaves Rhubarb*°                                       Leaves Sweet peas                                      Stem Tomato                                           Green foliage Tulip*                                             Bulbs Wisteria                                          Pods and seed Yew*                                              Foliage, bark, seeds Here is a list of : Safe and Poisonous Garden Plants Pets can also have different reactions to certain plants. The link below provides a list of plants that are toxic for your pets: https://www.humanesociety.org/sites/default/files/docs/poisonous-plants-to-pets.pdf I just inherited some lovely plants from my daughter since she has kitties. Be Safe!! .

There is no such thing as a silly question!

Let me tell you a story...



I was a nurse with a few years of experience under my belt when I moved to San Francisco. I was promptly hired at UCSF, which was, and remains in my experience, an excellent hospital. UC, because of its excellence, is a center where patients with many of the more exotic and hard to treat conditions are sent for care.

On one of my first days on the job I was getting report from a nurse; I don’t remember much about her and don’t know that I ever interacted with her again. She was passing along information about a patient who would be under my care for the upcoming shift. This little guy had an unusual illness with a long complicated name, no doubt named after the folks who discovered it. For the purposes of this post, and since I have long forgotten what it was, I will call it Hughie, Dewie and Louis disease. Here is the thing - this wasn’t something that I once knew and had forgotten. I had never, ever heard of it. Not even a glimmer of an idea.

“ So, Your patient X has HDL disease...These are his orders”

“Hold on a moment, What is HDL? I am not familiar with it.”

There was a pause and maybe a sneer

“You haven’t ever heard of HDL?”

I imagine that this was my opportunity to get a bit shame faced and say, "Oh! HDL, of course" and continue to get the report, but I don’t work that way. One of the things I respect the most in a person is to be comfortable with what they don’t know. Now, it is easier than ever to get educated. This was long before the days where I could pull out a phone and simply google it. This was now a game of poker. Some of you may not know, but Nurse Judy plays poker in Vegas.

“I have never, ever heard of it. Can you please tell me a bit about it so that I can take better care of the patient?"

She doubled down, I think she had come too far to save face and was hoping I would cave first.

“How long have you been a nurse? Where have you worked before this”?

“Is there anyone here who can tell me a bit about HDL?”

There was a resident sitting there who was happy to tell me all about this very rare condition. EVERYONE in the break room was hanging onto every word. Is it possible that no one had dared to ask? That was an isolated case at UC, but I carried the lesson along with me.

If I am talking to a parent and they are confused about a dose, a diagnosis or anything, the LAST thing I want is for someone to be embarrassed that they aren’t “getting it” and accept the information without clear understanding.

No one knows everything. As parents this is a good lesson to pass along to our children. Being comfortable enough to acknowledge what we don’t know and learning how to find the information we seek are important skills.

