Carbon Monoxide 2021

Carbon Monoxide

Carbon monoxide (can be referred to by its chemical symbol CO) 

 In a typical year, nearly 400 Americans die from carbon monoxide poisoning; this number might end up higher than normal due to the horrendous storms in Texas last week.

 Health officials reported that 450 carbon monoxide-related calls have been made statewide since Feb. 11th. Sadly quite a few of these cases were fatal. More people need to be aware of the risks! 

 How many of you own a carbon monoxide alarm? If you do, good for you. Make sure that it is in good working order. 

The units do not last forever. In some of the older units, batteries need to be changed annually (at least) and some units suggest that you vacuum the cover monthly to remove accumulated dust.

 If you are one of the many who do not yet own one, please remedy that immediately. 

It has been the law since January, 2013, with few exceptions. 

 Homes with a fireplace, attached garage, or any gas appliances are at higher risk, but there are many different factors that can cause an elevated level. 

A friend of mine is a lawyer who was involved in a heartbreaking case where a guest at a Bay Area hotel sustained long term health impairment from an exposure. 

The victim’s room was above the hotel pool and a faulty boiler used to heat the pool vented carbon monoxide into his room. When he didn't show up for dinner, his friends found him unresponsive. 

It was a very alert physician in the emergency room who figured out the cause. It was only at that point that the hotel was evacuated.

 This is not an isolated incident. As a result, my lawyer friend got in the habit of taking a portable detector along with him anytime he traveled! 

 Because heaters and fireplaces are often involved, exposure is usually higher during the winter months. In situations such as the one in Texas, people were trying to get warm anyway they could, and it cost lives. 

Outdoor appliances, such as grills, and even generators, need to be properly vented and should not be used indoors. 

If you have a generator as part of your safety plan (not a bad idea for earthquake or fire related power outages), it is essential to make sure that it is properly ventilated. 

 Carbon monoxide is a colorless, odorless and tasteless poison gas that can be fatal when inhaled. CO binds to hemoglobin with much greater affinity than oxygen, forming carboxyhemoglobin (COHb). It is hundreds of times more efficient than oxygen at attaching to the cells, so even small amounts can deprive our bodies of vital oxygen. 

In severe cases, for folks who survive an exposure, it can cause irreversible brain damage by starving the brain of oxygen. 

 Normally if someone is deprived of oxygen they may look pale or cyanotic (bluish); in the case of CO poisoning, the color will remain nice and pink. 

A standard pulse oximeter may not be an accurate indicator of where or not there is a problem. If carbon monoxide exposure is suspected, a specific blood test should be done to check the carboxyhemoglobin level. 

 One of our local ER docs who allowed me to pick his brain added that one of the tricky things about CO poisoning is that the symptoms are very vague and nonspecific. 

A faster than normal heart rate (tachycardia) is the only really reliable physical exam finding.

 Mild exposure might cause slight headache, nausea, vomiting and fatigue. 

This can easily be mistaken for flu or viral syndrome. 

Medium exposure symptoms would be a throbbing headache, drowsiness, confusion and a rapid heart rate.

 Extreme exposure will lead to unconsciousness, seizures, and cardio-respiratory failure that usually is fatal. The effects of exposure can vary greatly from person to person depending on age, overall health, and the concentration and length of exposure. 

Young children and pets are thought to be especially vulnerable. 

Pregnant women should also be especially careful because the fetus can be seriously impacted. 

 A carbon monoxide alarm is similar to a smoke detector because it monitors the air in your home and sounds a loud alarm to alert you of trouble. 

However, the way you respond to a CO alarm is very different from a smoke detector. 

When a smoke detector goes off, it is pretty easy to judge the level of danger. You can see or smell the smoke. 

On the other hand, because CO is completely undetectable to your senses, you are dependent on the alarm to let you know there is a problem.

 If the alarm sounds: 

 Operate the test/reset button 

Call 911 

Immediately move to fresh air (make sure that everyone in the household is accounted for.) 

Do not go back in until you have the ‘all clear’ from the emergency responders. 

 Concentrations of CO between 1 and 30 ppm can often occur in normal, everyday conditions. See the chart below for CO levels and corresponding symptoms. 

 If your unit is coming to the end of its life it may give off multiple chirps to notify you that you need to replace the device or change the batteries. 

