Monday update 12/24/ Holiday hours

The tummy bug is very active.
This has been short and intense and is getting the parents and nannies ill as well as the kids.

We have loads of coughs and colds. The wheezers are wheezing.

We have seen a few kids with ear infections and conjunctivitis.

We have had a trickle of positive flu cases. None of the kids were vaccinated.

We will be doing another drop in Flu shot clinic on January 5th from 9:30-12:30.
This will be the last clinic we do this season.
We can take care of any of your child's vaccination needs that morning, not just the flu.

We are closed tomorrow for Christmas.
We are back with regular hours the rest of the week.
We are open the morning of New Years eve for acute care needs and then closed on Tuesday, then back to normal on January 2nd.

Thanks to those of you who have sent over wonderful cards, photos and/ treats this holiday season.

Happy Holidays

Nurse Judy

Holiday safety tips

HAPPY HOLIDAYS
The winter holidays are a time for celebration, and that means more cooking, home decorating, entertaining, and an increased risk of fire and accidents.


Below are some safety checklists for dealing with the holiday season.
Some of these may seem like common sense but there might be a few tidbits in here that you haven't thought about.

For instance...button batteries. They are everywhere nowadays in all sorts of small electronics ( and musical cards), These can be quite hazardous if swallowed. Take time in advance to do a mental inventory of items that you have around that may be powered by these.
We have had to X-ray a patient not too long ago, because there was the possibility that a button battery was missing. (They had indeed swallowed it)

Certain Holiday plants like poinsettias can be toxic ( especially to someone with a latex allergy). You may not have them in your own house, but if you are visiting a friend or even a supermarket make sure little hands don't grab the pretty red leaves and put them in their mouths

Be very careful transporting hot food to a holiday pot luck. I have patients who have been burned from hot food spilling on them in a car.



Christmas tree and decoration checklist
*When purchasing a live tree, check for freshness. A fresh tree is less of a fire hazard
*Cut 1-2 inches from the base of the trunk immediately before placing the tree in the stand and filling with water to ensure absorption
*check the water level daily to avoid the tree drying out
*When purchasing an artificial tree, look for the label "Fire Resistant"
*Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights and a person touching a branch could be electrocuted
*Place your tree at least 3 feet away from all heat sources, including fireplaces, radiators and space heaters
*Make sure the tree is steady enough that it can't be pulled over by a toddler
*Trim your tree with non-combustible or flame resistant materials
*Before using lights outdoors, check labels to make sure they have been certified for outdoor use
*Make sure all bulbs work and that there are no frayed wires, broken sockets or loose connections
*Plug all outdoor electric decorations into circuits with ground-fault circuit interrupters to avoid potential shocks.
*String of lights and garlands are a staple of holiday decorating, but they can also pose a strangulation hazard.
*Avoid trimming the tree with things that look like candy which may pose a temptation to the kids.
*Keep sharp, glass or breakable ornaments out of reach of small children
*Holly berries and other small decorations can be choking hazards
*Don't overload extension cords

This is a great time to test your smoke alarms!!!

Stay safe and Have Happy Holidays!

Nurse Judy

Monday Update December 17th

This weeks is fairly similar to last week.
We haven't had any more positive flu tests, but there are a lot of "flu Type" viruses going around.
We are seeing moderate fevers with congestion lasting about 4 days.

There are so many coughs and colds. I am seeing quite a bit of croup. A handful of these folks have ended up in the emergency room.
If your child wakes up with a "seal like" barky cough, your first step is the steamy bathroom. Sit them on your lap in the steam and calmly sing for a few moments. More often than not this will ease the breathing. If they still feel like the respiration s are labored, a trip to the ER is reasonable.

We are seeing a bit more wheezing this week. The nebulizers have been busy.
Unless you are fully comfortable treating a repeat wheezer, we want to see them in the office. If you are a nebulizer owner, make sure you have medications that have not expired and fresh tubing for the season.

The tummy bug is still making it's rounds. Again a handful of patients have lost the hydration battle and have ended up needing an IV,
A dehydrated child has significantly decreased energy and is not peeing a lot.
If they are running around and laughing ( some of them are..they feel SO much better after they vomit) the plan is to give them tiny amounts of clear fluids or breast milk at a time until the stomach seems settled.


I have a few kids with hand foot mouth and some with mystery rashes and fevers. I think we are starting to see some "slap Cheek" around which can have those symptoms on and off.

We will be having Holiday hours next week.
We will be available in the morning on December 24th for acute care only.
We are closed on the 25th

Reminder that we will be having a shot clinic on January 5th

For parents of kids over 2 I do have a parenting class on the calendar for February 13th in the evening.
This is a fun little workshop that deals with creative consequences, rewards, problem solving, tantrums, meal times, bed times etc.
RSVP is needed you can contact me about classes through the nurseJudy.com website.

If any of you want to get on my direct mailing list let me know
Judy

FLu has arrived

I told you that I would let you know.
We got our first positive flu test in here today.
It was type B and the patient had NOT been vaccinated.
The symptoms are fever, aching joints, lots of cough and congestion.

If you haven't done it, it is time to get that shot.
We are going to hold one more shot clinic this season on Saturday morning January 5th 9:30 -12:30 am

We will do any shots that are needed, not just flu.
This will be a great time to get the second shot in the series for your little ones who have had the first one by December 8th.

Judy

Monday Update/December 10th

We have coughs of all shapes and sizes..croupy, wet, dry, wheezy, everyone seems to be coughing.
Most of the kids have some nasal congestion as well.
Most of these folks have some low grade fevers, but there are some kids out there with 3 or 4 days of very high fevers.

I hear rumors that RSV is starting to go around. That is your basic horrible cold/ cough virus.
Most everyone gets it at least once within their first 2 years of life.

