Intentional Communication/A Parenting Pearl

 

I No one ever said that being a parent was easy. I am not talking about the lack of sleep. I am referring to all the decisions that you need to make as a team. People come from different backgrounds, cultures and parenting styles. It is not always easy to merge approaches and points of view. Navigating the barrage of vastly differing opinions from grandparents, friends and online sources doesn’t necessarily make it any easier. As an advice nurse for so many years, I have been fortunate enough to forge authentic relationships with many of my patients and their families.  At some point,I  found myself expanding beyond the standard health topics and spending a lot of time discussing behavior challenges. Parenting styles and responses to behavioral issues are so personal.  It became common for parents to trust me to be a sounding board for their disagreements. They wanted ‘Judge Judy’ to be the arbiter, but I was always clear from the start that the only side I would be on was that of the child. My biggest piece of advice was “love your child more than your need to be right” Most couples have some common themes that they disagree about and tend to have the same arguments over and over. Feel familiar? These aren’t limited to parenting. (I think that the knives in the dishwasher should be pointed down!) Even if there isn’t agreement, the sense that you are being heard can be enormously important. As many parents have discovered, when toddlers are having a tantrum, they often will calm much sooner when the caregiver confirms what they are observing.   “You are mad that you have to leave the sandbox right now.”  “I know you don’t want to lie still right now, but you have a giant, stinky poop and I would rather not get it all over the walls.” “I know you don’t want to put shoes on, but that is the rule when we walk outside.” In the above instances, you are not letting them have their way, yet validating their feelings still makes a difference. That need to be ‘seen’ doesn't go away as we get older. You might be surprised how an argument loses its steam when the other person simply feels heard. It is also important to accept the possibility that rules can be amended and there isn’t always a clear ‘right or ‘wrong’. Optical illusions are the perfect example of the fact that there is often more than one right way to look at things. One  classic one pictured here is either a white goblet or two profiles in black. Both images exist. Some people can see both. Telling someone that there is only the image of the goblet is not going to do anything to change the mind of the person who sees the profiles. They see what they see. Many people actually feel threatened when deep beliefs are challenged. Take a few moments to watch the link below.  https://theoatmeal.com/comics/believe So often squabbles involve people going back and forth or talking in circles. You may even agree with many of the core issues, but get so caught up in making your next point that no one stops to see or evaluate what is actually being said or heard. If bickering is something that you actually get a charge out of, then by all means continue in your old patterns. (You might do your partner the courtesy to see if they enjoy it as much as you do.) But if you both are willing to break that cycle of bickering, not surprisingly, the magic ingredient is real communication. This deep communication that I am referring to, is the genuine attempt to hear and understand what the other person sees and feels. It relies on active listening There is a big difference between casual conversation, political debate and actual deep listening. A casual conversation can be effortless. It can bump along without a clear agenda and touch on a variety of topics. Do you always remember what you talked about? Not likely. On the other extreme, real communication in political debates these days is almost nonexistent. Usually the end goal of a discussion is not to try to hear the other person's point of view but rather to pontificate the same talking points over and over again. I  am guilty as charged and with some of the hot button topics, It would be a lot of deep work for me to try to get beyond my sense of what ‘should be’ to delve into what someone on the other side is thinking. If world leaders are interested in sitting down with me, that would be lovely, but until then, let’s focus on your micro world, where you actually have some power to affect change. Intentional Communication, step by step.... Start with something simple, like how you both want to handle your mother-in-law allowing your child more screen time than you are comfortable with, before working up to why assault rifles should not be legal for anyone who wants one.  