Newer alarms might be good for as long as 10 years. The one that we have has a digital display that will signal when it is time to replace it. 

 My first experience with a Carbon Monoxide alarm was back in 2007. I was at my family home in Pittsburgh and my dad had died several days earlier. 

My sisters and I were all staying at the house when on that cold November night, we were woken up by a shrill alarm. 

We frankly had no idea what it was. 

After searching around a bit we found that it was the carbon monoxide detector going off. 

We weren’t sure of the correct action plan, but to play it safe we called 911 and huddled outside on the front porch until the firemen arrived. 

They went through the house with all of the monitors and everything seemed safe. 

Our best guess was that it was my physicist dad on the other side trying to figure out how things worked. 

I kid you not, the very next night the smoke detector went off for no apparent reason. 

Radios and lights were turning on and off. 

In our family, we just shrugged. That is going to be my next book. 

 After that encounter, I educated myself about carbon monoxide alarms.

 Several years ago when my daughter Alana was still living in Michigan, her CO alarm went off and she knew enough to get outside and call 911 immediately. 

After the fact she recounted her conversation with the fireman who had responded: 

 “I am worried about my cats, can you help get them out?” 

“What do they look like? 

“They are CATS, they are furry, have 4 feet and tails!” 

 Happily the kitties were all safely brought out of the apartment. The best guess for what set off the alarm was something faulty with the air conditioning system. 

It went off several times with no clear source identified, which prompted her to move to a different apartment. 

 You may not think that your home is at risk, but there is NO downside for investing in an alarm (plus you are complying with the law.)

 They are inexpensive.

 If you are renting and there is not a unit in your apartment, call your landlord immediately and get that remedied. 

In January of 2017, in the Bay area, there was the tragic instance of a young couple and their pets all found dead with no obvious cause. It turned out that it was CO exposure from a malfunctioning 3D printer. A functioning alarm would have saved their lives. Don’t mess around with this. Please make sure you are protected.

Heavy Metals in Baby Food

If you have listened to any news these past couple of weeks, you have likely heard the story about the findings of unsafe levels of toxins in baby foods. 

What’s it all about? 

 Due to pollution, soil where the foods are grown can be contaminated with heavy metals.

 If you are a science nerd, the ones most commonly identified as an issue are lead, chromium, arsenic, zinc, cadmium, copper, mercury and nickel. 

These metals usually accumulate as a result of emissions from industrial areas, leaded gasoline and paints, some fertilizers, manures, sewage and pesticides to name just a few of the culprits. 

Even though we are no longer using leaded gasoline or lead based paints the damage has been done.

 Most metals don’t undergo degradation so they stay in the ground or water for a long, long time. Pollution in the air or water makes its way into the soil or into our rivers and oceans. 

When these toxins end up in the water, we can see this impact by measuring the levels found in the fish that we eat. 

 When they end up in the soil, they can be absorbed by food. 

Some foods are more susceptible than others. 

 At least we have started to make some changes here in this country. For example, we no longer use leaded gasoline and some industrial regulations have been put into place. 

The fact is that many of our regulations are too little too late. 

Even if our home grown foods were perfectly safe, which they aren't, many products are imported from countries who are not even beginning to enact any effective regulation. 

Trying to feed our children and ourselves clean food is stressful! 

 Knowing that we have issues with some of these contaminants isn’t new. 

Many people already limit certain fish due to mercury. 

We have been educated about the dangerous impact lead exposure can have on our children. 

We routinely get our kids tested to make sure the lead levels aren’t elevated. 

 Arsenic wasn’t something that most of us were paying attention to at all until the elevated arsenic levels in organic brown rice syrup created a media sensation several years ago. 

But it appears that even though concerns about unsafe levels were identified, current studies clearly indicate that not enough was being done. 

 To make things worse, many of the brands listed in these allegations are the ones that parents have counted on for generations to provide safe quality products. 

It is very frustrating that even with the changes that have been implemented, it is still evident that they were not enough. 

At the very least, customers should have been informed that mitigating these concerns was still a work in progress.

 I think it is perfectly reasonable to feel angry and betrayed. 

Go ahead; get good and mad. But then let it out and take a deep breath and release it. 

It is not helpful for you to hold in all that negative energy. 

Turn it into action. 

You can choose to no longer give these companies your business. 

Done! 

 What I wish you wouldn’t feel is guilt. 