We are also still seeing quite a few patients and families with the tummy bug.
This usually starts with vomiting and moves along to diarrhea.
Many times the diarrhea will last until we get the tummy to calm down. I strongly suggest getting rid of any dairy ( except for breast milk) and make sure the diet is bland and starchy. Add Probiotics. ( prior blog entries will give more specific guidelines)

I still have some cases of Hand Foot Mouth virus out there. Most of the kids are very mild.

We still have not had any positive influenza tests yet but the reports are that this will be an early flu season. They are also saying the the flu shot is a good match this season. We shall see.

I still have spots in the Wednesday evening illness class...
full info at nursejudy.com

Stay well,
Judy

Tips for giving medication

TIPS FOR GIVING MEDICATION TO YOUR CHILD



Parents have to pick their battles. Sometimes things really aren't so important and we don't have to necessarily get "our way". Generally though, the medication battle has to be one where we come out on top.

The assumption of course, is that you have decided for a valid reason that your child has a condition that needs to be treated. If this is the case, have firm but loving attitude.

(Think Mary Poppins and her spoonful of sugar)

Make it clear that you mean business and whether or not they like it, they will be getting the medicine, one way or another.

For your young child, hold them at a 45 degree angle, If they are flat they can choke a bit, and if they are sitting up too high they can spit or let it dribble out of their mouth.

If they are using their hands to knock the medication away, wrap them in a blanket ( think straight jacket)

This may be a two person operation.

A syringe is much more effective than a spoon and is better for measuring.

Squirt a small amount in the side of a cheek.

Keep the chin elevated

Give a tiny bit at a time and wait for a swallow in between.

Some of our tough customers are most likely crying and screaming throughout the process. It gets easier.

If you are giving a teaspoonful, that would be 5 ml in a syringe. Giving .5 ml per squirt would mean 10 squirts. This may take several minutes, but the dose will go in.

The only kiddos that can beat this system if you are doing it slowly enough are the ones that learn how to vomit.



Okay, what are your options if you have a vomiter on your hands?

If your child needs antibiotics, sometimes we can give an injection.



If you are simply trying to get in a dose of fever reducers, Acetominophen ( Tylenol) comes in suppository form that is quite easy to give.



For kids who are old enough to reason, lets give them some choices. What would they like to drink after the medicine? Should we have the pharmacy add a flavor?

Sometimes holding a lollipop and taking a lick after each squirt helps with a bitter taste.

Some of the generic antibiotics are truly vile. Azithromicin (Generic for Zithromax) is one of the worst. The name brand is significantly easier to get down, but most insurance companies won't cover it without an enormous co-pay)





Do some role play ahead of time.

Have one cooperative stuffed animal one stuffed animal ( or doll) who kicks a fit.

For the cooperative doll say things like " I know this tastes a little yucky, but it is really important and it will help make you feel better. I am really proud of you for being so good.



Let them be the parent who has to give the medicine to the uncooperative doll.



Choices and rewards are fine, but make it clear from the get go that the discussion will last 5 minutes and no more ( set a timer) when the timer is up they will be given the medicine the same way a baby gets it, with no choices involved. When the kids realize you mean business they cave fairly quickly.

One reward method is to make it possible to earn 10 pennies per dose. Put the money on the table.

A penny is taken away for every 30 seconds that passes without cooperation. Kids hate seeing something concrete being taken away.

If your child is old enough, this is a great math opportunity. A 10 day course of antibiotics can be worth 2 dollars ( adjust the reward however you choose)



Never try to sneak medicine into a larger volume of food or drink. Your kids will know it is there. If they do end up taking only part of it, you will have no real idea how much of it they got.

I have actually had some pretty young kids who hate taking liquid medicine learn to swallow capsules or pills.

I start with tic tacs or other small pieces of candy. See if they can swallow one. If they fail, Oh well. They have a piece of candy in their mouth. If they can't swallow it with water, try putting it on a spoon tucked into some yogurt, or jelly and see if it goes down.

Remember you are doing this with your child's involvement. No sneaking things. Don't lose their trust over something like this. You are on the same team, trying to help them feel better.



Most kids do end up taking some syrupy medications at some point or another. Please make sure you brush their teeth after each dose.

If they are taking antibiotics I strongly suggest that they also take probiotics to protect the body chemistry and prevent yeast and/ or stomach upset. Ideally, don't give a probiotic at the same time as the other medications, but stagger it throughout the day if possible.



Some children take a daily medication or vitamin pill and quite like them.

Telling your child that medicine and vitamins are not candy and can only be given by the grown up is a start, but it is also essential that they are kept in a child proof area. If your child does take an overdose of any medication call the Poison Control Center to find out how concerned you need to be.

Poison Control number for California is 1-800-222-1222



If you are ever giving a medication and are not sure about proper dosing, never hesitate to call your doctor's office/ advice nurse for clarification.

Good luck!!!
Nurse Judy

December 3rd/ Monday update

The illness taking the starring role so far today is the tummy bug.
Lots of kids out there seem to be plagued by it.
This has started with about 12 hours of vomiting. The kids start retaining fluids, but then move along to loose stools. This has been lasting about 3 days.
Bland starchy diets and probiotics are helpful.
If you are lucky enough to have breast milk that is great. Many of the kids have been having trouble with other dairy.
There is a formula that I use for all ages, Similac DF ( diarrhea formula) that is soy based and has been very useful. You should be able to find it at the Noe Valley or Diamond Heights Walgreens in the pharmacy.
Many of the kids have decreased appetites and low grade fevers. The key is their hydration. If they are very low energy and have decreased urine output, then they need to be evaluated.
If your child is still in the vomiting aspect of this, give small amounts of breast milk or clear fluids ( pedialyte, cocunut water etc) every several minutes.