Step one: Agree that you are willing to listen fully Step two : Find a time of day when no one is exhausted, hungry or in pain, try to have a long enough stretch that you won’t feel rushed or get interrupted. (I know, good luck with that.) Step three: agree on the ground rules Pick one focused topic. The speaker holds an item that ‘gives them the floor’. This can be a teddy bear, bottle of wine, or wearing a silly hat. Bonus points if you can keep your sense of humor throughout. Whoever possesses the item gets to talk with no interruptions; you will get your turn. Set a timer for 5 minutes, not as a limit, but for awareness. If they have more to say, reset for another 5. The first speaker hands over the item and it is time to swap roles. The first listener starts by repeating a short summation of what they ‘heard’ from  the other person's narrative. If there is something you don’t understand ask for clarification. If there is a part that you agree with, highlight that. (This is not the time for you to tell them why you think they are wrong.) Switch sides. One important ground rule is that no one just walks out on the conversation when things get heated.  Either person can ask for a ten minute break, and then the conversation continues. I asked Oath’s wonderful therapist for her input on this Brittany’s offerings: Asking for verbal consent before starting the conversation can be helpful for those deep, emotionally charged topics. An example, “I am ready to initiate repair from our last argument and discuss what that experience was like for both of us. Are you in a space mentally and emotionally right now to have this conversation with me?”  There are always two streams of communication occurring simultaneously, the report (verbal, the content of what we are communicating) and the command (nonverbal communication, rate of speech, tone, body language). When you’re the communicator, it’s important to make sure both pieces of your communication are flowing in the same direction. As the listener you want to make sure your nonverbal communication is reflective of what the speaker is saying. This is essential to the communicator feeling seen at a neuronal level (think satisfying those mirror neurons).  Once you have both had a chance to share your point of view, the real problem solving can begin. Naming the issues often makes them much easier to work on Review the things you agree on. Come on, there must be something…. You can decide how you will make this decision. Do you both need to come to a full agreement? Are there compromises that you can both feel comfortable with? It may be that even though there is some doubt, there is a willingness to try one person’s approach and see the results. If you can’t find common ground right after this conversation, that doesn’t mean you won’t. You each may need some time to absorb and let your perspective adapt to new information.  Revisiting the topic a day or a week later may soften the rougher emotional edges and make a shared solution more evident.  It isn’t always easy.There are some really tricky issues where it is clear there is fundamental disagreement and no real middle ground. These are the tough ones. It still helps to be able to identify, name them and calmly discuss where you are coming from. If it still feels incendiary, would a therapist or a 3rd party be of help? Going through this exercise is not just healthy for your relationship. Modeling good communication for your kids can be a valuable gift. Beyond that, the end result of hopefully having parents who find a way to act as a unit, is such a positive thing for the entire family.  And if you can’t be in complete agreement, you can still be united as you try one person’s approach. This also models mutual respect and a spirit of cooperation. On the other hand, if you don’t figure out how to work as a team, I promise you that your older kids will certainly figure out a way to divide and conquer. Barbara Kivowitz, my sister-in-law and coauthor of Love in the Time of Chronic Illness: How to Fight the Sickness, Not Each Other (a guide for ill partners and their family caregivers) offers this final thought:  Once you have come to your combined decision about how to address the behavioral issue, agree to observe the results over the next few weeks (or months) and assess how you both think it's working and consider any tweaks you might want to make.  Addressing your child’s behavior is a never ending process. They grow and change, and so do you. If you approach this with the tools of Intentional Communication and an attitude of try/observe/adapt, you’ll all learn, together.