Assuming your children have consumed some of these products, I am guessing that you made the best choices that you could based on the information that you had. 

We don’t know what we don’t know and we can’t manage the past, so as hard as it might be, please forgive yourself. 

 I think that it is actually very beneficial that this information is surfacing so that we can make healthier choices moving forward. 

See if you can take any anxiety that you are feeling and channel it into a resolve to take positive action.

 What choices can you make now that you have this information? 

 Alas, while going organic can minimize pesticide exposure it doesn’t have much impact on the heavy metals. 

 Pay attention to the biggest culprits. Rice cereal is one of the biggest offenders. Brown rice has some nutritional advantages but white rice is the safer option. 

The heavy metals absorbed into the food from soil are going to impact the surface of the food the most. White rice is processed to remove that outer bran layer. 

If you are cooking your own rice, start with a little more water than called for and then do an extra rinse. This can help decrease potential toxins significantly. 

Rice has nutritional benefits and by no means needs to be completely removed from your diet. 

As I have been saying in my solid foods class for years, some amount of rice cereal is fine, I just wouldn’t give it daily. 

Variety is beneficial. 

Be a label reader - organic rice syrup is an ingredient found in many snacks. 

 Sweet potatoes and carrots are two popular veggies that have been found to absorb the highest amounts of the heavy metals. They still have some worthy nutrition, I certainly think there is room for them in a healthy diet. 

Just like the rice, the outer part is going to be the place that has absorbed the highest level of the metals. Deep peeling can help a lot. 

 Fruit juices are also on the list. This one is easy. No kid really needs to be drinking juice. That being said, of course, the occasional bit of juice is not something to stress over. 

 Certain nutrients may offer protection. 

Antioxidants can help prevent absorption of toxins. 

It has been well documented that lead doesn’t absorb as well if a diet is high in iron and vitamin C. 

This is true for the other heavy metals as well. 

 Making sure that you give your kids adequate fluids is great for flushing out the system. 

 Variety is important. 

Make sure you switch things up and offer a large assortment of foods, rather than eating the same thing over and over.

 In conclusion, I don’t know of many adults who got through their childhood without partaking of these same products, and we all seem to have survived. Having some exposure to these heavy metals is not ideal, but at a mild to moderate level it is absolutely not something I want you to panic about. We can’t live in a bubble (although during covid, some of you might dispute this.) As with all things, simply do the best you can. If you like more data on this subject, check out this article written by my colleague, the wonderful Dr. Ted from Oath.

Covid/ One year later

It was a year ago that I was doing my first post about COVID. Always with an ear out for items in the news that could cause worry for my patients, I was on alert. Over the years it was not unusual for a virus to circulate that made the news. Measles outbreaks, West Nile, Ebola, Zika, even one called enterovirus D-68 that most of you probably don’t even remember (that one was a cousin to Polio and caused some paralysis). These were terrifying, but in terms of actual threat to our Bay Area families, were soon enough in the rear view mirror.

If I ever claim to have some psychic abilities, that ESP was nowhere to be found when it came to covid. At the very least, I would have bought extra toilet paper. My initial covid post from last year warned families to be prepared in the unlikely event that we might need to do the unthinkable and quarantine for a couple of weeks. Wow, what a difference a year makes.

So many of us had plans to travel, tickets to shows, weddings and events on our calendars. It was unfathomable that everything would be put on hold, but 2020 put us in uncharted territory

It is fair to say that we have found ourselves in a brand new landscape.

• The horrors of the shocking numbers of cases, deaths and chronic consequences.
• The staggering economic hardships of so many people who have lost jobs and livelihoods 
• Frightening number of people who maintain that the virus is a hoax...WTF!
• The isolation of people who are living alone and the sadness of family and friends who are not able to be together.

Sigh.

For anyone reading this, congratulations on making it through a very difficult year. For all of the difficulties and sadness some moments of light have floated through.

Zoom...who had even heard of it? Yes we can all get zoom fatigue, but I have had routine zoom sessions with friends and family near and far. Now I gather once a month virtually with my 98 year old uncle and cousins. More and more extended family members join in the call and it is lovely. We fill our screens with old family photos and take advantage of uncle Melvin’s remarkably sharp memory while he identifies the people in the pictures and regales us with tales.

Working at home in your pajama bottoms and bare feet.