Chickenpox/Shingles exposure guide

Chickenpox/Shingles exposure guide

Zoster is one of the eight herpes viruses known to infect humans. The primary illness is varicella zoster, more commonly referred to as chickenpox. After the course of the chickenpox illness, the virus goes dormant in the nerves. It can resurface years later as Herpes Zoster, more familiarly known as shingles. While there have been some exposures at various schools, I haven’t had an actual case of chickenpox among my patients for over a year. These days I get way more calls about shingles than I do about actual chickenpox. Of course it isn’t my little patients with the illness. Usually it is a relative who has been diagnosed with shingles and the parents are wondering if it is safe to visit or if their child has been exposed. This post will give you the scoop about both Shingles and Chickenpox including exposure information. Don’t try to read this when you are sleep deprived, it might make your head spin. When the Varivax (chickenpox vaccine) came out in 1995, it took us a few years before we started giving it widely. We did an about face one season when we had hordes of chickenpox patients who were absolutely miserable. There didn't seem to be a sensible answer as to why we shouldn't simply give the shot to prevent it. The answer that "we had them and survived" seemed a little weak. While it is true that most chicken pox sufferers simply have a very unhappy week, complications do occur. Even the moderate cases can have painful lesions in the genitals and mouth. Some folks get them in the eyes and need round the clock eye drops. Some of the lesions end up leaving scars. At the very least you have a sleepless, itchy week and will need to take time off of work. One of the bigger concerns about the disease is the potential for future shingles. Here in California, as of July 2019, if you are going to be in the school system, 2 doses are now required before getting into kindergarten. One of the best things about getting the chickenpox vaccine and avoiding the misery is the fact that studies indicate that future occurrence of shingles may be less likely in a patient who had the Varivax than someone who had the actual chicken pox. In all honesty that question probably won't be answered for another 40 years or so, when the first wave of kids who got the vaccine become middle aged. Keep your fingers crossed. At the very least, in our office, almost all of our patients are vaccinated and cases of shingles are exceedingly rare. Infants are thought to have some maternal protection to the chickenpox virus that starts to wane when they are about 7 months. The protection is probably gone by a year. The first dose of the shot is usually given between 12-15 months. Unlike the MMR, Varivax is not recommended before the age of a year even if traveling or your child has been exposed. A booster is given between 4-6 years. For children playing catch up who are getting the Varivax for the first time, the minimum interval between doses for children 7-12 is 3 months. For kids who are over 13 the minimum spacing between the 2 doses is only 4 weeks. If you are a parent who isn’t sure if you have had them as a child, there is a blood test that can determine if you are immune or not. Kids are contagious a day or two before they get any lesions. They may have a low grade fever and be cranky. It is very likely that they are out and about in school, daycare or activities during this period spreading this virus to anyone who is not immune. It is what it is. No reasonable person expects you to keep your child home every time they are cranky. They remain contagious until all of the lesions have crusted over. That usually takes about a week. Most kids these days are vaccinated so there is good herd immunity working in our favor. So there you were in the park, playing with patient X. You get an apologetic call the next day from patient X's parent that their child seems to have come down with chickenpox. If the kids were having close interaction with each other, it is likely that your child was indeed exposed. The chickenpox virus is very contagious. It is airborne and can live on some surfaces. If your child is vaccinated or already had the illness, you likely don't need to worry too much. The vaccine is about 85% effective, however the CDC bumps that up to 98% after the second dose. The rare vaccine failures tend to get much lighter cases. If your child in not immune you are now on alert. From the first moment of exposure, the incubation period is usually 2 weeks but can range from 10-21 days. If 3 weeks go by with no sign of anything you are likely in the clear. Just because your child has been exposed is not a reason for you to keep them home from school or daycare and for you to miss work. They may or may not catch it. Someone who is immune is not likely to carry it. If your child has been exposed, be on the lookout for any signs that your they might be succumbing. The words "I want to go take a nap now" may be a red flag. If they get a fever you should probably issue a warning to any friends or caregivers as you wait to see if spots appear. If your child does come down with it they are now patient X and were likely contagious a day or so before the first sign of a rash. The chicken pox rash is pretty distinctive. Once the chickenpox rash appears, it goes through three phases: Raised pink or red bumps (papules), which break out over several days Small fluid-filled blisters (vesicles), which form in about one day and then break and leak Crusts and scabs, which cover the broken blisters and take several more days to heal. New bumps continue to appear for several days, so you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time. They usually start on the trunk but then spread. When they scab over they are very itchy. Be aware if you are traveling out of the country that there are many places in the world where vaccination for chickenpox is NOT routine. Dr Schwanke is frustrated that we are not supposed to give an early shot for travelers. Most of the cases we see now a days are folks that were exposed while visiting family abroad. As I mentioned earlier, after you recover from chickenpox, the virus can enter your nervous system and lie dormant for years. Eventually, it may reactivate and travel along nerve pathways to your skin - producing shingles. It is most common in folks when they are older adults. It may be stress related. One easy diagnostic trick is that the blistery and usually painful rash will usually not cross the midline of the body. About 10-20% of folks who had the chickenpox will end up with shingles. Shingles can be spread only if someone comes into direct contact with the lesion. A healthy person who has immunity to chickenpox is generally not considered to be at risk. Someone with a compromised immune system or someone who has never had the chickenpox needs to be a little more cautious. If infected, they would catch chickenpox, not shingles, from the infected person. Over the years we have had a couple of patients who came down with cases of chickenpox that we traced back to a shingles exposure, but again, that is most unusual. It is NOT airborne. If the shingles patient keeps the lesions covered you can still go visit grandma. For those of you over the age of 50 there is a new shingles vaccine that looks quite promising. It packs a punch. This is a 2 shot series. Most people complain of a sore arm and feeling fluish (hit by a truck) That is still better than getting the shingles, as most people who have ever had it will tell you.