I have lots of kids out there with the cough and cold. More of the kids are getting wheezy this week and the nebulizers are starting to hum here in the office.
If your child has a history of wheezing make sure that you have medication on hand that is not expired.
I am more than happy to phone in refills as needed. While you are checking, let us know if you need a fresh set of tubing for the nebulizer. They should be replaced every 6 months at the very least.

I have a couple of kids out there with slap cheek so I am seeing it out in the neighborhood.
Slap cheek is a viral syndrome that we don't actually treat. Time will fix it. Most kids show up with a really red chappy cheek. Then they get a mottled, lacy rash over the arms and legs. Some kids have very high fevers with it and are quite miserable.
I still want to see anybody out there that has a high fever with a rash, because strep throat can look similar.

My illness class on December 12th will discuss all of the above in much greater detail.

Stay well and stay dry
Judy

November 26th/ Monday

We were horribly busy in here for most of the day. Thanks to all of you who waited patiently though the busy signals.
We had a lot of travelers who came back sick and were exposed to all sorts of stuff during the travels. The flu has arrived in other states and we will see how quickly it makes it's way out here. So far all of the local flu tests are still coming back negative.

There is a flu like illness around with congestion, body aches and a moderate fever that lasting for about 3 days or so. ( parents are getting this one too)

I have had several kids with hand food mouth. This is their second time around with it. It starts with a low grade fever and moves along to the rash on the hands and feet and spots around the mouth.

I have a few kids out there with rashes on the arms, legs and cheeks.. It is possibly slap cheek. Typically when slap cheek comes around it spreads quickly, so we will watch and see.

I have a few kids with vomiting that moves to diarrhea and lasts for a few days.

There were lots of kids with conjunctivitis. About half of those have a sinus infection or ear infection to go with it.

Good hand washing folks!!!!
Judy

Monday update November 19th

There a lots of little moderate illnesses floating around. No one is ill enough to cause me any worry.
I am still seeing croup.

I have several kids who have had a day or two of vomiting along with a low grade fever.

Some of these kids have had red cheeks, I am keeping my eye on this. It has been awhile since we had an out break of slap cheek. If I start to see more of it I will blog more about it.

There are lots of little coughs and colds around.

Our office will be closed for Thursday and Friday this week for the Thanksgiving holiday.

If needed, patients can be seen in the Pediatric after hours clinic. 387-9293

Happy Holidays!
Judy

Travel tips

We are approaching the time of year when many of my patients will be traveling.
I am commonly asked the question, “when is my baby old enough to fly?”
There are so many different factors to consider that there is no one simple answer.

I have some families with babies who are adopted or born to a surrogate out of state. These young infants often fly within the first week or so of life just to come home.

Other folks make the valid choice to fly way earlier that we are really comfortable with in order to see an aging relative or deal with a family crisis.
In ordinary circumstances I would prefer to have the babies wait until they are over 2 months of age and have had their first set of immunizations. ( that first shot does NOT give full protection against some serious illnesses, but it is a start)

The size of the baby as well as the time of year are also factors. If there is some kind of crazy flu epidemic I would think long and hard before taking a young baby on a plane.

BEFORE YOU LEAVE:
I get calls from all over planet from parents who are dealing with a sick child during their trip.
Before you leave home, check with your insurance company to see what the best method is for having out of state or international doctor visits covered. Some plans are way easier to deal with than others.
You also need to figure out what your actual options are. Is there an urgent care facility near by? Do you have a friend or relative with a pediatrician who is willing to see patients who are not in their practice? Does your insurance only cover an emergency room visit?

Hopefully you won’t need to use this info, but if you are dealing with a sick child away from home it is nice to have “Plan B” in place

SURVIVING THE FLIGHT:
A few months ago I sat next to a mom with a very young baby. She was so worried about the possibility of getting evil looks from the other passengers that she had actually brought ear plugs to hand out to the people sitting around her. What she Didn’t have was anything to soothe her baby. Please always make sure that you have Tylenol or Motrin with you on the plane ( Not packed away in your suitcase) It is okay to bring small bottles through security.
I don’t tend to give it ahead of time, but I am quick to medicate during the first sign of fussiness.
I often get questions about the use of Benedryl.
Benedryl is nice option for a child who is over 8 months with a long flight ahead. It helps dry up any congestion and makes 90% of kids who take it deliciously sleepy.
Aha, but what about the other 10% you might ask? It turns those little darlings into hyperactive, wild hooligans. You do NOT want to find out on the plane that you are the parent of the 10%.

You may want to give a test dose a few days prior to the trip to make sure it is a viable option for you.
I like parents to have the tools with them to deal with an unhappy child. Don’t give any medication unless it is necessary.

Many babies and children can have trouble with their ears . For the younger ones, try to nurse or have them feeding during take off and landing. Sucking on a pacifier may be helpful as well.
Have a lollipop or chewing gum for older kids.
Ayr saline gel is a nice thing to have along. A dab at the base of the nostrils can moisturize the dry air and make the breathing easier ( use it for yourselves as well)
If you have a child with a history of ear trouble, have some of the little gel heat packs in your bag. You can activate them as needed and the warmth feels great to a sore ear.

Take WAY more diapers with you than you think you need for the trip. I was on another flight not too long ago when we sat on the tarmac for 3 hours. There was an unfortunate family behind me who had planned on a short little trip and was out of diapers long before we took off. It wasn’t pretty. Plan accordingly.
Many folks automatically bring a change of clothes for their baby. It is also worth bringing an extra outfit for yourself. If you have a long flight ahead of you with a child on your lap, it may come in handy.
I learned that one the hard way and sat for several hours covered with poop.

Changing your baby on the plane can be a challenge. It is helpful to have little changing packs, with a diaper and some wipes, in individual zip lock bags. This will prevent you from having to take the entire bulky diaper bag with you into the tiny bathroom.

