Skin Fold irritations

 

SKIN FOLD IRRITATIONS

I began this blog back in 2013. It is almost 10 years old! I started doing the weekly newsletter soon after. One fun little feature that you can see if you visit the actual blog is that the ten posts that are getting the most activity will show up at the top. It is an easy way to see what is going around. You can always count on head lice and pinworms to make the top ten. One of the other ones that is almost always in the top is one of my oldest posts on skin fold irritations. Most of the older posts are in dire need of editing (according to Sandy who took on this task several years ago.) This week alone, I have had multiple discussions about severe skinfold irritations; I decided it was time to freshen up the skinfold post. We love pudgy babies. There is something about all of those chins and chubby thighs that is so delicious. But as your baby gets rounder and rounder, they develop all sorts of little creases. It is common for the skin in these areas to get irritated. This doesn't only affect babies of course. Many folks have enough skin and sagging parts that this can remain an issue throughout the lifespan. The fancy medical term for this is intertrigo. Intertrigo is inflammation of the skin. It tends to occur in warm, moist creases of the body where two skin surfaces rub or press against each other. These troublesome spots can occur all over the body. Common areas are: Upper thigh/ groin area,  Butt creases Under the breasts In the armpits  Behind the ears. In the creases of the neck and chin  Prevention is key!!! If you ignore the skinfolds, you may be caught by surprise by how red and stinky they can get. When you are bathing your child make sure you get into all of those folds. I like to add a splash of apple cider vinegar to the bath water. I don’t have an exact amount, but roughly ¼ cup. This seems to prevent a good number of rashes When you are toweling them off, make sure those creases get completely dry.    Babies and children don't need to bathe every day, but they do need a bit of daily hygiene. It is important to be paying attention to all skin folds on a daily basis. Do a routine naked check. This includes separating all areas where the skin makes contact with itself, and making sure that there isn't trouble brewing in those creases.  My favorite tools for both prevention and treatment are pretty simple. Use a gentle cleanser. There are many where you don’t even need water. Apply the cleanser and wipe off. Some goods ones are Cetaphil and Mustela. Then apply a protective ointment: Aquaphor Tummy Todd (Lauren’s favorite) Emily’s soother Cerave ointment Calendula See if there is an obvious cause. When your baby is teething and drooling up a storm, the creases in the neck can be quite challenging.  Is there an irritation? In the upper thigh area, a poor fitting or new brand of diaper might be the culprit. Is it fungal? Yeast loves warm, moist, dark areas. If the area has any odor or has red dots then this could be the culprit. If you suspect yeast, I would go ahead and use a topical antifungal cream; lotrimin is fine. There is no such thing as a pediatric version. It is actually the same one that you would use for athlete's foot. For really red areas adding over-the-counter hydrocortisone cream twice a day. If the area is very raw, you can also add a dab of Neosporin (generic triple antibiotic ointment is fine) several times a day.  It is okay to mix and match any of these. Always start with the cleanser, add medication and follow with protective ointment. Dr. Ted sometimes uses a thicker diaper rash cream instead of ointment. If you are not seeing improvement after a few days of treatment, call your doctor to have a look. Some anti-fungal powders can be useful in creases, but the challenge is applying them without your child inhaling harmful particles. If you are someone who likes powders, sprinkle the powder into your hand away from the baby and gently apply it to the trouble area without causing the powder to get airborne. Paying attention to your baby's skinfolds, head to toe, is something that I wish parents would put on their daily to do list. I know you are exhausted and don’t need more tasks, but in this case, two minutes a day can spare you and your baby from being caught by surprise by a nasty crease.

What's Going Around? RSV is so prevalent that many pediatric ER's and ICUs are at capacity.  Croup There are lots of colds and coughs that linger There are lots of older kids with sore throats. They have all the classic symptoms of strep, but most of them are testing negative There is still some covid going around. There is misery associated, but I haven't seen any serious cases. Tummy bug. It is a combo, but perhaps more vomiting than diarrhea.  Hand Foot Mouth is not going anywhere, still very prevalent. Make sure you get your flu shot if you haven't yet. Some states are starting to see the flu. It hasn't taken hold in the Bay Area yet.