Urgent Care options 2019

Urgent Care Options 2019 PLEASE SEE UPDATED POST MARCH 2025

Murphy's Law generally seems to make certain that the fever spikes, or the vomiting starts, right at 5:01 pm when the average doctor's office turns their phones off. It is important to be familiar with your after hours/urgent care options. At the bottom of this post I have some blog links that may help you decide if you need to be seen or not. I put the dosage chart link down there as well since that is a common question that many folks have after hours. Please try to keep track of any refill needs. We are happy to help with that during routine business hours. Waiting until you or your child is ill is not the best time to start learning about what choices exist in your area. Does your insurance plan have a preferred option that won’t cost as much? Are there after hours advice nurses available? Where is the closest emergency room? Is it staffed with pediatricians? If you are traveling, plan ahead and figure out local options for care before the trip. For Noe Valley Pediatrics patients who need help after hours, we ask you to start with the pediatric after hours clinic/triage nurse line:415-387-9293 If the nurse is NOT able to help, you will be directed to our answering service where the Noe Valley Pediatrics physician who is on call that night will be paged. If your child needs a prescription, it is unlikely that the on call doctor will be able to prescribe without an evaluation. The answering service number is 415-753-4697 Here in the San Francisco Bay Area we are lucky to have very good options for after hours care. The UCSF Benioff Children’s Physicians Pediatric After Hours Clinics and Advice Service: PERC Clinic In San Francisco 3490 California Street, Suite #200                          415-387-9293 In Berkeley 3000 Colby St Suite 301 (New Location 7/2017) 510-486-8344   Patients are seen by appointment: Monday through Friday 6:00 pm - 9:30 pm, (phones open at 5:00pm for appointments) Saturday, Sunday and holidays 8:30 am -9:30 pm (phones open at 7:30 am) Weeknight pediatricians are made up of participating private pediatricians, including several of our doctors who work an occasional shift in the clinic there. Weekend doctors are fully trained and board certified pediatricians. The advice nurse triage team is available from 5 pm through the night, even after the clinic is closed. The availability of the triage nurse makes this our number one choice. The Pediatrics After Hours Care at St Luke’s Hospital is affiliated with Sutter/ CPMC and is located at 1580 Valencia Street, 7th Floor #701 This clinic has been open for several years now: Pediatrics After Care at St. Luke's It is now open 7 days a week. Monday-Friday 5:00pm-10:00pm Saturday-Sunday 8:30am-10:00pm Phone: 866-961-8588 This service does not currently have an advice nurse team, but the person answering the phone can help do some basic triage when making the appointment and help redirect you to an emergency room if that seems necessary. This clinic has some advantages besides the convenient location. They start the scheduling process as early as 2 pm, which may make it easier to make a plan if we are already solidly booked here in our office and can’t get you in to see us that same day. They also offer weekend weight and bilirubin checks for our newborns. As a bonus, there is a special waiting area so that the healthy newborns aren’t exposed to the other sick kids. The two options listed above are the only urgent care facilities with which our office has a close relationship. When things are going as they should, both of the above after hours options send a report to the primary doctor's office. In our office, the nurse team reviews the reports and follows up to see how you are doing to maintain a sense of continuity. I am listing the others below as a convenience. If you are not in San Francisco, on the Peninsula you have several good options: http://www.afterhourpeds.net/ is a pediatric urgent care facility. There is no appointment needed. 