Your pets are thrilled to have you around all day.

Many people have taken up new hobbies. The tap dancing classes that I took from a friend only lasted for several weeks, but I have been playing piano more than I have in years. My son-in-law Adam has perfected his sourdough bread!

Flu numbers are unusually low for this time of year. Pediatrician’s offices are seeing way less of common colds and viruses. No doubt this is in part thanks to the social distancing, masks and hand washing.

So what’s next?

The promise of vaccination is already here for many, and within the next several months for many more. It will no doubt take some time to get everyone protected but at least there is some hope in sight.

While we are making progress, this is the proverbial two steps forward, one step backwards. Alas, as promising as the vaccine is, covid is a wily virus and new strains are popping up. Some of those newer and more contagious strains have recently been identified in the Bay Area. Until there is herd immunity, even with the vaccination, wise people will continue to mask up and continue with social distancing until the public health experts spread the message that we can get back to normal. We simply can not afford to get quarantine fatigue.

Here are some of the quarantine related blog posts that I have done this year:

https://nursejudynvp.blogspot.com/2020/03/managing-quarantine.html

https://nursejudynvp.blogspot.com/2020/03/assessing-our-priorities-in-this-time.html

https://nursejudynvp.blogspot.com/2020/04/tips-for-dealing-with-too-much.html

https://nursejudynvp.blogspot.com/2020/04/finding-humor-in-this-time-of-quarantine.html

https://nursejudynvp.blogspot.com/2020/06/stop-feeling-fuilty-for-finding-moments.html

https://nursejudynvp.blogspot.com/2020/06/decisions-about-how-to-ease-out-of.html