Conjunctivitis/causes/ treatments/ eye drop administration tips

 

Conjunctivitis

There was just a new study that just came out about pink eye. It prompted me to dig out this old post and update it! Let's start with some basics. The conjunctiva is the thin clear tissue that lies over the white part of the eye and then folds back and lines the inside of the eyelid.   Conjunctivitis is the term for when the conjunctiva has some inflammation. When this inflammation happens, the small blood vessels in the conjunctiva become more visible. This is what causes the whites of the eyes to appear reddish or pink. Common symptoms of conjunctivitis might include:   Redness in the white of the eye or inner eyelid Increased amount of tears Thick yellow discharge that crusts over the eyelashes, especially after sleep Green or white discharge from the eye Itchy eyes Burning eyes Blurred vision Increased sensitivity to light   The white part of the eyeball isn’t always noticeably impacted. If you suspect conjunctivitis, see if the inner lining of the eye looks redder than normal. My favorite way to check is to put a finger on the upper part of the cheek and gently pull down. This will allow you to assess the color inside that lower lid. Check both eyes. It isn’t a bad idea to get a baseline and see what normal looks like before there are any symptoms.   Pink eye has a number of different causes, including: Viruses Bacteria Allergies  Irritants    Viral: Many cases of pink eye come from the same viruses that cause a common cold. If there is discharge it is usually fairly thin. It is common to wake up with crusty eyes. Kids might complain that it feels like there is sand in their eyes. Just as a cold must run its course, so must this form of pink eye, which usually lasts from four to seven days.  Treatment is focused on relieving the symptoms; soothing eye drops are great. Also warm or cool compresses can ease the symptoms. Do you have access to breastmilk? You can apply some drops directly into the eye.   Bacterial conjunctivitis typically is redder and beefier looking with thicker discharge. Both bacterial and viral can start in one eye and then spread to the other. If there is a lot of green and yellow pus, it is more likely (but not absolute) that it is bacterial.    Historically, pinkeye that is suspected to be bacterial has been treated with antibiotic eye drops.  The new study out of Finland showed that many kids did just as well with lubricating eye drops instead of the prescription medication. The groups using either kind of drops recovered much faster than the group who did nothing at all.   Perhaps this is one of the reasons that breastmilk is so effective (aside from the fact that it is magic). I have seen it help many an irritated eye.   If you don’t happen to have breastmilk, Similasan eye drops are a good choice   Simple conjunctivitis can clear up on its own, although as noted above, any kind of soothing eye drop can speed up the process. However, it is not uncommon for patients with goopy eyes to have something else going on. I am even more suspicious if kids are fussier than usual. Pinkeye is often part of a ‘package’ with an ear infection and/or sinus infection. Those kids may end up needing oral antibiotics.   Both viral and bacterial conjunctivitis can be highly contagious. Understandably, most schools and daycares will not want your child to attend if there is a suspicion that they might have conjunctivitis. The general rule is that kids can return to school once they have been treated for 24 hours. The problem with this is that many cases are actually viral in which case, antibiotic drops are useless; it does get a bit mucky. Lots of parents make the choice to start drops immediately so that they can get back to work sooner. In any case, if your kid's eyes are super goopy they shouldn't be around other kids.   I asked Dr Ted what he likes to use for a case that needs to be treated. His preference is a brand called Politrim. He added that he knows of other doctors and ophthalmologists who will often prescribe erythromycin ointments because the medication stays in the eye for longer, making it more effective, technically. However in his opinion ointments are very difficult to instill into a child’s eye. He would rather try to get clear liquids into the eye four times a day instead of a ribbon of thick goop twice a day.   The directions will often come with a range of time that you need to do the treatment; for example 3-7 days. I suggest that you continue to treat for an extra day or two after the eyes have cleared up. Don’t partially treat it or it is likely to come back - 3 to 5 days is usually standard. Your child is no longer considered contagious after they have completed a full day of the drops.   