210 Baldwin Ave in San Mateo. Telephone 650-579-6581 The Palo Alto Medical Foundation has several pediatric urgent care options: Palo Alto Medical Foundation They have a choice of appointment or drop in. The website gives info about the various locations and current wait times. There are plenty of general urgent care places popping up all over the place as well. They are not usually staffed with pediatricians. For a teen, this is not much of an issue, but for my younger kids, I would try to stick with one of the pediatric after hours clinics. Children are not just little adults. Some general practitioners are not versed in the treatment modalities of the pediatrics patient. If you do end up at another urgent care, please ask them to send over a report to your primary pediatrician so that they can stay in the loop. If you are Noe Valley Pediatrics patient our fax number is 415-826-1308 EMERGENCY ROOMS In a true emergency of course call 911. If it is less urgent, but you are certain that you child needs immediate medical attention we are lucky to have excellent options here in SF. When given the choice I will generally opt for one of the true pediatric emergency rooms. You are not competing for care with the elderly heart attack and stroke victims that may be populating the waiting room and getting ranked higher on the triage scale. You will also be assured of seeing a pediatrician and having appropriate pediatric equipment. If an admission is needed, my preference would be either CPMC at the new Van Ness campus or UCSF Mission Bay. There also won’t be any transport needed if you are already at one of those ERs. I think it is worth the extra ten minute drive across town and may save you time in the long run. The UCSF Pediatric ER in Mission Bay is located at 1975 Fourth Street: UCSF Pediatric ER This emergency room has scored very high in a nationwide ranking for getting patients seen in a timely manner. CPMC Pediatric Emergency Room On March 3, 2019, the CPMC Pediatric Emergency Room relocated from California Street to the new Van Ness Campus in San Francisco at 1101 Van Ness Avenue DAYTIME URGENT CARE While we strongly prefer to have our youngest patients be seen by a pediatrician, there are ‘those days’ when our office is completely booked up early. If there is something going on that is not worthy of an emergency room visit and you don’t want to wait until the pediatric urgent care offices open, there are more and more urgent care options popping up all of the time. Many of these are conveniently located throughout the bay area. It is worth checking the prices, they can vary greatly.  Check with your insurance to make sure that the place you go is considered in network. Places that offer appointments are also a bonus so that you are not sitting around a crowded waiting room. With any urgent care, make sure they send a report to your primary doctor’s office. If you were not seen by a pediatrician, it is always a good idea to touch base with your own doctor the next day to review the diagnosis, treatment plan and follow up needs. Some of the common calls that folks need help with after hours are dosage questions. Here is the link to a post with that info: Tylenol-vs-Advil dosage charts https://nursejudynvp.blogspot.com/2019/02/from-mild-head-injury-to-traumatic.html https://nursejudynvp.blogspot.com/2017/09/fevers-2017.html https://nursejudynvp.blogspot.com/2013/09/croup.html

Tech time/ How much is too much?

Tech Time/ How much is too much?