Swimming 2022/An advice nurse's guide

 

I blinked and it is mid Summer already. I have gotten several questions lately about babies and swimming, prompting me to update my swimming post. Participation in formal swimming lessons is absolutely associated with a huge reduction in the risk of drowning, but all the lessons in the world cannot take the place of having a designated adult keep a constant, watchful eye on anyone in, or around water. That being said, I don’t usually recommend lessons until your child is at least 6 months old. Swimming lessons for children under 3 years are mostly about getting them comfortable in the water. Water play is also a fun and healthy form of exercise for the entire family. As a bonus it may improve strength and motor skills. I give swimming with your kids a big thumbs up. Recent AAP (American Academy of Pediatrics) guidelines actually suggest that all children over the age of one take swimming lessons. At the bottom of this post is a list of swimming options for families in the SF Bay area Even if you aren’t looking for local pools or classes, many families might have some opportunities to swim during summer travels, or even a visit a friend's pool. One of the most common questions I routinely get is the one asking how old a baby needs to be before it is safe for them to go into the water. I am assuming that you are sensible enough that you aren’t planning on taking your one month old on a tropical vacation. If your baby isn’t brand new, then generally my answer about getting into the pool is “sure!”, but there are several factors to consider.   For young babies, a little splashing is okay, but I wouldn’t let them submerge their heads until they are old enough to keep their mouths closed. There are claims that very young infants are natural swimmers and don’t take in a lot of water; I prefer not to test that out. A big gulp of chemical filled water is yucky at any age.   Is the pool outdoors? We all need to be careful with the sun, but a baby's thin skin is especially vulnerable. Young children need to have a big floppy hat and perhaps sunglasses and sunscreen. Remember that sunscreen needs to be reapplied even more often if the kids are getting wet. Get in the habit of doing a sun assessment at least every 15 minutes. If they are getting pink, it is time to get out of the sun. Don’t wait until they are bright red. While it is true that my fairest patients are the most at risk for a sunburn, all skin pigments should be protected. Shade is best!    https://nursejudynvp.blogspot.com/2021/06/sun-protection-2021.html   There are some cute little umbrella baby floats that offer quite a bit of shady protection if you are in a pool. But be aware that the reflection from the water can add to the risk of burning.   The next factor is the water temperature. Young babies don’t regulate their body temperatures very well, so make sure that any pool water is nice and warm and that the outside temp isn’t too chilly for them.    As an advice nurse I have all sorts of swimming related issues to share that go beyond safety. Here are some other considerations:   Hot tubs Most hot tubs and jacuzzis are too hot for kids under 5 years old because they are at greater risk for overheating. For kids over 5, if the temp is 104 degrees, a child should be in for five minutes or less. If the temp is between 98 and 102 you can let them hang in there for 15 minutes at a time. Be warned, if the hot tub isn’t clean, people can get a pimply rash called folliculitis. Most of the time this is self resolving, but it is worth checking with your doctor if it isn’t resolving.   Foot fungus Anytime you are hanging out at a pool please wear flip flops when wandering around poolside or in the locker room. Fungal infections and athlete's foot are fairly common from public locker rooms.! A spray bottle with some diluted vinegar solution to spritz on the feet, followed by making sure that the feet are very dry before putting shoes and socks on, are good preventive measures.   Yeast/irritations Little girls that spend a lot of time wearing a wet bathing suit can also get irritations. It is a good practice to get the kids out of the wet suits as soon as possible. Do a good rinse off as soon as you can and then apply a nice moisturizer to avoid exacerbating dry skin.   Ear issues If your child has had a recent ear infection, it is okay for them to swim as long as the tympanic membrane is intact. If your child has had ear tubes or a recent ruptured eardrum, they should NOT be submerging their ears in the water (or the bathtub for that matter) without having protective ear plugs.  Sound Speech and Hearing makes custom ones with sparkly color options that may help with compliance.   If your child has been doing a lot of water play, they may be prone to otitis externa (better known as swimmer's ear.)  