If there is no improvement after 3 days it is worth having them rechecked.   Allergic: If allergies are the culprit, both eyes will likely be affected. The eyes are usually watery and itchy, They are usually not crusty. Common causes can be dust, pollens or exposure to an animal. Allergy eye drops can be used on an as needed basis. You don’t need to commit to doing a course. Some good choices are Zaditor (3 years or older) Pataday(2 years or older) Similasan (2 years and older)     Irritation: Common causes include harsh shampoo, dirt, smoke, chlorine from a pool, poor fitting, or dirty contact lenses, or a foreign body.    The best treatment is flushing the eye out with sterile saline or an eye wash. Keeping an eyewash solution is a good addition to your medicine cabinet. Of course, do I even need to add that Breastmilk is an excellent flushing agent as well?   Dr. Ted’s Science: When trying to tell the difference between bacterial, viral, and allergic conjunctivitis, there are a couple of key indicators. The discharge can be telling: your body sends lots of white blood cells to fight bacterial infections, which will lead to copious thick white discharge that needs to be wiped often (almost hourly). The eyes here will become deep red. Viral conjunctivitis doesn’t recruit as many white blood cells to fight, so there can still be discharge, but it tends to be thinner, less frequent, and more yellow. These eyes tend to be more pink. On average, bacterial conjunctivitis will impact one eye more than another (the site of inoculation) while viral pink eye tends to go to both eyes more quickly. Allergic conjunctivitis tends to be quite faint and mostly itchy without any pain, while both viral and bacterial can occasionally be painful. And finally, ear pain plus conjunctivitis should always raise suspicion for bacteria, specifically alongside ear infections.    What’s the difference between pink eye and a stye? A stye is a red and painful bump that forms on the eyelid, near the edge of the eyelashes. Conjunctivitis and styes have some overlapping symptoms, such as redness, light sensitivity and crusting along the eyelids. However, these are different conditions, with different causes. Styes are usually caused by an infection in the oil gland on your eyelid. Most of the time the treatment is warm compressing Treating a stye with antibiotics is not indicated.   Eye Drop tips I have some parents who claim that it is easier to give a bath to an angry cat than to administer eye drops to their kids. Getting those drops in can be somewhat of an art. If you have the luxury of having a willing partner, It may indeed be a two person job. If your child is very uncooperative you may need to wrap them in a blanket so that they don’t have their arms to flail around. Gently pull down the lid. Even if they are clenching their eyes tightly shut, you should be able to find a little pocket in which to put the drops. Try not to touch the dropper tip to the eye.  This is harder than you think. For older kids, a little preparation before you go at them with the eye drops can go a long way. Let them do some playing. Have them give “drops” to 2 different dolls or stuffed animals. Make one cooperative. Give them lots of praise for being brave. Make the other one kick a fit. You get the idea.     If your baby is under 4 months,  Crusty eyes may be from a blocked tear duct. Blocked tear ducts mostly will be an issue when the babies wake up from a stretch of sleep with their eyes all gummy. If you are seeing more frequent goopiness, it is worth checking in with your doctor.   What makes me worried? If the area around the eye looks very pink or red and swollen, that could be something called periorbital cellulitis and it can be quite serious if untreated. This would generally come with a fever and a child who looks ill.   Extra considerations Frequent hand washing with soap and water is essential. To avoid spreading the infection, swap out pillow cases, and wash clothes or towels that might have been in contact with the goopy eyes.   Please don’t share drops between family members!   If you have a little one who is getting recurrent infections, little hands going from a snotty nose, up to the eyes could be the culprit. Beyond making sure the those hands are kept clean, make sure you scrub under the nails. For the grownups - get rid of makeup that might have been used within several days of having conjunctivitis, especially mascara,   If you are a contact lens wearer, you might do better wearing your glasses for a few days.