https://nursejudynvp.blogspot.com/2020/07/talking-to-your-kids-about-germs.html

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Basic Butt Care/Diaper Rash

Basic Butt Care/Diaper Rash

There is nothing quite as cute as a baby’s little butt and nothing quite as sad as when that cute little tush is covered with a rash. With any rash, it is worth playing detective to see if there is an obvious source. A new diaper brand, a diaper that is too tight, a new soap or detergent can all be culprits. Believe it or not, once your little one is old enough to be eating solids, acidic foods such as citrus and/or berries seem to be connected with diaper rash flare ups.  But the fact is, most diaper irritations are simply caused by your baby's delicate skin being in contact with irritating stool and urine. Even with the most careful parents, rashes happen. It is much easier to prevent a rash than to treat it, so it is worth some effort to avoid rashes in the first place. The basics of prevention include: Change the diaper frequently. Use alcohol free wipes that don’t have added scents. https://www.babylist.com/hello-baby/best-baby-wipes After the wiping, I like to blot the damp skin with a tissue, this helps make sure that the area is completely dry. That simple tissue can also find leftover pieces of poop that were hiding in the creases. You would be amazed what is lurking in all the little crevices. You will see that the tissue will actually stick to the skin when it is still tacky from being wiped. Keep gently tapping the tissue until it no longer sticks. Some people use a warm hair dryer to get the skin dry. Both methods work well. Having some ‘diaper off time’ and letting the tush get some air is key. Give your little one some time with no diaper for several sessions a day. Babies are less likely to fuss for this if they are kept warm, so try to have a cozy place for this to happen. Lauren and Adam actually blew some warm air from the hair dryer on baby Elliot the other day during some ‘air time’ and he seemed to love it. The combination of the noise and the warm air kept him pretty happy. A short session of indirect sunshine through a window is also beneficial if you have the opportunity. Of course your little one is going to take this opportunity to pee and poop all over the place. Using the blue absorbent pads (you can actually get them from a pet store) or a towel can help contain any mess. Have a washcloth or a pee-pee teepee handy. Don’t underestimate the ability of poop to squirt impressive distances. Boys of course are the most likely sprayers, but don’t count out your little daughters in their ability to make a mess. Another good preventive measure is to add a splash of apple cider vinegar to the bath water. I don't have an exact amount because tubs vary greatly, but somewhere around a ¼ cup for a normal tub full of water. Keep your baby well hydrated; concentrated urine is more irritating. You may hear diaper creams also referred to as a barrier cream; this is simply because they are creating a barrier between the skin and the irritating pee or poop. Once your baby is giving you a longer stretch at night, I would suggest that it is now time to start automatically applying a barrier cream. For preventive care I don't have a favorite, there are lots of wonderful brands. The Environmental Working Group, EWG, is always a good source of information. They have rated some of their favorites. They do a deep dive into every ingredient and rank them accordingly: https://www.ewg.org/skindeep/browse/category/diaper_cream/?sort=score#! Dr. Den’s  favorite is one called Emily Diaper Soother. If you are local, you can get it directly from her. My daughter Lauren really likes Tubby Todd. It is a bit pricey, but it works really well for Elliot If you already are dealing with a rash and the cream that you are using isn’t doing the trick, here are some options that I especially like: Bag Balm is a standout, with a good rating from EWG. Originally used by farmers to soothe cows irritated udders, I have seen it clear up some stubborn rashes with remarkable success. Another favorite of mine that is not quite as highly rated by EWG, but is still fine to use is Calmoseptine. This is a cream originally used for ostomy care. I have found it very effective for some of the more raw skin situations. You can also make your own concoction by mixing together an assortment of ingredients. I learned about this from an old baby nurse that I worked with in a NICU back in NY. This is especially helpful for rashes that appear to be associated with food sensitivity or teething. Take a clean container and add equal parts: Thick white paste of your choice (Desitin/ Zinc/ butt paste) Clear stuff of your choice (Aquaphor/ A%D ointment/ shea butter) A squirt of a liquid antacid such as Maalox or Mylanta You may have heard of a prescription cream called APNO (all purpose nipple cream.) This is a combo of antifungal/ antibiotic and a steroid cream. When I was working at Noe Valley Pediatrics we would have our local Walgreen’s compound this for the most severe rashes. A rash that is severe enough to require this, also likely needs an appointment to evaluate it first. Beyond the common diaper dermatitis, there are some other potential causes. Once in a while a rash can be caused by yeast. Yeast thrives in warm, dark moist areas. It is no surprise that a diaper area (and nursing bra) is the perfect breeding ground.  Yeasty rashes can look very spotty or very red with distinct borders. They also like the creases and can spread outside of the diaper area. The prevention and treatment are similar to the ways we would treat a standard diaper rash. The air and apple cider vinegar are even more important but usually not quite enough to get rid of it. For suspected yeast I am going to add an antifungal cream to the mix. Over the counter creams such as Lotrimin (used to treat athlete’s foot and jock itch) is fine. There is not a baby version.  After the air time, add a thin layer of the antifungal cream and follow with whatever protective cream you prefer. Do this three times a day. It takes a week or so to get rid of it completely, but you should start to see a difference within a day or so if you are on the right track. Some rashes get so raw that the poor little bottoms bleed. I would put a thin layer of Neosporin on any open, sore areas, also three times a day (sometimes it feels like a little paint by numbers kit...a little of this here, and a little of that there.) If there is absolutely no improvement after a couple of days, it is worth having an evaluation. Your doctor will most likely always want to see any diaper rash that is pimply or oozy. Some very red diaper rashes are caused by bacteria. Strep is the biggest culprit for this. One more thing to consider. Evivo is a probiotic that is given to the baby. They have some impressive clinical data that shows that Evivo reduces bad gut bacteria by 80% and restores the baby’s natural fecal PH. 72% of mom’s using it report a decrease in diaper rash. Okay, get that tushy out for some air ( sorry about your carpet!) If you need some more diaper changing tips. Check out this previous post. Diaper changing tips post The photo on top is courtesy of Jake and Shachar's baby Noam's epic poop episode that actually got the walls and the lamp. Don't say you haven't been warned.

No matter how much help you have, no matter how perfect your baby is, being a new parent is HARD!

No matter how much help you have, no matter how perfect your baby is, being a new parent is HARD!

 Little black bug, little black bug where have you been? I’ve been under the rug, said the little black bug… Lauren and I were sitting together as she nursed her newborn. My first grandchild.

 She was telling me that she had been singing the songs that my mom used to sing to her and that it made her cry. As she told me that, tears were welling up in her eyes. So, I also got weepy and we sat there letting the feelings in and crying together about the people that we were missing. 

 Lauren is a lucky mom. She has a wonderful supportive husband who takes initiative and doesn’t wait to be asked. She has two sets of grandparents, and other close family who are in her COVID bubble and have been all hands on deck. Everyone is happy to hold the baby and give her and Adam a break whenever they need it. 