You can’t count on airlines giving you any reasonable snacks, so it is important to bring along enough provisions to count on delays.
For older kids make sure you have little activities to keep them busy.
If you are visiting family, print out a bunch of photos of the people you are going to see. You can use these for all sorts of art projects on the plane. Make a paper doll family! This can help your kids recognize folks that they don’t see too much of.

Once you get to where you are going, make sure the place is adequately child proofed (this is also a discussion that it is worth having with your hosts before you get there).
I had one situation just last year, where a 3 year old opened a drawer and got into grandma and grandpa’s medications.
Is there a pet where you are going?
Make sure that any dogs are safe with children.

If you are staying in a vacation home, do a quick safety check. Do they have smoke working smoke detectors?





Time zones are tricky.
My best suggestion is eat when you are hungry, sleep when you are tired and just do your best.

Even the best sleepers may have a period of needing a sleep training tune up when you get home.

You can have lots of fun while you are away and it is wonderful to see family, but in my opinion, if you are traveling with children under the age of seven, don’t call it a vacation. It’s not. It is a TRIP. (We used to call our visits to the various grandparents the “bad bed tour”)

A little preparation goes a long way, so have safe travels, make great memories and remember that some of the roughest times make for the best stories!

Happy Thanksgiving!
Judy

November 12th update plus random info

I received a question about an earlier post asking about contagiousness from the hand/ foot/ mouth rash.

My best guess is that someone with a revisit of the rash is not terribly contagious.
In general our guidelines for hand/ foot/ mouth are to keep the kids home with you if they have a fever or if they are miserable from a lot of mouth sores.
If they seem well and happy, even if they have a rash, we don't bother to isolate them.
Chances are they were spreading this virus around the day before they showed any symptoms.
That being said, Please to be kind to any newborns or folks with a compromised immune system and try to keep your child away from them until they are all clear.

This week the viral rashes continue and we have had multitudes of kids in here with all sorts of rashes and splotches.

I am still seeing croup.

I have several kids with diarrhea ( this is lasting for about 3 days) Many of the kids are getting diaper rashes with this.
If you baby has loose stools try to give them as much air as possible.
Blue pee pee pads from the pet store are a nice resource to avoid a mess.

Calmoseptine ointment is a good barrier cream for this. Probiotics are very helpful.

I have a bunch of kids out there with moderate fevers that have been on and off for 3 to 4 days and then they are gone.
This is likely viral. The kids don't seem all that miserable.

In a nutshell, my rule about fevers is as follows.
I am much more concerned about a miserable lethargic or super fussy child with no fever than I am about the singing kid that has 104. It isn't just about the number, BUT if I have a child with the temp over 102, I want you to treat with appropriate doses of tylenol or Motrin, get them sponged down, give them fluids etc.
Re measure the temp in an hour and if it is still over 102...that is a fever that needs to be evaluated.

Stay well
Judy



Now onto the random info.

Next solid food class will be held November 21st. I have the one after that scheduled in January.


Emergency Preparedness

With the recent Hurricane in the East Coast it brings to mind that we all need to be prepared for emergency
I came across a great little blog with a very good entry about dealing with earthquake preparation..
www.dealtrackersf.com search earthquake

Great little place for visitors or grandparents

A great garden studio apartment, perfect for your visiting friends and relatives. Private, quiet and convenient. Sit and relax in the garden or explore the neighborhood. Just ½ block from Dolores Park and MUNI and a walk to all the great fun, shopping, bars and restaurants in Noe Valley, the Mission and the Castro.



Comfy queen bed

Wi-Fi; Cable TV

Bath with shower/tub

Fully equipped kitchen

Washer/dryer

$95/night, 3 night minimum.

For more info contact:

mjs@mjsimonlaw.com



______________

viral rash

I wanted to add that I am seeing lots of rashes. Interestingly several of the patients who recently had hand foot and mouth virus and were doing fine, seem to have some of the spots coming back. Some viruses indeed to take months to be completely out of our systems. Most of these cases are very mild.
Judy

November 6th update/ safety class this week

It doesn't seem quite as frantic this week.
We still have lots and lots of kids and families with the cough and cold.This has started with several days of low grade fevers. Once the fevers are gone, the dry cough hangs on for a few weeks.
I wish I had a magic wand for this. I would have the well family members take Zinc and Sambuccol lozenges to try to keep themselves healthy. I think those both work pretty well, but seem to be better at preventing than fixing.
Humidifiers at night are useful, but mostly this is one that time will fix. If we have fevers roaring back once they have been gone, or any labored breathing, please give a call.

Last week most of our sore throats were positive for strep, So far all tests this week have been negative.

I am seeing lots of little rashes and bug bites, I am sure that this gorgeous weather has something to do with that.

Do take your kids to the polls tomorrow and let them see you voting!!!

I have space available in my safety class on Wednesday evening. This class deals with basic first aid, head injuries, burns, poison, child proofing and choking rescue.
RSVP is required but you can sign up through the website www.nursejudy.com if you are interested.
Stay well
Judy

October 29th update

We are super busy in here today.

There are lots of coughs and colds around. The coughs are lingering for weeks. Many of my parents are ill with this one.

We are seeing lots of croup.
Most kids will be okay with steam and some outside air.
If you child still has air hunger after a good dose of steam, then you do want to take them over to the ER. We have had a handful of kids who have needed a shot of steroids to calm things down.

I have lots of kids with fevers that are lasting 4-5 days. The kids do NOT look too sick.
At day 5 I will be bringing them in for an evaluation if the fever hasn't gone.

There are quite a few cases of diarrhea starting up.

We had a few cases of strep throat reported through the weekend clinic.

Safe trick or treating out there!!