Baby Poop 101

 

Baby Poop 101

The Poop Series/ Chapter one/ Baby Poop Most folks don't realize when they sign up for this "parenthood" gig that poop is going to be the frequent subject of many conversations. I am not kidding when I tell you I have poop related conversations in the Oath chats every single day. And if someone told you that you would be sending poop photos, you might not have believed them. But it makes sense…baby poop is like an alien substance when compared to adult poop. Parents don’t have a baseline for what’s normal. At some point, if you are like most parents, you also will get poop on your hands, your clothes, the carpets and just shrug it off as no big deal.   The first poops  When babies are first born the stools are greenish-black and thick. This is called meconium. The meconium can be a bit challenging to clean because it is so sticky. Nurse Judy Tip: Vaseline, Aquaphor, Cerave ointment or anything nice and goopy can help you gently remove the meconium from your child’s delicate skin better than regular baby wipes. Within about 48 hours, the baby will have some transitional stools that are not quite as dark and tarry (the color ranges from greenish to brownish). Those first bowel movements help signal that the system is working and some milk is moving through.   If the baby is taking a bottle, there is no mystery about the amount the baby is taking in. It can be more challenging for a breastfeeding mom to be certain that the baby is successfully nursing. Some babies might be hanging out on the breast for hours without reliably transferring adequate milk. The not-being-able-to-know-for-sure how much the baby was getting drove me nuts with my firstborn.  Listening for swallowing and watching the changes in mom's breasts are important clues that the milk is coming in. The ultimate proof that milk has made its way into the system comes when we see the first yellow stools. I always want to give mom a big congratulatory hug.  Dr. Ted’s Poop Science: Meconium stools are thick and black because they are concentrated digested molecules, including bile, baby hair, mucous, and cells from intestinal lining. The change to yellow poop signifies that fresh milk has passed by the gallbladder and picked up more bilirubin, the yellow pigment that makes jaundice, and helped it to excrete the bilirubin into the poop, without the concentrated stuff from the meconium.   Color Once babies start to successfully feed, the stools will gradually transition to a lighter color. Normal colors can be a veritable rainbow and range from yellow, orange, green or brown. I rarely pay much attention to this color palette unless it is accompanied by a fussy baby or other symptoms that are telling us that something is off. Normal breast milk stools are very squirty and yellowish. Some may have little seeds.    There are many factors that can impact the color. Stools from a formula fed baby tend to be a bit greener than the yellow ones from breast milk.    If blood is noted in the stool, you want to report that to your pediatrician, but most of the time it is not something I am alarmed about as long as the baby looks fine. Here are some key questions. How is the baby’s color and general appearance?  Are they calm or fussy? Is the belly nice and soft?  Are they eating well?   Red blood is usually fresh and comes from near the anus. It can be caused by the gentle skin down there getting irritated. Darker blood is not as fresh and comes from higher up in the digestive tract.  The first thing I will ask you to check is mom's nipples. If they are very sore, it is likely that there was some bleeding and the blood you are seeing in the stool is actually maternal blood. (I know, yuck.) If stools are mucousy with some fresh blood it can also be connected to mom’s diet. Often removing dairy completely will alleviate the issue. If stools are greenish and mucousy along with a fussy baby, it could be the lack of hind-milk   Gripe water, a popular colic remedy, can also make stools greenish If you are interested in a comprehensive list for colic relief click here  Very pale white stools are worth checking with your pediatrician.   Consistency It seems that almost every new parent checks in to make sure it is okay for the stools to be so runny. Yes it is. Diarrhea would be clear watery stools with only flecks. Baby poop is routinely very liquid. Remember, they are not eating any solid food - liquid in/liquid out!  It is considered constipation when the actual stool is hard, formed and pellet-like. If that is the case, check in with your doctor's office. This is very unusual for a breastfed baby. I have found some organic formulas can cause the poops to be a little firm.   