As opposed to an inner ear infection that requires an otoscope to make a diagnosis, an outer infection is often visible to the naked eye. The ear looks red and sore and may have some drainage. If that is happening, it is worth a visit to your pediatrician so that they can see what’s happening and prescribe some antibiotic ear drops if warranted. Keeping the ear canal as dry as possible may help prevent this condition. There is a simple proactive measure that can be cheaply and easily made by mixing equal parts of rubbing alcohol and white vinegar (50:50 mixture). This solution will increase the rate of evaporation of water in the ear canal and has antibacterial properties. Using this solution to rinse the ear before and after water exposure can help protect against infection.   Hazardous Algae Blooms If you are planning on swimming in open water (lake, river etc) make sure you check ahead of time to make sure there are no advisories. There are some local lakes and rivers that occasionally have some toxic algae blooms that I would not want any of my patients to get near.  The EWG has a good article on how to recognize this hazard . I mentioned that drinking pool water is not ideal, but I am going to double down on the yuck factor in some lakes and rivers. These are the kids that end up with giardia. Try hard to make sure they aren’t getting any water near their mouths.  Basic water common sense Most of my local families know to be very wary of our local Ocean Beach, but if you are traveling to a place with a warmer and more inviting ocean, never turn your back on the water and beware of currents and strong waves. When you are near water, it is important to make sure that one adult is the appointed water Guardian.   If you are looking for swim lessons, here are some of the great options here in SF. Here are some of the more popular options   La Petite Baleen Swim School . They have several different sites. The one in SF is in the Presidio at 933 Mason St.  https://www.swimlpb.com/ 866-896-3603   Jewish Community Center of San Francisco https://www.jccsf.org/fitness/aquatics/ 3200 California St San Francisco, CA 94118 Phone number (415) 292-1200   Bakar Fitness & Recreation Center https://campuslifeserviceshome.ucsf.edu/fitnessrecreation/aquatics Mission Bay 1675 Owens St Phone number (415) 514-4545   There is an indoor and outdoor pool here with all sorts of options for just swimming with your baby or doing classes.   YMCA http://www.ymcasf.org/ There are several branches in SF that offer swim classes. sessions are likely full already, but if you plan ahead you may be able to join some July classes.   Stonestown 415-242-7100 Presidio 415-447-9622 Embarcadero 415-957-9622   The city pools also have some classes available but they also fill up fast. Register at www.sfreconline.org  https://apm.activecommunities.com/sfrecpark/Home  to sign up for swim lessons (and other great classes). This website will also give info about the city pool hours if you are interested in just having some pool time with your kids and skipping the expensive lessons. You may want to go by yourself first to scope out the water temperature.   My kids grew up going to the Janet Pomeroy Center. This is out by the zoo at 207 Skyline Blvd. It used to be called the Recreation Center for the Handicapped. The lovely thing about it is that the pool is very warm. They have several slots every week where you can go and play in the pool with your child. It is reasonably priced, but you need to call to enroll in advance, They don’t have any drop in sessions. The phone number is 415-665-4241   https://www.prrcsf.org/swimming   Do you have a pool that should make the list? Please share the info and I will add it to the post.   If your child is enrolled in swimming classes and they have a mild runny nose, they can probably still go swimming if they are feeling up to it. If they are vomiting, have diarrhea or a fever, do everyone a favor and keep them out of the pool!   Swim classes are NOT a reason to take your eyes off of your child in the pool; no one should ever have a false sense of security!  -----------------------------------------------------------------   Dr. Ted’s Tidbits:   It always bums me out to talk about summer pool safety. I don’t like feeling like I’m ruining your ability to relax by telling you your kid might die on vacation. But I couldn’t agree more with Nurse Judy’s advice above. The most important part is the designated water guardian. Every time I take care of a young near-drowning child in the hospital (it happens at least annually), I hear the same refrain “I just went inside for one minute.” When liquids enter the lungs, seconds matter. The longer liquid is in there, the more reactive the lungs become. After children inhale water, they need to be monitored in a hospital setting for a number of hours, as their blood oxygen concentration can change hours after being rescued. It’s a big to-do, and easy to avoid with some vigilant oversight!