"Enjoy media, not too much, mostly together" - Anya Kamenetz (author of The Art of Screen Time) Tech Time/ How much is too much? In this ever changing world, the topic of how much screen time we should allow our children is one that affects most of us. I am not alone in thinking that most kids have too much screen time and tend to be overscheduled in general. They need time to just be kids and have some free play. When a child is in front of a screen, they are not talking, running around, or playing. These activities are essential for cultivating some basic skills. While I understand that a bit of the peace and quiet we might get from the ‘electronic babysitter’ (for the purpose of this post I am referring to screen time as anything computer, tv or video related) is so tempting, I want kids outside when possible, not inside glued to a screen. I want my patients to know what it feels like to turn the pages of a real book, not just to swipe their fingers across an iPad. I want them to know how to get messy with finger paints, not just how to create virtual art. I want them to interact with friends in person, not with avatars online. However, as much as we may be tempted to wrap the Luddite cloak around our households, is that really fair to our kids? Those who try to ignore all the technology may be at a disadvantage. While they live under your roof, you are in charge of how much screen time your child gets. I think that there is absolute value in getting some. It is a wonderful thing to be able to facetime with long distance friends and relatives. The instant gratification and ease of real time virtual visits is a game changer in the relationships that grandparents can now establish even when they are not local. It certainly beats our old method of sending VHS tapes in the mail. (I just rescued a box of those from my mom’s house. It is time to get those digitized!) Technology also offers a vast array of education and entertainment. We can learn so much from computers. The games are fun. Television has some nice programs; Daniel Tiger is my favorite. Getting time while you get something else done and your child is happily engaged is essential for some busy parents. How many of you have been in the position when you want to strangle your partner because they voiced the "no computer or videos for you ALL week!" as a consequence for some errant behavior. Some of you need that down time more than the kids! The key is figuring out how much is too much. You might be surprised that some high tech names limit the amount that their kids were allowed. Several years ago when I ran a post about this topic, I opened with an article about Steve Jobs that ran in the NY Times: Steve Jobs was a low tech parent! He was onto something. There are more and more studies coming out that are a bit alarming. Some of these studies indicate that there are actual changes in the brain of young kids who are spending too much screen time: Screen Time Inhibits Toddler Development Other studies are worrying about potential eye damage from too much time in front of a screen. Researchers are finding the exposure to the blue light prior to bedtime might impact sleep. We probably won’t really have firm data for many years, but common sense would come into play here. Unlimited time in front of a screen is not a good thing. Dabney Ingram, who used to be a NVP mom but has since moved out of SF, let me know about this worthy organization that she is involved with:https://www.screensense.org ScreenSense is a great resource for any family grappling with this issue. While we can all agree that too much is a problem, having a no tv/no computer environment is not something that I recommend either. When your child emerges from that protective bubble of a screen free existence, they may feel a bit like Alice in Wonderland. Back in the "olden days" when my kids were young, our screen was simply the TV. They had friends come for play dates who were not allowed any television at home. If I allowed it, the only thing those kids wanted to do was watch tv because it was such a treat for them. I give the same advise with candy. If it is forbidden completely, there are some kids that will seek it out as a treasure. So both tech time and dessert have some commonalities..They are enjoyable but too much is not healthy and we can’t forget about the main course. My goal is for your child to have a healthy relationship with technology. Learning how to use it at a young age will keep them on the level playing field with others. Not all tech time is equal. There is a lot of research going on that describes the different pathways in the brain when you are producing something or learning while using tech versus simply playing or gaming. Andrea Dunn, a teacher up in Marin, sent me a list of some cool free activities that would fall under the "productive use" label. Duolingo - learn a language Koma Koma - make fun stop-action animations Snapseed - take a photo and use lots of neat photo editing tools to jazz it up. Adobe suite of productivity/creativity tools (Adobe Spark Video, Adobe Spark Post) iMovie - make fun short creative movies Pic Collage - make a collage with lots of backgrounds and design options (free but has annoying pop-up ads) Blogger - create your own blog around any topic, invite readers and authors or keep it private just for you, as a virtual diary. Each family should discuss what their tech usage plan will be. Some families will allow more than others. Your own family should be the only one to make rules that make sense to you, but please, set some sensible limits. Dabney makes a good point. A family movie, with everyone snuggled together on the couch does not need to count towards the screen quota. Don't sabotage each other. If you have a partner, figure out the rules that you both feel comfortable with. Be consistent. If your kids figure out that the rules are meaningless, you