She has more support than most, especially during COVID. What’s remarkable is that, even with all these resources... IT IS STILL HARD! 

 She has the “Nurse Judy Network”, where her baby has been treated like royalty and guess what? IT IS STILL HARD! 

 She has plenty of milk and her baby got back to birth weight the first week. IT IS STILL HARD

 Nursing is challenging. It is not intuitive. Getting the baby to latch works well one moment, but is tricky the next. 

 Not being able to sleep longer than a 3 hour stretch is exhausting. Hormones are a force to be reckoned with.

 All new parents need support. That is where Oath comes in https://www.oathcare.com/

 I can’t sit by you in your nursery, but I can be right there when you have a question about spit up, poop, purple feet, hiccups ... you get the idea. 

 The Oath community is a place where small, facilitated groups of parents can share their wisdom as well as the ups and downs of parenting. 

It is a place to cheer each other on as well as a safe place to be messy and vulnerable when things are feeling a bit overwhelming. 

 Beyond the collective wisdom and experience of your fellow parents, we have a team of providers to assist you. Starting when you are pregnant, there is an OB, a nurse midwife, doula, pelvic floor specialist, traditional Chinese Medicine practitioner, and a mental health therapist available to you.

 Once the baby is born, our Oath parents can tap into a provider network that includes a pediatrician, lactation specialist, sleep expert, physical therapist and speech therapist. 

We are continually adding to our panel of experts. Oh, yes...then there is me, the advice nurse, helping you figure out when to worry and when things are perfectly normal. 

 We furnish you on the way with stage appropriate educational content that is empathetic, data based, and draws from decades of experience caring for kids just like yours.. Your pediatrician is sure to be grateful that your source of information is a trusted one, as opposed to the minefield of disinformation that you may find when searching the internet for answers. 

 If you are pregnant or know of someone who is expecting, I think you will find joining Oath incredibly valuable. This also makes a great baby shower gift! If you already have young children (our current groups are for 3 years and younger) please click the link to join the waitlist, so that we can match you with the perfect group. A value of $500, the Oath membership is only $19.50/month. Such a deal. Enter the promo code NURSEJUDY for a free month I would love to see you in one of the Oath circles.

Car seat guide 2021

Car Seat Guide 2021 

 Make sure you little ones are strapped in properly! It is important to check the fit as they grow! 

 The Rules

 Car seats are an essential part of keeping your child safe. Countless children’s lives are saved annually by being properly installed in a car seat during a crash. Governor Jerry Brown signed a law that went into effect on January 1st, 2017. 

This law requires children be rear facing to a minimum of 2 years old: https://csftl.org/updated-car-seat-law-california/ 

 Even though the law is until they are 2, it is recommended that they remain rear facing until as close to age 4 as possible! 

More and more studies are showing that rear facing is the safest place and position in the car. In fact, it is 5 times safer than forward facing. 

 In the case of an accident, a child's head and spine are better protected if the car seat is rear facing. 

One study shows that children ages two and under are 75 percent less likely to die or be severely injured in a collision if they face the back. 

I know kids might appear to be squished but most children are actually quite comfortable sitting criss-cross, or with their legs up the seat. 

For those parents/caregivers who are concerned about leg room, Graco has released the Extend2Fit, a new seat which has a 4-position extension panel that provides 5" of additional leg room. 

 Children who are 40 pounds or 40 inches are exempt from the law and can face forward, but while they may be exempt from the law, they are not exempt from the laws of physics.

 Rear facing is safer. Please take a moment to click the link 

Here is another one.

This video is a good illustration about why rear facing is so important: 

 Rear facing versus forward facing Toddlers who have outgrown the rear facing weight or height limit for their car seat should use a forward facing car seat with a harness for as long as possible, up to the highest weight or height allowed by the car seat manufacturer. 

 The current California law also requires a car seat or booster seat until your child is 8 years or 4 feet 9 inches tall.

 Height parameters make more sense than the previous weight ones. 

For a child to safely transition into a booster, we look beyond the child's age/height/weight. There's another set of criteria to help determine if your child is ready to transition to a booster. 

There is a "4 Step Test", in which all criteria should be met; don’t dismiss the importance of Step 4! 