Melatonin 2022/ Is it safe? Is it useful?

Melatonin has been in the news recently.  Here are the shocking statistics that are making the headlines… melatonin ingestions by children accounted for almost 5% of all of the calls to the poison control centers in the US this year! Basically the number of pediatric melatonin ingestions increased a whopping 530% from 8,337 in 2012 to 52,563 in 2021. This is no doubt due in part to the fact that it recently has become more widely available with a variety of pediatric friendly options.  By far the majority of these were young kids getting access to it because it wasn’t stored safely. Your kids are smarter than you think. Just putting something on a high shelf does not mean it is childproof. Don’t underestimate the lure of yummy gummies.   Fortunately 83% of these overdoses were completely asymptomatic; only 1.6% lead to more serious outcomes. Those who showed symptoms had Headache Dizziness Nausea Drowsiness So what is Melatonin anyway? Melatonin is a hormone that occurs naturally in the body. It is produced in an area of the brain known as the pineal gland. Melatonin is released and helps control the body's circadian rhythm. It is not a sedative, but works in combination with light to get the body drowsy when it is time for sleeping. It may help adults and children fall asleep faster and improve the quality of sleep. It is not habit forming. It is interesting to note that melatonin production tends to decline with age (hmm, maybe that’s why I sometimes have trouble sleeping?)   There are no known ill effects, but there is no conclusive research yet on what the impacts may be from long-term use in children. For children older than 3, short term use seems quite safe.   The most common and most widely sanctioned use, is to help combat jet lag. Dr. Kaplan, over at Town and Country Pediatrics, says that it is fine for her patients who want to use it to help get adjusted to a new time zone.   Jet lag can make the first couple days of a trip pretty rough. Your best bet to get over it quickly is a multi pronged approach. It is very important to focus on hydration. Also, try to get as much daylight as possible when you land. If you are arriving someplace after 2 pm, try hard to stay awake and then crash early. If you are getting in earlier than that, a short nap might be necessary.   Then, by all means, add the appropriate dose of Melatonin to the mix. Unfortunately there are no clear dosage or safety guidelines in place. The studies range from 0.1 to 10 milligrams of melatonin. Most doctors think that 2-3 milligrams are a good amount to start with. The common recommendation is: Preschool-age: 1 to 2 milligrams School-age: 2 to 3 milligrams Adolescents: 5 milligrams In all cases however, experts recommend always starting with the lowest dose of melatonin available, then increasing the amount only if necessary. It is best to give it about 30-60 minutes before bedtime. As I mentioned above, melatonin comes in a wide variety of options for how to take it. Aside from tablets, chewables, quick dissolving and liquid, it also comes in sprays, creams, powders, and patches. Not all the forms have the same absorption. Choosing the right one is all about personal preference. For routine sleep .  For a healthy child, melatonin should NOT be part of a regular sleep routine, but there is no harm in giving it for several days to help reboot and get on a good schedule. If sleep issues persist, it is worth having a consultation with your pediatrician. Here are some things that can contribute to healthy sleep habits   Going to bed and waking up at the same time can get the body into a healthy rhythm. You may hear this referred to as 'sleep hygiene'. Make sure your child is getting plenty of physical activity during the day, but avoid too much rough housing right before bed. Try to avoid eating a large meal right before bedtime. Also, if any caffeine or sugar sneak into the diet several hours prior to bedtime, this can make it harder to get a good night's sleep Have a regular bedtime routine. Do some soothing activities, make the room progressively darker and darker. Don’t include any electronic devices as part of the bedtime ritual. The blue lights that are emitted are disruptive and should be avoided for at least an hour before bedtime. A pre bedtime massage is a lovely way to wind down.   White noise machines are fine. A hepa filter can do double duty.   Keep the bedroom cool. According to the National Sleep Foundation the ideal bedroom temperature is actually between 60 and 67 Fahrenheit. You can bump that up a bit for infants and toddlers to 65-70, but cooler rooms are better for sleeping. Consider trying the natural calm gummies. These are magnesium based. They can help you get a good night’s sleep (as well as a good poop). I am a big fan.   Not everyone knows that low iron and/or vitamin D levels can impact sleep. If you or your child are having insomnia, it might be worth getting those levels checked.   Other potential Melatonin benefits My 'go to' pediatric dentist, Dr Rothman shared the following: In the anesthesia literature it has been shown that giving melatonin does not increase depth of sedation during a procedure and therefore may be helpful in getting a good night's sleep prior to dental work, thereby decreasing anxiety. Keep this in mind and chat with your dentist if you have a procedure coming up.   There are ongoing studies exploring other potential benefits for all sorts of issues including migraines, eye health, calming kids on the autism spectrum as well as GERD. It will be fun to see what the future findings are.   Other safety considerations In the United States, melatonin is categorized as a dietary supplement, rather than an actual medication. There is no prescription needed. Supplements are not regulated by the FDA and are subject to less regulatory oversight.  A recent study measured the actual amount of melatonin in 31 different brands and found enormous variations from what was on the label and what was actually in the bottle. Some had significantly more or less than the claimed amount. Because of this, some countries such as Canada have banned the sale of over-the-counter melatonin. It is worth checking to make sure that the brand you buy is USP certified.   There are no safety studies for use in children under 3, pregnant or breastfeeding moms. Melatonin might interact with some medications, so for you grown ups out there, it is important for you to check with your primary physician. Medications that you need to pay attention to include some contraceptives, blood pressure medications, diabetes medications and most sedatives.   The biggest takeaway from this post? If you have melatonin sitting around on the counter, go and properly store it right now.

 

Covid Shots for the little ones/Answers to frequently asked questions

 

Covid shots for the little ones!!