Judy

and rainy season is here...

We are loaded with sick kids and families this week.

The biggest complaint I dealt with today is a cough and cold. This viral syndrome has started with a mild fever ( 101 ish) for a few days. The fever goes away, but the cough has been lingering for several weeks.

I have had lots of croup out there as well.

There are reports that RSV is here in the community.
RSV stands for respiratory syncitial virus and it is your basic NASTY cold and cough. The cough has a harsh barky quality to it and there is plenty of congestion as well.

Last week we had lots of kids with vomiting and diarrhea, That seems a bit quieter this week so far.

We have lots of odd blotchy rashes. Most of these are likely viral. If the rash comes along with a fever check in with us.

There were lots of Pink eye cases today. Younger kids with goopy eyes often have ear infections, so if they are pre verbal and fussy, I will likely want to take a look.

I have one child with mouth sores and a blotchy rash. Hand/ foot / mouth has been quiet lately, but I will let you know if more cases start showing up.

Stay well
Judy

Drop In Flu Clinic TODAY 9:30-12:30

If you can make it, we are in the office NOW giving flu vaccines to Noe Valley Peds patients and their families. No appointment necessary, just drop in between now and 12:30 for your flu shot/mist.
If you can't make it in today, our regular flu vaccine hours are Tues/Wed/Thurs between 10-11:30 and 2-4pm. Just call the office (641-1019) the morning of the day you'd like to come in (we open at 9am and have a limited number of appointments for vaccines.)
Hope to see all of you for vaccines soon.

Vomiting, Croup and Elmo

We have been talking with a lot of parents caring for kids with vomiting and diarrhea! Some with fever, some without. Remember to monitor for dehydration (dry lips and mouth, infrequent urination, low energy.) A dehydrated kid is not happy and playful - but if you are unsure give a call and we can discuss.

There are also a lot of croupy coughs out there. Remember, the first few nights are always the worst! But if your child is having difficulty breathing - usually a few minutes in the cooler night air will help. Some kids have had to be evaluated at the ER, so don't hesitate to call the advice line if you think your child is having trouble breathing.

Finally, there is a warning about a SF sighting of a man dressed as Elmo who is known to shout obscenities and anti-Semitic remarks. He is well known in New York and was reported in Rossi Park last Saturday. Read the following link and please call the non-emergency police line if you see him. This is a useful phone # to have programmed in your cell phones!


http://blog.sfgate.com/parenting/2012/10/15/elmo/

SF Non-Emergency Situations - 415-553-0123

Judy is back next week!
Jennifer

October 8th update

We still have quite a few patients with a high fever/ congestion illness. This has been lasting 4-5 days. Many of the parents have been quite miserable with this as well.
So far, although it seems quite flu like, it is NOT testing positive for the real deal Influenza.

We have some cases of strep throat, but most of the sore throats out there are testing negative. ( and sore throats abound!!!)
For the patients over one year of age, I do really like Honey Loquat syrup ( you can get it from whole foods) It is very soothing. For the older kids, gargling with salt water is also very useful.

I am still seeing lots of blotchy rashes and bug bites.

I am seeing a few patients with loose stools.

Last week I had a few cases of croup. (The kids wake up during the night with a seal like, barky cough)

If you are still not protected for the upcoming season, We do have our drop in flu shot clinic scheduled on October 20th 9:30-12:30 for our patients and families.

Stay well,

Judy

October already?

There is a pretty high fever making the rounds. Many of the kids have some coughs and congestion with this. The fever is hanging on for four or five days in some cases.
Please check in with us for any fever lasting 3 days or longer.


I also have quite a few cases of pretty severe wheezing. One of our patients had such a rough time getting clear that she was admitted.
Any time you have a child who is struggling with their breathing I especially want to have them looked at.


We have all sorts of blotchy rashes, Some seem to be bites, others may be part of a virus.
For those of you who have not taken my illness class, Here is a review of Nurse Judy's Rash Rules..

Rashes fall into one of two categories.
Rashes I am worried about vs rashes I am curious about.
I am worried if we have a child who seems ill, if the rash comes along with a high fever, if the rash is purplish and doesn't get lighter when pressed, or if the rash is oozy and crusty.

All of those need an appointment. (A purplish rash that comes with a fever could be a sign of meningitis and needs Urgent attention. These kids will appear very ill.)

All of the other blotchy, spotty rashes out there make us curious.
They could be viral, or bites, or food related, or a new detergent.
Feel free to give us a call or send us a photo, but more often than not we will take the wait and see approach and only see you in the office if things are getting worse, your child is bothered by the rash, or it seems really stuck.

I still do not have any documented cases of influenza yet.
We will be doing another flu shot clinic on October 20th in the morning.

I still have some spots in my solid foods class on Wednesday evening.

Enjoy this warm weather while it lasts

judy

Weekly update September 24th

We had quite a few folks in here for our flu clinic on Saturday.
We will be doing it again on Saturday morning October 20th from 9:30-12:30
I have been seeing a fussy/ fever reaction in about 20% of the patients. This is usually resolved by the following day. It is actually an immune response that lets us know that the shot is working!

Hand Foot Mouth is still going around. Most of the kids are not terribly ill with it this week, but have the spots on feet, hands, butt and around the mouth.

I have seen tons of diarrhea out there.
Some of the cases seem to be food related, but I think there is a virus out there as well.
Food poisoning usually is accompanied by chills, body aches, fever as well as diarrhea and/ or vomiting.

There are lots of coughs and colds. Many of our kids with sensitive airways are pretty reactive and are wheezing. If your child has a nebulizer this is a good time to make sure you have some fresh tubing and medications on hand before we are hit with the Winter ailments. Call if you need refills!!