 1. Child is an absolute minimum of 40 pounds 

 2. Minimum of 4 yrs old 

 3. There is a lap & shoulder belt in child's seating position 

 4. The Child can be trusted to sit properly for the entire trip, every trip - even while asleep. 

This means no slouching (back straight up against seat), no leaning to either side, no playing with the belt, etc...even unsupervised. Developmentally, most children don't meet all of these steps until somewhere between 5-7 years old, and generally closer to 6 or 7 than 5. 

A lot of this has to do not only with physical maturity, but emotional maturity. 

 This is one of those times in your parenting life where your child NOT graduating is actually a good thing. The longer your child is harnessed, the safer and more protected they'll be. 

Your child needs to be tall enough so that the seat belt goes across the chest, not across the neck. The purpose of a booster is to properly position a child in the adult-intended seat belt. 

What you’re looking for is a proper belt fit across the lap and shoulders - the belt should be low and tight on the hip bones (not on the belly), and should be hitting the shoulder bone, not the child’s neck.

 Be aware that most newer car and car seat models use the LATCH system (Lower Anchors and Tethers for Children). 

The Latch system attaches the car seat to the vehicle through anchor points that are installed in the car and connectors on the car seat. 

This is supposed to make the installation easier as well as eliminating potential errors that can result from installing a car seat with a seat belt. 

The LATCH system has a 65 pound weight limit. 

What many parents are surprised to find out is that this limit includes the weight of your child as well as the weight of the car seat (some can weigh up to 25 pounds!) 

 When children are old enough and large enough to use the vehicle seat belt alone, they should always use Lap and Shoulder seat belts for optimal protection. 

To determine if your child is ready to sit unassisted, they must pass the 5-Step test: The 5-Step Test: Does the child sit all the way back against the auto seat? 

Do the child's knees bend comfortably at the edge of the auto seat? 

Does the belt cross the shoulder between the neck and arm? 

Is the lap belt as low as possible, touching the thighs? 

Can the child stay seated like this for the whole trip? 

 If you’ve answered NO to any of the above, your child should remain safely in a booster seat! 

 If your children complain about this rule, show them photos of race car drivers all bucked up in their restraint system. 

Be matter of fact about it and explain that there is no compromise for safety (there is also a mighty large fine if you are caught breaking this law.) 

 All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection. Airbags can actually be quite dangerous to a child so it is worth making sure that this isn't an issue with your car and the placement of your child's safety seat. 

 Picking the right car seat

 If you are looking to buy a new car seat, check out these helpful links:

 https://carseatblog.com/safest-recommended-car-seats/ 

https://www.babylist.com/hello-baby/best-convertible-car-seats 

If you are someone who doesn’t own a car and is popping the car seat in and out of car services, finding one of the cars that is easier to install in becomes even more important. 

 Making sure it is installed correctly! The AAA states that 75% of car seats are installed or used improperly. 

As your child grows, there are services offered here in the San Francisco Bay Area that will check out your car seat or booster seat and make sure it is properly installed. 

Have the infant car seat checked before the baby is born and then again with each transition to a larger seat. 

 Below are some local resources for making sure that not only is your car seat properly installed but that it is the right fit for your child's size and age. 

They can make sure that all the straps are where they need to be and that you pass the "pinch test", making sure that the seat's harness is tight enough. 

 To be super safe, consider having the car seat fit and installation checked every 6 months. 

The reality is unless you are a certified child passenger safety technician, you’re not aware of some of the nuances of different kinds of seat belt systems, or the different features on different car seats. 

 When you go to get help with your car seat make sure you go to a certified car seat technician. Then you will know you are getting the best information available.

 I have updated this information to reflect the changes during the pandemic. If you are reading this and we are fortunate enough to be in the clear, call the numbers below for current guidelines and info

 AAA https://calstate.aaa.com/automotive/car-seat-inspections 

Appointments need to be made ahead of time. You do not need to be a AAA member to take advantage of this free service. 

During COVID, they are offering virtual appointments only 

 CHP (California Highway Patrol) 415-557-1094 

This is very popular, and by appointment only. Please make an appointment as far in advance as possible. 

The inspections are done at 455 8th Street in San Francisco. They are NOT doing inspections during COVID 

 SFPD 415-575-6363 They try to have an officer at all of the local police stations who is trained to do the car seat safety inspections. Call the number above for more info.

 They are NOT currently offering inspections during covid 

 Willing to pay to have someone come to you? 

 http://www.buckledbaby.com/services/ Bryan is continuing to offer his services during the pandemic.