Frequency Once the baby is gaining weight and having a regular pooping pattern, it is no longer necessary to closely monitor the frequency. Some babies seem to have loud squirty poops every time they eat (or as soon as you have put a fresh diaper on them). As long as it has a color, it is likely fine. A baby with actual diarrhea does need to be monitored because they could be at risk for dehydration.   Some probiotics, such as Evivo, will cause the stools to be dramatically less frequent, but many babies naturally make this switch on their own. You can bet the parents reach out when they are used to poopy diapers several times a day and suddenly there is nothing but pee for almost a week. As long as the stools remain soft, less frequent poops are not a concern   They seem to be uncomfortable A pooping baby tends to be a happy baby. If you have one of those infrequent poopers it is hard to watch them struggle. It is quite normal for babies to grunt, groan and turn bright red as they work on a bowel movement. There is a term for this. It is called Infant dyschezia (you can promptly forget that term, you will likely never hear it again, and there won’t be a test).   There are some things you can try. Massage their tummy. Go on youtube and search out some Infant Massage techniques. A good belly massage can help stimulate peristalsis (which is the movement within the intestines that moves the poop along.) The tummy may be the most important area, but doing an entire body massage will help them relax.  Don't forget their little hands! Take your thumb and make firm little circles on their palms. This is a reflexology technique that grandmas have been practicing for generations. Let gravity help them out. Hold them in an upright position and pull their little legs up to a squat position. Nobody poops as easily if they are flat with their legs straight. You can also bicycle those legs. Push the thighs all the way up to touch the belly. If you are doing anything that is uncomfortable, trust me, they will let you know. Swirl their little hips around, like a little hula as you move the thighs up and if you do it correctly it will make them fart. (very satisfying)   Sometimes a little rectal massage will also help. To do this you can put a dab of KY jelly or Vaseline on a Q-Tip and stick it a tiny bit of the way (just the cotton tip worth) into the butt. When I would take a rectal temp, back when I was working in the pediatric office, more than half of the time the baby would poop right on the thermometer. The Windi is another gentle way to stimulate pooping and help relieve gas at the same time.   Epsom salts in the bath can sometimes stimulate poop My chiropractor, Sandra Roddy Adams, tells me that her gentle treatments often get the little ones to to have a bowel movement     When you can’t stand it any longer There is no intervention needed for infrequent stools as long as you have a happy baby. If it has been many days in between poops, your baby seems quite uncomfortable and none of the actions above have helped, my next step is using glycerin. With the glycerin you have 2 options. Glycerin suppositories are little sticks of glycerin (over the counter in most drugstores.) You break off a piece and stick it into the butt (KY jelly helps.) This stimulates the babies to poop fairly soon. The other option is a product called Pedialax. These are little bulbs full of liquid glycerin. You pull off the cap and insert the pre-lubricated tip into your baby's butt and squeeze the liquid in. This product works really well. The box says that these are for babies two and over, but I have found them safe and quite effective for younger folks. As soon as they poop you can assess the quality of the bowel movement. If it was soft and mushy, you probably could have let it ride for another day or so, but don’t stress. Occasional use is quite safe. Often just going out and buying glycerin will make your kid poop. In any event, it is a useful product to have on hand.  If the stool is hard and firm, then it is good that you helped it pass. At that point it is worth checking in with your pediatrician to see if there are any adjustments you need to make.   Dr. Ted’s Science Tidbit: It’s not typical that children will become long-term dependent on help for pooping from agents like glycerin suppositories. All of our bowel movements, young and old, depend a little bit on mucous produced by the lining of the intestines. This mucous is the lubrication through which our poop is able to slide out of our anus. Shortly after a suppository is used, the mucous can be wiped away, and the next poop can be temporarily slowed. But after some time, mucous is produced again and the next poop is passed.