The Covid 19 vaccination is now approved for children who are 6 months and older. Many parents are celebrating this. Some have questions. Sadly most of us are not immune to the politicization of this issue. I am betting that many people are getting a barrage of strong opinions from either side. Uncle Frank is warning you that your child will be irreparably damaged from the shot, while cousin Harriet is prodding you to get it as soon as possible or you are a bad parent. Others agree that they want the shot, but aren’t sure of the timing, or how to choose which vaccine. Consider the following quote: “Statistics are like bikinis. What they reveal is suggestive, but what they conceal is vital.”― Aaron Levenstein I am not going to inundate you with slides that can be interpreted depending on who is looking at them. You can find statistics to validate your point of view in plenty of other places. If you are interested in learning more about my data, shoot me an email and I will be happy to share my sources. The purpose of this post is NOT to pressure you in any direction or to judge your decisions. My goal is to present up to date information that might answer some of the more frequent questions. Here are my takeaways, starting with the question “why should I get my child vaccinated for COVID?” Vaccination can protect your child from severe disease It is very fortunate that for the most part children have weathered the various strains of COVID much better than the adults. But some kids DO get quite sick and some can die. Deaths due to Covid are higher than from any other vaccine preventable illness. Ever since vaccinations have been approved for children from 5-17 the data has clearly shown that hospitalization, critical illness and deaths are all much more common among kids and teens who are not vaccinated than kids and teens who are vaccinated and boosted. I am guessing that we will see the same trend in the younger kids. Multisystem inflammatory syndrome in children (MIS-C) is another reason to avoid Covid. This is a rare but serious condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. They don’t know yet what exactly causes it but most children with MIS-C had Covid -19 or a strong Covid exposure. Kids do get long covid. Mt. Sinai in New York has been actively studying this and came out with some findings this week that even the youngest children can experience long covid. There was a study this week in the Lancet Child & Adolescent Health. It concluded that while long covid symptoms are generally ailments that kids might get anyway, headaches, fussiness, tummy issues and fatigue…etc., the kids in the study who had previously tested positive for Covid-19 were more likely to experience at least one of these symptoms for two months or more than the children who had never tested positive for the virus. The study also revealed that a third of the kids who had tested positive experienced at least one long-term symptom that was not present before testing positive. You might also have read that Israeli studies are linking the new and mysterious case of pediatric hepatitis to Covid. It is still too early to make a definite connection. The bottom line is, if you have a choice of having your child getting covid or avoiding it, I would prefer that they get some immunity from the shot rather than risk the unknowns that come along with this virus. Vaccination can protect others. Kids are an enormous vector of disease; in other words, they have cooties. Seriously, parents who send their kids to daycare for the first time can attest to the fact that kids bring home all sorts of colds and illnesses. Kids who are not showing signs of COVID because they have such a mild case can still be spreading the virus. Babies under 6 months, people who can’t get the shot, older vulnerable and immunocompromised people, need our help stopping the spread. I don’t know about you, but I am willing to take any steps that I reasonably can to move out of this pandemic. Would I put the young kids at risk in order to do this? Absolutely not. The vaccine is safe  During the trials, short term side effects from the shot were minimal. The most common ones were fever, headache, fatigue, body aches, chills and nausea with vomiting. It was interesting to see that across the board, the reactions from the placebo were remarkably similar to the reactions from the shot. This is because at any given time, kids tend to have those symptoms from other little illnesses that they tend to get. There were no reports of myocarditis in this age group. In fact, in the adolescent group where this was showing up, the incidences of myocarditis were 6 times higher in patients from having the Covid virus then from the vaccine. Every possible issue was reported. My favorite example of this was recounted by the awesome epidemiologist Katellyn Jetelina: In the Pfizer clinical trial, one potentially life-threatening adverse event occurred in an infant—coffee was spilled on them causing a thermal burn. Pfizer reported it to the FDA. This is an example of the rigor and comprehensiveness behind clinical trials. What about Uncle Frank’s