I do have some kids with high fevers and congestion, so far they have NOT been positive for influenza. This virus seems to be lasting about 4 days.

We have seen several cases of strep throat.


Nurse Judy Class update:
My next solid foods class will be held Wednesday evening October 3rd at 7:30pm
full class info can be found at www.nursejudy.com

hand foot mouth is back

I realize that hand foot mouth didn't make the list earlier this week.
Unfortunately this afternoon I have been fielding call after call about it.
It seems to be going through quite a few day cares out there.
Some of the kids have very spotty butts and seem reasonably well otherwise,
Some poor kids seem to be having a lot of mouth pain and are quite miserable.

Time fixes this virus. Your goal is to keep your little one hydrated.
A dehydrated child will have very low energy, decreased urine output and not a lot of tears or drool. They seem dry and droopy.

If you are worried about hydration do make sure to get them seen right away.
If your child is running around, has normal activity level, and reasonably wet diapers, then I am not concerned.

Keeping them comfortable is the best way to get them drinking. Even if they have no fever, it is appropriate to dose them up with tylenol or Ibuprofen ( motrin/advil).
Tylenol comes in a suppository form if they are resistant to taking medicine by mouth.

For older kids with mouth sores 1/2 teaspoon of benedryl mixed with 1/2 teaspoon of maalox..squirted around the mouth every 4-6 hours brings some good relief.

Most of the kids with the mouth sores do much better with cool, creamy foods. Avoid tangy things like orange juice that might sting.

Check out past posts for more info about the virus.

I will check back in next week

Judy

Update September 18th

We are seeing a little bit of everything.
Mostly the garden variety back to school illnesses abound.

There are lots of coughs, colds with fevers. Plenty of these have been turning into ear infections.

There are lots of kids with sore throats.
Less than half of these have been positive for strep.

There is a vomiting/ diarrhea illness that lasts for a couple of days..

There is active pertussis out there in the community.

I have had LOTS of head lice calls, Check those heads!

We have NOT seen positive tests for Influenza or RSV yet.

Remember that we do have our drop in FLU shot clinic on Saturday the 22nd from 9:30-12:30 here in the office. ( for our Noe Valley Pediatrics patients and families only)
Stay well, enjoy the last bits of summer
Judy

General update 9/11

There are a lot of illnesses out there.

We are seeing a fever/cough that has been lasting about 4 days. The fever has been less than 102.

There are quite a few patients with nausea/vomiting. (some have a low fever), once the vomiting subsides along come the loose stools that hang on for 3-5 days.

There are lots of coughing kids around, some wheezing

Strep throat is around as well.


After a fairly quiet summer I am getting lots of calls about head lice.
We do have a fairly comprehensive head lice treatment guide that we will be happy to email you, but there is also a new prescription lice treatment out there called sklice if our plan A doesn't work.

It is also heavy tick season.
If you are out in any wooded areas please check yourselves and children from head to toe for ticks.

West Nile Virus is on the horizon.
Make sure there is no standing water around your house, and make sure your windows are screened!

FLU is not here yet, but we are busily getting folks protected. We will be having a drop in Flu shot clinic on Saturday September 22nd from 9:30 am-12:30pm
Please refer to earlier posts for more details.

Judy

September 4th Weekly update

School has started and we are seeing a big upswing in the number of illnesses out there.
Here is what seems to be going around




We are seeing some croup ( barky cough at night, mostly okay during the day)
This typically lasts 3 days. Lots of fluids during the day and a humidifier at night are your best bets. If your child seems to be having labored breathing..Sit inside a steamy bathroom for a while, if not clearing head to the ER, the night air often helps a lot and more often that not they are much better before you get there.

There are lots of coughs and colds out there. Many of our kids who have a tendency to get wheezy are having a little flare up.

There seem to be quite a few kids with conjunctivitis.

I have seen quite a few kids with fairly intense vomiting that lasted for less than a day and then was gone. This was NOT associated with diarrhea or fever. it remains a mystery but all the kids are fine now.

We also have had a few cases of diarrhea

There is some strep throat out there. Some of the cases are Strep G that is not picked up by the quick test in the office. ( strep G can be treated with antibiotics if your child feels lousy, but it will go away on its own. We don't feel compelled to treat it the same we we do the Group A strep)


FLU SHOT UPDATE.
We currently have all forms of the vaccine in stock.
Call to make an appointment to get the shot, or come by our drop in flu clinic on September 22nd from 9:30-12:30 ( this is for Noe Valley Pediatrics families only)

Stay well!

Judy

August 27th Monday update/ illness class

There are 2 spots left in my August 29th illness class.More info at WWW.nursejudy.com if you are interested in attending.

This is the kind of day where kids are eating the hand sanitizer and sticking paper up their nose, but in terms of illnesses the biggest culprits are....

*Tummy Bug

I have many kids out there with several days of on and off vomiting and diarrhea. Most of the kids are not appearing too sick with this, but they have very sensitive tummies for a few days.
Get the probiotics started, do the BRAT diet and watch the hydration.
Check out past blogs for more detailed management.

*Coughs and colds

We have lots and lots of kids with coughs and colds. It is not unusual for colds to linger for a week to 10 days.

*Mystery fevers

I have a few kids with fairly high fevers just starting. I want to see anybody with a fever that is lasting more than 3 days


FLU SHOTS:

We are giving flu shots Tuesday Wednesday and Thursday
Morning 10-11:30
Afternoon 2-3:45

There is a limit to how many patients we can manage in each time slot.
In an effort to take care of the flu shot needs without negatively impacting our patient flow, we are not doing drop in shots this year. Please call ahead for an appointment.
Stay well!!
Judy

Flu shot update

We currently have in stock and ready to give:

*the preservative free baby flu vaccine ( 6 months-36 months)

*Flu mist ( 2 and over...but don't kid yourself. 2 year olds do NOT like to have something squirted in their nose, some times the shot is easier)
Flu mist is a live vaccine.