Grandparents/starting the relationship off right/Boundaries

 

No matter how strong the relationship you have with your parents or inlaws, many new parents struggle with boundaries once the baby comes along. Maryellen Mullin, local therapist and relationship expert, advises that ideally you start developing clear guidelines with your parents and in-laws long before you are ‘panting and blowing’. In even the easiest relationships, having some clear communication with family members ahead of the arrival of the baby can be very helpful. In my case, I know that we were so fortunate in the grandparent department. Neither of our families were local. My mother in law did the first shift for us. This was her first grandchild and she was more than ready. Aside from some tears shed when Nanya inadvertently left some expressed breastmilk (more precious than gold) out of the fridge, we forged a deep bond over the mutual love for the baby. We had always gotten along just fine, but this took us into new territory and we never looked back. My MIL had chosen to be Granny, but Lauren pronounced that as Nanya, and that’s what stuck. My mom came out next. She already had her Grandma name and was called Oogie (a story for another time!) I will never forget all these years later that she gave us the gift of being on duty during the nights. For the two weeks that she stayed with us, I would nurse and then she would collect Lauren and go downstairs to watch the news, peppered with reruns of I Love Lucy or whatever was on at 2 am. Not everyone is so lucky. Some don’t seem willing to offer any assistance. Some live far away and can’t be with you. Some are physically unable to help. Some are helpful, but overstay their welcome. At some point the time comes when the new family is ready to see what it feels like to just be on their own. Some are deeply connected. Some are estranged, but trying to reconnect.  No family is exactly the same.  Alas, frankly, some family members are toxic, and a new baby in the equation is not going to be able to fix that. Examine complicated feelings It’s not uncommon for the adults to watch their parents, who never seemed to have enough time for them when they were growing up, suddenly be a source of unlimited support and affection to the baby. It is hard not to listen to the the little voice inside, saying ‘wait a minute” that’s not fair.” Remember that grandparents are usually at a different phase of life now. Also, as Maryellen points out, Sometimes grandparents LEARN from their mistakes, but often, can't communicate that with adult kids. They try harder with little ones at times, and just want to be loved. Like all of us do. In the case of my mother-in-law, when her adult children would point out all of the mistakes she had made as a mother, I didn’t allow that to factor into this equation. She was a WONDERFUL grandmother, and my children were extraordinarily blessed with all the effort she made into building her relationships with them. Here is some suggestions for the grandparents out there. Giving advice There are SO many opinions out there about every element of parenting. Sleep, feeding, how much can the baby be held? Ask a question and get 100 different answers. Let them know that your advice is there for the asking, if they want it. No hard feelings if they don’t.  Trust me, I know this isn’t necessarily easy. Of course you have plenty of wisdom and experience under your belt, but it isn’t your turn at bat. Please don’t tell them that they are doing things wrong. They are in the process of figuring things out. Also be aware that some things have indeed changed. If you are like me, when our kids were little, they slept on their tummies in a crib full of stuffed animals. Recommendations have evolved.  Please don’t get in the middle and make the parents feel the need to take sides. They need to learn how to work together as a unit, not to get into arguments about sparing your feelings. (For the new mom and dad, it’s fascinating how often suggestions from your parents have the potential to turn you into a teenager again. Take a breath and try to resist the knee jerk reaction to dismiss anything they say out of hand. Sometimes they know what they are talking about.) Helping out The new parents are likely exhausted. New mom is dealing with hormone shifts and a battered body. Find out what kind of support she needs and then offer it. It might be as simple as making sure she is eating and drinking. I find it useful to put the assistance into one of 3 categories. One: Full body yes! This is not a favor. You are thrilled and delighted to be spending time with the new family, doing anything you can to help…including lots of baby snuggles. Some grandparents have been waiting a long long time for this! Two: Happy to help as needed Three: Willing to do anything that is needed in case of emergency  This system has been useful for my daughter and I because it makes everything very clear. She still doesn’t love needing help, but trusts the “full body yes” when it’s offered. Helping out also mean no judgment. If you notice dishes in the sink? Wash them! Is there laundry piling up? Do it! The only adults who are welcome in the house with a baby need to be ready to pitch in. Rules This doesn’t usually become a consideration until the kids are a little bit older. Grandparents may like to spoil their grandkids, but it is NOT okay to ignore or undermine the parents wishes. Common issues are often over diet and screen time and schedule. Maybe there is wiggle room with some treats or extra screen time (within reason) but talk about it. See if you can negotiate some compromise. Maybe the nap doesn’t have to happen at exactly the same time when Grandma is on duty. Heads up - telling your grandchild that the extra cookie is a secret and they shouldn’t tell mom or dad is NOT okay for so many reasons and will surely come back to bite you. Social Media Check with the parents to see if they have any limits on social media BEFORE you post any photos. Parents: Before you give this a hard no, see if you are willing to let your parents show off the occasional photo. Again, no sneaking around; don’t wreck your trust over this. Parents get the final word! Please get vaccinated Anyone who is going to be around an infant should make sure they have had at least one TDaP as an adult. The T stands for tetanus, Plenty of people don’t even have a clue when they had their last tetanus shot, so this will be a great way to remember when your most recent shot got done! All adults should also get the flu shot, and ideally the covid vaccine. If for some reason grandparents are reluctant to get vaccinated, that is certainly their right. But the new parents also have rights. If they are listening to me they will ensure that anyone who spends significant time around the infant during those first vulnerable weeks is either vaccinated or is willing to wear a mask. In any case, anyone, vaccinated or not, who has any signs of illness should avoid being near the new baby. Essential conversations One of the core members of the Oath team shared a story. While she was still pregnant with her first child her mom had an important talk with her. This wise grandma-to-be gave her daughter permission to set whatever boundaries the new mom felt needed to be set, and shared that she herself never regretted barring her own difficult mom from visiting for the first month. She then asked her pregnant daughter to think about what things were most important to her during the rest of the pregnancy and after the baby arrived. She ended with an important piece of wisdom. She reminded her daughter to savor the upcoming time, because even though it would likely be challenging, there would be magic moments that she should capture in her memory because you can’t rewind and get this time back. I wish every mom-to-be could have that kind of frank conversations with both mom and mother-in-law. If possible carve out some special one on one time. Use this time for grandmas to share their own stories about what they remember about their first month postpartum. What worked, what didn’t work? Do they have a special piece of wisdom that has been handed down from their mom? Mom-to-be can talk through what the ideal support would look like. When the reality of the baby comes along, much of what you think you need can significantly shift. You have an opportunity here. Your support and choices now can pave the way to solid and positive relationships moving forward. If you are lucky, you can have some intergenerational magic, even in some cases that you never believed it possible.