 ON-LINE RESOURCES 

The following links can you assist you in finding the right car seat: 

 The National Highway Traffic Safety Administration website has a place to click to find updated local car seat inspection stations for those of you who are not in the Bay Area. 

 NHTSA/Get Your Car Seat Inspected has a page where you can plug in your child's age and size and they will tell you what type of seat they should be in. 

 Car Seats for the Littles - Car Seats for the Littles gives lots of great info about the specific brands of car seats on the market https://csftl.org/ 

 The Car Seat Lady The Car Seat Lady video

 Other considerations 

 Car safety doesn't end with being safely buckled. I know it is hard to avoid distraction with a baby fussing in the back seat. 

Consider getting one of the specially made mirrors so that you can keep an eye on your rear facing baby. 

Make certain that they can't reach anything that is a choking hazard. Don't let them hold the keys; they can lock you out!! 

 If your child is asleep in the car seat and you have arrived at your destination, leaving them snooze for a few minutes is fine as long as they are supervised, but keep them tightly buckled. Having a baby in a car seat without being tightly strapped in not safe. The loose straps can be a safety hazard. 

 WINTER CAR SEAT TIP: The straps need to be tight up against your baby; puffy coats or blankets need to be OVER the straps! 

 Never leave your child unattended in a vehicle. Children can die from prolonged exposure to excessive temperatures in a hot car. 

 Most accidents happen within a few miles of your house. Even a short trip down the block requires the full "buckle up". 

Hey parents, model good behavior and always make sure you fasten your own seat-belt! 

 Did you know that car seats expire? Most of them have a 6-9 year life span. This date can usually be found underneath or behind the seat. 

Buckles and straps can wear out. Prolonged exposure to sunshine can weaken the plastic. Also, the technology is always changing and this ensures that nothing gets too out of date.

 Save the instructions/registration in a safe place. I know most of us never register the products we buy but make sure you register your car seat! If there is ever a recall, this will ensure that you are notified, and this is one of those products where you must know if there is an issue! 

 Let me close by confessing that I am NOT a car seat expert. The seats that my children grew up with were much simpler (but not nearly as safe!) When I see new parents struggling with all the straps and trying to figure things out, I am often as clueless as they are. Here is the takeaway message. Putting your baby or older child in a car seat is an essential skill that you need to learn in order to travel with them safely. Find an expert to help you master this and make sure that you are using the car seat restraint properly. Safe travels!

I am a grandma

I am a grandma!

 I was all set to update my car seat guide this week. I planned to check in on the local resources to see what is available for people who want to get the car seats inspected during COVID. 

Making sure that the seats are installed properly is important. I didn’t get to all of the calls, but I have a very good excuse. Instead I will tell a story that involves a car seat. 

 I am a grandma! Lauren was due on January 18th, but in the early hours of Monday morning her water broke. Coincidentally, she had an appointment already scheduled with her OB later that morning. They confirmed that her water had broken, she was sent home for the day with orders to return to the hospital that evening. 

 Another lucky coincidence was that afternoon her doula was already scheduled to do a home visit. I went over and watched Jen help Lauren and Adam get prepped for labor. 

Sadly with Covid, the doula support would be virtual. Even though the due date was two weeks off, Lauren and Adam had been all ready to go. The nursery was ready, the go bag was packed, they had a cooler with meals and snacks all set. The only thing missing was causing some stress. The car seat had been ordered more than a month earlier but was on backorder. 

Without a car seat, a baby won’t be allowed to leave the hospital. We were figuring out a plan B of either buying or borrowing, but just in the nick of time, ding dong, UPS was at the door with the car seat. 

Fortunately, Jen the doula used to be certified to install car seats, and she was still at the house. Timing and serendipity, my grandson is part of my family for sure. 

 Labor was the hardest thing Lauren had ever done (take that Kilimanjaro and Everest Base Camp!) Not being with her was one of the hardest things I have ever done. But, Now I am a grandma of a beautiful 6 pound 8 ounce grandson. 

Mother and baby are doing well. This boy will be welcomed into a village of family and friends with so much love. He couldn’t have picked better parents, that’s for sure. 

Next week I will make those calls and update the car seat information for you. As I call, I fully intend to have a baby snuggled in my arms.