*Regular flu shots for anyone over three ( this is NOT preservative free, the amount of thimerisol in these is not a concern unless you are pregnant)

We should be getting preservative free flu vaccine for the over three year old crowd in the beginning of September


The first year that a child under the age of 9 gets the flu vaccines, they need 2 doses within the same season to give full protection.
Once they have had a year with 2 shots, they should only need one for future years.
The 2 doses need to be at least 4 weeks apart, ( it is okay if it is a little longer than that)

I am getting reports from parents that this years flu vaccine has packed a bit of a wallop. About a quarter of our babies have had an extremely fussy night after the shot. Some have had low grade fevers.
This reaction has NOT lasted for more than a day or two.

We will be holding a drop in Flu Shot clinic here in the office on Saturday morning September 22nd from 9:30-12:30
This will be for patients and family members.
Cost for parents is $35/shot. We do not bill your insurance. You may find it cheaper to do it elsewhere, but for convenience we are happy to vaccinate you ( and we give cute band aids)
if the demand exists we may do another weekend shot clinic in October.

Once the season is in full swing I will keep you undated on "drop in" flu shot hours during the week.

Stay well, I hope that this coming flu season is a "non Event" but sometimes they are quite horrid and scary ( remember H1N1) I do suggest getting the protection. It is worth a fussy night.

Judy

Monday update August 20th

It is hard to believe that school is starting already. It seems so early this year.

We are seeing lots of kids with fevers. One of the cases just ended it with a rash (typical roseola), it is too early to tell what the others will end up doing.

We have several patients with odd rashes.
Poison Oak is pretty active right now, so pay attention if you have been hiking.

I still have a few patients showing up with Hand/Foot/mouth virus. Typically this is a childhood illness but there are a few unfortunate parents out there who are getting it as well.

We have lots of coughs and colds. More of the coughs are starting to get wheezy.

Wishing everyone a healthy and happy start to the school year!!

Judy

Monday update August 13th

We are extremely busy in here with our well child checkups. Thankfully the illnesses have been pretty quiet.
Here is what I am seeing

* mild croup

*mild diarrhea

*all sorts of odd rashes

*a handful of kids who are active and running around, but have fevers around 101

With school starting soon and then end of summer approaching, I do have an illness class scheduled August 29th.
If you ever ask questions like, "when should I be worried about a fever?" then this is the class for you.

full class info can be obtained at WWW.nursejudy.com

Enjoy the last bits of summer

Judy

August 6th. Monday update

Our illness list today includes
*diarrhea ( some of the cases have been lasting as long as 10 days or so)


* Rashes and hives ( as long as these are not associated with a new medication or food, they are likely part of a viral syndrome)


*Hand foot mouth ( yes...it is still out there)


*Strep throat ( some of our in office tests have been negative. Our tests only are sensitive for Group A strep..follow up cultures that have been sent to the lab have been positive for other strains)

*Lots of kids are coughing ( not a lot of wheezing)


We got our first doses of the baby flu shots ( for the under 3 year old kids)
Babies can get the shot when they turn 6 months old. The first year of getting the vaccine requires 2 shots a month apart to achieve full protection.
We expect to get the rest of our flu vaccines later in the month. This season the shots will be protecting against 2 new strains, plus the H1N1.

For any parents out there with special need kids who are worried about back to school transition, there is a free workshop on August 15th from 6-7:30 pm at 36A Monterey Blvd.
Email marie-laure@gatewaylg.com to reserve a spot

For all of our back to school kids, remember that a Tdap booster is required for entry to 7th grade

Stay well
Nurse Judy

Monday Update July 30th

Dr Hurd worked in the weekend clinic and reports that she saw tons of strep throat. We continue to have more cases in the office today. These kids generally present with sore throats, swollen glands, fever and stinky breath. They may also have body aches, dizziness, headaches and rashiness. If you are suspicious, it is worth an office visit. Strep throat is an illness that we do want to treat with antibiotics. We are also still seeing hand food mouth virus. This illness has several strains associated with it (which is why you can get it more than once) The strain that we are seeing in this country is one of the mild ones that is not a significant public health concern, but it is an annoyance. We are seeing some kids with a mild tummy bug and lots of little summer time colds and coughs. Believe it or not, we should be getting our first doses of flu vaccine next month. They are predicting a few new strains of the illness this coming year. This season's flu shot will cover several of the new strains. we will likely hold some weekend flu shot clinics and extra drop in times for the shots. I will absolutely be using the blog to keep you up to date with that. For all of the breastfeeding moms out there, Nurse Charity will be holding her first ever Breast feeding and Latch clinic this Saturday August 4th. It will be here in the office. Come anytime from 10:30 am until noon. $20/person. Drop ins are welcome. If you want a little help with your latch or want some breast feeding guidance, come on by. Judy

Monday July 23rd update

There is a tummy bug making the rounds. Some parents complain that they have gotten this illness as well. It has cleared up within 2 or 3 days. Some of the kids have rashes and fevers with it. I have had some patients with several days of fevers, cold, cough, sore throat. This seems mostly viral and also has cleared within 4 days ( the cough lingers a bit longer) I have one patient with a rash that is consistent with Slap cheek. Typically when I see one, there are many more to follow, but I will let you know. Stay well, Nurse Judy