Hitting/Biting/Kicking

 

If your child has never hit, kicked or bitten anyone, I say….what? Are you sure?? I can not begin to count how many calls I have fielded about these behaviors. Biting tends to elicit more of a visceral response, but it is hard to see your sweet little one do any of the above. When parents get ‘that call’, to be honest, I haven’t yet figured out if it is worse to be the parent of the biter or the victim. Or maybe your child bit you?! In any event, it’s upsetting. In the moment: Make sure everyone is safe. This includes the ‘victim’ as well as the ‘aggressor’. Remember they both may be having a hard time and need help. Tend to any injuries. I need to point out that human bites can get infected rather easily, so if a bite breaks the skin it is worth having it evaluated by your doctor. Arnica is good for little bumps and bruises. A cute kid friendly ice pack makes almost anything feel better Now let's see if you can figure out what is causing the behavior. If the biter is young, often they are just exploring. Check to see if they are teething. Offer them cold things to chomp on. A mesh teething bag filled with a cold piece of fruit feels great to their sore gums. Kids often test limits to see what they can get away with. That is very normal behavior. Having every adult show consistent responses is SO important. Kids need to know the rules. Gentle hands when touching people or animals…Always! It is not okay to bite another person or animal...Ever! Many kids hit/bite/kick in their quest of attention.   Behaviors fall into one of three categories.  Those you want to see more of Those you want to see less of Those that are dangerous, or can hurt someone and require you to take immediate action to protect people or property. Hitting, kicking, biting etc...usually fall into the third category. If a child is overtired, or hungry it is going to be harder for them to regulate their emotions. But kids get mad, sad or frustrated even if they haven’t missed a snack. There are things you can do in advance Make sure that your little ones understand the difference between gentle and rough.  This is something that should be taught. Demonstrate what soft and gentle feels like. If your child is going through a phase where they are quick to hit, bite or be rough, the adult in charge should watch closely for warning signs and redirect or distract before they have a chance to act out. Julie King, co-author of How To Talk So Little Kids Will Listen, suggests acknowledging the child's feelings that might give rise to these behaviors. You might say, "It's frustrating when baby knocks over your toys. It's hard not to push her! I'm moving you farther away, so that doesn't happen." Letting them know that you can see that they are going through something difficult is often the first step in diffusing the situation. Julie also points out that there is a subtle but important difference between: It's frustrating when……. and You are frustrated that….. Try empathizing rather than labeling. After an incident, If they are old enough to do some reasoning, have your kids help you come up with solutions for dealing with or preventing a similar situation from happening again. The key is making opportunities to teach your kids how to manage difficult feelings, and then how to resolve conflicts. Do they need help, or practice, learning how to wait? Try to find ways to give them (positive) attention, so they don't resort to these less acceptable strategies Find quiet moments to work on these skills and make it a game. This will give them tools so that when stressful situations arise, at some point they will be able to react in a way that doesn’t include whacking someone in the head. (When they succeed, make sure you let them know that you approve and give them a big high five.) Another activity is to do a deep dive into all different feelings. Remember that all emotions are valid. To quote Mr. Rogers, “anything mentionable is manageable.” Talk about activities that can make some of the hard feelings feel a bit easier. I have a list of things you can put in your destress/calm down tool kit in this link, including making sure that you have a comfy corner where they can sit with a stuffed animal and some fidget toys where they can calm down. Read books about how hands are not for hitting. Watch some videos (don’t be afraid using some screen time) Hands Are for Helping Video,  What Shall We do with the Angry Monster? ,  What is Anger? As you watch these videos with your children (aka co-viewing)it is important to talk about what is happening. Ask how your child thinks the characters are feeling. How do they feel about the alternative behavior? If you can even bring in one of their real life scenarios that increases the relatability for the child.  Give kids plenty of opportunity to do sanctioned ways to have physical activity. Do they feel like hitting? Here is a pillow Do they feel like throwing something? By all means, find something soft that they can throw. Have a sign for ‘pause’. If you practice this enough it can come in handy. What about when kids start hitting themselves? It is actually not that different. Repeat the mantra “We only use gentle hands on people and animals” Gently hold their hands to stop them from hurting themselves A list of random tips and thoughts Do NOT let your kids beat you up. I'm serious. I have witnessed parents just sitting there as their kids repeatedly try to smack them. The message has to be consistent. It is Never okay to hit. This includes you (no matter how guilty you are feeling about something). If they are being too rough, remind them to be gentle. If they don’t listen (assuming you are in a safe place), use your ‘walking away power’ This means getting up and moving to a safe space. This is generally NOT the response they are going for. 30 seconds is often all you need. Avoid exposure to violence on tv or computer If the problem behavior is happening at school, make sure that you and the teachers/daycare providers are all on the same page. It is important for kids to get a consistent message. If your child is under 7, yours might be the exception, but their concept of honesty is still pretty shaky. If you ask them directly what happened, many kids are going to try to pick the answer that will get them into the least amount of trouble. The actual truth doesn’t usually factor too heavily into the equation. Other kids can actually start believing their own stories. This does not mean they will grow up to be pathological liars! If your child bites. It does not mean your child is an evil cannibal. Because these situations can bring up many emotions in the parents, I asked Brittany Williams, Oath’s founding Mental Health therapist, to weigh in. Take a second and be self-reflective and see how you feel and move through difficult uncomfortable emotions and situations. By doing this you can more clearly see your own humanity and as such build empathy for your child’s behavior. After all, we’re all human beings doing the best we can with what we have available to us at every moment.  A giant thank you to Julie King for allowing me to pick her brain on this topic! If you'd like more practice addressing challenging behaviors, and a place to get answers to your specific questions, see below for Julie's upcoming online, interactive workshops, or check out her website, julieking.org.

Flu shot information 2022/23. with bonus tips for the shot-phobic

 