warning about long term consequences? These shots have been given billions (yes, with a "B") times over the past few years. In addition, the Pfizer and Moderna vaccines were created using messenger RNA (or mRNA) technology, which has been used for about 10 years in cancer treatment, with no long-term effects detected. I am much more concerned about the future consequences of long covid that are still surfacing. What are the differences between the brands? The Moderna vaccine is a 2 dose series of 25 mcg each. The doses are given 4 weeks apart. The Pfizer vaccine is a 3 dose series of 3 mcg. The second dose is given 3 weeks after the first dose. The 3rd dose is 8 weeks after the second. Your child should get the dose that matches their current age, even if they started the series at a lower dose. Your child is NOT protected from one dose. Protection starts about 2 weeks after the completion of the series. The Moderna series has shown to give quicker protection, simply because the series is shorter. For those of you eager to get your kids protected, it would seem that the Moderna is an obvious choice. If you could get the Pfizer tomorrow and might have to wait 3 months for the Moderna, then that would be a consideration. Also, some parents might be inclined to go for the lower dose. You have been so careful for so long, another 3 months might be something that you are willing to put up with. I have heard some argue that starting the Pfizer series now would give peak protection right in time for fall illness season. The most important factor is probably which one you actually have access to! What if my kid already had COVID, do they need the shot? The quality of an immune response is relative to the severity of an infection. If a child had a mild infection (which many do), then they likely had a lower viral dose and broad protection is less likely.  The current recommendation is for you to wait 3-4 months after the first symptoms of a positive test, before getting the shot. Isn’t natural immunity better? Not necessarily. Dr Ted has some extra thoughts on this down below. I have seen some people, including kids get covid multiple times. Also, consider the case of varicella (chickenpox) .Once you get the disease it stays dormant in your body for years. In some unfortunate people this shows up as shingles. People who got the vaccine for chickenpox rather than that natural virus are LESS likely to have shingles. So in regards to covid, we really don’t know all the long term implications of the virus.  What side effects should I expect? Going back up to the trials, about one third of the kids had fever, fussy, aches and perhaps some vomiting. These were worse with the second dose (which makes sense). The symptoms also seemed to be a little worse on day two. If you child is still having issues more than 4 days after the vaccination, I would get them checked. My best guess is that they have something else going on. The most serious complication was febrile seizure . This was RARE. I added my link because all parents should know about them regardless. What are some comfort measures for after the shot? Once they get the shot, I like to apply topical arnica to the area. Baths, plenty of fluids, a lovely popsicle and maybe some extra screen time can help you all get through a day or two of not feeling quite right. Of course, have Tylenol and/or Motrin on hand for a really miserable kid. If the popsicle and watching a video of trains going in and out of tunnels (Elliot’s current favorite) don’t do the trick, go ahead and give them a dose. I wish I could tell you that getting the shot was going to completely protect your child and end this pandemic. Sigh, unfortunately the protection is not 100%. What we do know is that vaccinated kids are not getting nearly as sick. Think of it like a dart board. It is probably not a bull’s eye, but at least it is on the board. My grandson will be getting his shot shortly. Dr. Ted’s Tidbits Let me talk about natural immunity and COVID-19. The people who really know me know that I’m a surprisingly big hippie when it comes to medicine. If we can do something the natural way, I’m going to recommend it. So when it comes to kids and COVID-19, it might have been safe to assume that I would support relying on natural immunity.  I wish that were the case, but it’s not. The virus that causes COVID-19 changes shapes after it invades the body and attaches to cells. So the immune system is only trained on a shape that is not very helpful for long-term protection, and that’s what we see in the data. Natural immunity from COVID-19 wanes very, very quickly, much quicker than vaccine-induced immunity. It also doesn’t seem to protect as well from complications of COVID-19 on reinfection. When it comes to avoiding the complications that Nurse Judy lists up top, nothing is better than having the vaccine on board, as it trains your body in a more lasting way. Hybrid immunity, which is infection combined with vaccination, is the absolute strongest. If your child already had COVID-19, be happy that hybrid immunity is something you can achieve with the addition of the shot.