have significantly weakened your credibility. At my solid foods class when I discuss "safe eating" I tell parents that they need to set a good example. If you shovel food in your mouth and talk with your mouth full, why would your child learn to eat any other way? Put in a small piece of food, chew and swallow. Set the standard. When it comes to being a role model, technology is no different. I am no hero here, I have reached an embarrassingly high level on the time suck of a game Candy Crush. If you are always looking at a screen, if your forms of relaxation are all technology related, consider making some small changes. Extra screen time (still with limits) can be a commodity that can be earned for good behavior. But because I don't want it elevated to the most important thing in their lives, I would rather make the rewards that they work towards be special non-tech activities with you. Let kids enjoy their allotment of tech time, but focus on opportunities where they can have just as much fun reading a book, or doing other things that don't have a screen involved. There are so many options: https://nursejudynvp.blogspot.com/2017/12/the-best-present-is-your-presence.html Board games are a wonderful way for a family to spend memorable hours together. I rescued a tattered box of the game RACKO back from my house-cleaning escapade last month in Pittsburgh, and brought it home. I have such warm memories of playing that with my dad and sisters. Marie Kondo would approve. It gives me joy. If you are going to a restaurant, create a restaurant activity kit to take with you so that you are not all sitting on your phones. Or have some restaurant games at the ready. I spy with my little eye...what do you see? Find different letters on the menu. Being at a restaurant is also the perfect place to play some math games. You could start with basic counting (how many peas are on the plate) and then up the skill level for your older kids and have them help you figure out the tip. Check out this very cool book that addresses getting your child comfortable with numbers and math: www.talkaboutmath.orgHaving kids have a basic understanding of numbers so that they don’t go through life depending on a calculator is a worthy goal. Our family's all time favorite game was the “act out the emotion” game. The girls would hold the napkin over their face. We would call out "sad" or "scared" or "surprised", or "in love" and they would lower the napkin making the assigned face. Make sure you put some child control limits on your device. There are lots of apps out there, with more being developed all the time. Some can help you make sure that all the sites that your child can access are safe and appropriate, others can help you limit the time allowed. https://www.consumersadvocate.org/parental-control-apps/best-parental-control-apps As your child gets older, it becomes much trickier. It is reasonable for rules to be renegotiated with each age. When to get your child a cell phone is another layer to this discussion. A limited phone plan has tremendous benefit to you, but I emphasize the word limited. Starting younger kids with a basic phone that is not a smartphone is an option for those afraid of going down the slippery slope while still being able to reach each other throughout the day. Have your child be part of the discussion and verbalize understanding of the family rules. Until they are a certain age, many experts agree that all computing should be done in a common room. Be clear from the start (if it isn’t too late) that while you are providing them with the digital tool and data plan, you have the right to go on to all accounts and check their texts if you have concerns that make that warranted. Changes in mood or behavior, as well as sudden ‘tanking’ grades would be reasons for checking. It is not breaking trust if you make it clear from the beginning that it is not just your option, but your job as the parent. This is also a time to remind them of another important lesson, that nothing that they put online is actually private. As Dabney suggested, “If they want privacy, they can write in an old fashion journal."

Talking to your kids about sex

Talking to your kids about the birds and the bees

While the majority of the calls we deal with are about little acute illnesses, we also field queries about all aspects of growth and development. Recently I have had several folks ask me my two cents about answering the "Where do babies come from" question. So here goes. Comes the time 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, that 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 to 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. 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...no need to talk about it any more. 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 of 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 quite 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. It could even be something like pin worms! 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 parent 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 to 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 so many good ones out there. I would suggest that you read 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. 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 she 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! The following books should all available through the library. Perhaps 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. ****************************************************************** In our practice we are fortunate to have 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 your 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 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. 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!) 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.