Flu Shot information 2022/2023

Covid still seems to get the lion’s share of the attention, but the flu is not something that should be ignored. Influenza is one of the deadliest vaccine-preventable diseases. Each year, the flu kills more children in the United States than meningococcal infection and whooping cough combined. It can also lead to serious complications such as bacterial pneumonia, ear infections and sinus infections. It can worsen chronic medical conditions, such as congestive heart failure, asthma or diabetes. The flu is no joke. Plus even a mild case can be completely miserable. The aches, the coughing, the chills, that horrible feeling that you don’t want to be touched…Nobody wants to get this. The covid pandemic actually made the last couple of flu seasons significantly lighter than average. When people avoid crowds, wear masks and wash their hands, things don’t spread as easily. As the world tries to move out of our pandemic existence, many people are relaxing that cautious behavior and moving towards a new normal. Might we see more flu activity because of that? News from the southern hemisphere would seem to indicate that the answer is yes. Based on what they have seen so far, experts are predicting that this year’s flu season could be early and severe. Your best protection is to get a flu shot! Getting the vaccine is not just about keeping you or your children from getting ill. It is also about minimizing spread within your family and community. It means protecting people who are vulnerable, including infants under 6 months who are too young to get the shot. In addition, flu vaccines can reduce the burden of flu illnesses and hospitalizations on our health care system. After the last several years, all of those health care workers need a break! Kids can start getting the flu shot at 6 months. If you have a baby at home who is too young to get vaccinated, please take extra care to make sure that all the household contacts are protected so that you don’t bring the virus home. Pregnant and nursing moms can and should get the shot. Anyone who is under the age of nine, and is getting the flu vaccine for the very first time, needs to receive two doses of the vaccine in order to be considered fully protected. The first dose “primes” the immune system; the second dose provides immune protection. The two doses need to be separated by at least four weeks. Over the years I have seen patients who have had only their first shot come down with the flu. One dose will not fully protect them. If your child has ever had more than two previous doses of any flu vaccine, they only need one this year. It takes about 2 weeks for the shot to take effect. For children aged 6 months through 35 months, flu vaccine dose volume is dependent on the product that is administered. Some brands require only half of the adult dose. Every year the disease trackers do the best they can to predict which strains of the virus will circulate and try to match the flu vaccine to the anticipated strain. Typically the vaccine changes from year to year. Some years have better matches than others. Even when they don’t get it exactly right, the shot seems to protect from more severe illness. For 2022-2023 the quadrivalent vaccines protect against two B strains and two A strains including H1N1 If you are pregnant or have young children, double check before you get the shot to make sure yours is preservative free. 93% of the supply this season is, so it shouldn’t be an issue. The flu mist is another option that is approved for healthy, non-pregnant people between the ages of 2-49 Since we never really know when the flu season will start with a vengeance, getting your child vaccinated early in the season is your best bet. As soon as a baby turns 6 months old you can get them started with their first dose since they need two doses to be fully protected. It does seem to vary a bit from year to year, but most of the time the reactions to the flu shot are quite mild. It is common to have a low grade fever and some soreness at the injection site. Remember that a day or two of aches and a bit of fever is still better than a full-blown case of the flu. If your child has a mild to moderate egg sensitivity it is still considered okay to get the standard shot. For folks with a known severe egg allergy, talk to your doctor about some new options that might be available. In any event it is a good idea to keep a close eye on your child for at least 30 minutes after the shot. If they seem to be having any breathing issues or exceptional fussiness they should get checked out immediately. It is impossible to predict possible delays and shortages with the supply. The safest way to prevent having an issue with a potential shortage is to get the shot in September or October. A mild illness does not affect how well the body responds to a vaccine, so a little cold is not a reason to put it off. Dr. Sophia Hurd, A UCSF physician at the Laurel Heights location says that the flu shot visit is a great time to get caught up on any other vaccines that your child might be missing.Their office has the flu vaccine in stock already and is giving it by appointment only. For frequently asked questions, here are a couple great resources from the CDC https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm Tips for the immunization visit A little preparation ahead of time for either the flu mist or the shot can make a world of difference. The flu mist is a nice option for kids over 2, but to tell you the truth, getting a 2 or 3 year old to cooperate with something being squirted in their nose can be more of a challenge than the 2 seconds it takes to do the injection. If you can practice with a little saline in the nose at home, you will have a much better chance for success. If you can’t get them to do this in the safety and comfort of your home, save yourself the trouble of trying in the office and just opt for the shot. For the injection, get out the doctor's kit and do a little playing. There are also loads of little videos that you can watch in advance. I have one link here - Daniel Tiger gets a shot, but do some homework and see if you can find one that might resonate with your little one. Make sure you give appropriate choices, such as which arm they want the bandaid, or what kind of treat they might get. Dr. Hurd pops a gummy or piece of chocolate into her kids mouths right after the shots and they are a big fan. No fussing at all. Be clear that whether or not to get the shot is not one of the choices! When you go in for the appointment it is helpful if your child is wearing short sleeves or clothes that will allow them easy access. Perhaps bring an ice pack with you and give yourself a bit more time for some icing in advance. The shot usually doesn’t hurt too much but an ice pack gives some kids a little boost of confidence. You might also order a product called a Shot Blocker from Amazon and bring it with you. These little gizmos have helped a few of my ‘shot haters’ have an easier experience. I have found that there is no age limit to people who are terrified of shots. Some parents are so upset by the sight of a needle that they can’t be in the room when their kids get vaccinated. If you are one of those, see if you have the option of having a partner be the adult on duty. Wishing you all an influenza free year. Now go ahead and make an appointment!