Hepatitis A 2022

 

Hepatitis A has been in the news recently. 

This is an inflammatory disease of the liver that is caused by a virus. It is the most common vaccine-preventable illness that people get infected with when traveling. 

Hepatitis A is certainly more common in countries with lower standards of sanitation, but this virus doesn’t care about borders. Even if you aren’t going anywhere, everyone over a year old should get the shot. 

As the recent finding of contaminated strawberries illustrates, there are plenty of cases right here in this country.

There are several types of Hepatitis. The ones most of you have heard of are A, B, and C. There are big differences in how you get them, how long they last and how sick you can get.

Hepatitis A is usually not chronic like the other forms.

Transmission of Hepatitis A occurs through:

• Close direct person-to-person contact 
• fecal-oral transmission (touching a contaminated surface and then putting your hand in your mouth)
• contaminated shellfish 
• water (Hepatitis A can only be removed from drinking water by boiling or chemicals. Filters aren’t effective because the viral particles aretoo small)
• Raw food (including fruit and vegetables..organic doesn’t make a difference, alas)
• Any contaminated food (Cooking foods at 185 degrees F for at least one minute will kill the virus, but cooked food can still spread the disease if contamination happens after cooking) It is essential for anyone who is preparing food to thoroughly wash their hands.
• Ice cubes

I actually have a funny story about ice cubes. Sandy and I were in Cambodia several years ago. We had been scrupulously careful about where and what we ate. But there we were in a lovely bar on Pub street in Siem Reap. We ordered some drinks. They came with ice and we each took a sip before I put my glass down, “Oops, ice cubes are off limits' ' Here is the difference between us, I opted out. Sandy just decided to drink it quickly before the ice could melt.

Hepatitis A is hardy and can live outside the body for quite a while. It is important to note that it can survive being frozen. If you are in the habit of freezing berries and have some of the tainted ones in your freezer, get rid of them!

This is a nasty virus. Hand washing is important and can stop you from spreading it, but won't necessarily protect you from catching it. Poor hand washing, and then handling food, is a common mode of transmission, but so is changing a diaper. Thus diaper age children, infected with the virus, are a large reservoir for spreading it. 

The incubation period averages 28 days (range 15–50 days). People are most infectious 1–2 weeks before the onset of clinical signs and symptoms, and can shed the virus in the stool for months and months.

Infection can be asymptomatic or range in severity from a mild illness lasting 1–2 weeks to a severely disabling disease lasting several months.  Most common symptoms include: 

• abrupt onset of fever, 
• Malaise (you feel tired and generally crappy)
• poor appetite,
• nausea, and abdominal discomfort
• Joint pain
• Dark colored urine
• stool is often clay colored or freakishly light. 

A few days after the first symptoms show up, many patients end up with jaundice (yellow skin and eyes). Although it is rarely fatal, adults with this can become very SICK!

The likelihood of having symptoms with a Hep-A infection is often related to the age of the infected person.  

It is worth emphasizing: In children aged <6 years, most (70%) infections are asymptomatic. 

Unless there was a known exposure, in an adult patient, jaundice is often the biggest clue that will lead a doctor to suspect Hepatitis. As I noted earlier, most of the time, young children don’t usually exhibit many symptoms at all. In the young children who are actually acting ill, jaundice is not a common symptom, so it might be a while until someone figures out what’s going on.

Unvaccinated caregivers are the ones who get walloped. I have seen it sweep through a daycare.

Here’s the thing. If you are vaccinated, you don’t need to worry! The shot is nearly 100% effective. It is also very safe.

The vaccination first became available in Europe back in 1993 and started getting phased into our vaccine schedule in 1996. It has been a routine childhood vaccine in the United States since 2005. Interestingly, although it is recommended, it is not one of the vaccines that are required for school entry. 

It can be given as soon as a child reaches their first birthday and should be followed by a booster six to twelve months later. 

If you are traveling, be aware that the protection isn’t instant. Protection against hepatitis A begins approximately two to four weeks after the initial vaccination. The recommendation for travelers is to get it at least 2 weeks before your trip, so plan accordingly. 

The vaccine comes only in preservative free form (no thimerosal concerns). I rarely see any side effects at all. Once in a while a baby post vaccine might be extra fussy, but that is rare and not necessarily shot related.

This one requires little thought. You should make sure that Hepatitis A vaccine is included in your child’s immunization schedule. Parents, also please check your own health records and make sure that you are protected. Adults are often quite clueless about their own vaccination status!

If your child is between 6 months and a year you can get the shot early if you are traveling to a high risk area. This early dose won’t count towards the routine 2 dose series. High risk travel zones include everywhere except Canada, western Europe and Scandinavia, Japan, New Zealand, and Australia.

If you are interested in resources that will alert you to outbreaks and recalls:

 FDA.gov safety recalls, alerts and market withdrawals

Food Safety.gov

Fightbac.org

This one has all sorts of education and activities for teaching your kids about safe food handling