Monday update July 16th

The most prevalent illness we dealt with today is croup. We are seeing lots of coughs with fevers. I also have some possible cases of Roseola out there. Those are the mystery high fevers with the not so sick kids that end up with a rash once the fever goes away. We have had quite a few kids with burns from the BBQ. PLEASE be careful about that. We have had lots of seasonal bug bites as well as ticks. If you are doing any camping or hiking you may want to have a tick removal tool with you ( that you can get from any sporting goods store) I recommend doing a head to toe check ( including the hair) after any woody or grassy outing. We have been having very full schedules in here. If you have any last minute checkups for back to school or camp forms please call sooner than later to get those appointments set up. Stay well Judy

solid foods class

I have a solid foods class scheduled for Wednesday July 25th at 7:30 pm Full class info and schedule for all of my classes can be found at my updated website www.nursejudy.com

Monday update July 9th

Having just been back in the sweltering east coast, I am happy to see our fog. The illness front has been mild to moderate. We still have some cases of hand-foot-mouth floating around. We also have quite a few folks with several days of high fever, congestion, sore throats and loose stools ( the whole viral package) Most of the kids with sore throats have NOT been strep throat this week. I have had a handful of patients with a fairly mild tummy bug. There are quite a few kids with all sorts of bug bites and rashes. Stay well Judy

Monday update June 25th

There is a little bit of everything going around. We have continued to have kids with a tummy bug. This one has vomiting, diarrhea and a bit of a fever. It has lasted several days. Some adults have gotten this bug. I have quite a few kids with coughs, colds and ear infections. There are some kids with random rashes. We have heard about several cases of chicken pox out in the community. We have several of our older patients with a flu like illness that has high fevers and coughs. I will be in the East coast during the next week, but If there is anything exciting floating around the neighborhood, I will have Charity or Jen chime in here with an update. Stay well Judy

tummy bug alert

We are still not seeing an alarming volume of ill kids, but I have spoken to quite a few folks who are dealing with a diarrhea/ vomiting/ fever bug that seems to be starting up. It is too soon to tell how long it lasts, although some folks cleared within a day or so. With any vomiting/ diarrhea situation our main focus is keeping the kids ( and any unfortunate parents who may catch it) hydrated. Someone who is dehydrated will present with significant low energy and decreased urine output. In other words, if your little one is running around playing, then I am not too concerned. Get fluids in with small frequent amounts of breast milk or clear fluids. Pedialyte is great if you can get them to take it ( it tastes a bit like soap.) If they are losing a good bit of fluids from vomiting and diarrhea, they are losing some electrolytes as well, so we don't want to replace with plain water. Coconut water is a good option as well. Once they are keeping fluids down, move the diet along to small amounts of bland starchy foods. I avoid dairy ( except for the magic breast milk or yogurt) until the stools are back to normal. I also have found probiotics VERY useful. If anything seems to be lasting for more than a few days or you are worried about hydration, please check in. Stay well, Judy

Monday update June 18th

Nothing much new and exciting today. I spent much of the morning on routine sleep and feeding questions rather than illness calls. I have a handful of kids out there with fevers and a few still showing up with hand- foot- mouth. There is some strep throat around. Summer check ups are in full swing. If you need one and aren't scheduled yet, make sure you call for an appointment. I just updated my nurse Judy class summer calendar which can be seen on my website www.nursejudy.net I am going to do a bit of a trial with facebook. (it might not work and it may make me nuts, but......) If you are interested and are a facebook user, you can "friend" nursejudynvp. I will be posting all the classes, interesting links...and who knows what else. Stay well Judy

Monday update June 11th

We are seeing a hodge podge of all sorts of stuff. Whenever the thermostat gets up there I know the heat rash calls are going to come in, and today didn't disappoint, I saw all kinds of rashes out there. The warm weather makes them all worse. Hand foot mouth isn't showing any signs of fading away. I am still talking to many new cases. Most of the kids have very mild forms of it, but the rashes come and go for a few weeks before they are done with it. I have seen lots and lots of kids with a fairly common cold, cough and fever. The fever has been lingering for about 4 days and is low grade. Any fever that lasts longer than that needs to be seen. Beware Beware the tummy bug is back. Mostly afflicted have been our older kids who are showing up with vomiting, diarrhea and tummy aches. This has lasted for several days. I have spoken today with more than one case of likely pin worms ( I know...yuck). If your child is waking up during the night with complains of Itchy or painful butt or vagina..pin worms are the likely culprit. Our schedule in the office has been very full. We struggle with trying to fit all the checkups and new born visits in while still keeping appointments open for your acute care needs. Please call as soon as possible to schedule any check ups. For the younger kids, it is always a good idea to make your next check up appointment when you are leaving the office and that way you will get a choice of times. For those of you who are having a tough time getting something set up I do appreciate your patience. If you have an issue that can't wait, give me a call and I can try to fit something in or schedule an acute care visit sooner. For those of you who saw the recent news story on vaccine storage. I am happy to report that we are in full compliance with the industry standards and check our Fridge temps twice daily Enjoy this weather while it lasts...hydrate..sunscreen etc Judy

New Class scheduled/surviving the first 3 months

I have a new class scheduled for June 23rd at 10:00 am. This class is geared to new or expectant parents. It will deal with many of the routine issues that you may face with your newborn. This will include colic, diaper rash, infant acne, cord care, blocked tear ducts, cradle cap...etc etc. The classes are $20/person sliding scale, but this class is $30/couple. To hold a spot or if you have any questions about the class email nursejudynvp@yahoo,com ( The website won't have much info about it until I can get my web master kid to get on there and update it) Judy

Monday update June 4th 2012

We are loaded with Well Child appointments. Some of the Doctors are booked until August. Please call ASAP to schedule summer check ups so that we can try to accommodate your needs. I have seen an absolute upsurge in Hand Foot Mouth cases. Most of the kids have rashes on other body parts as well as the hands and feet. If you check out earlier blog entries about this virus you may get most of your questions answered. We have seen quite a few sore throats today. Half of them were positive for strep throat. We are seeing a normal amount of coughs/ colds and ear infections. Stay well, Judy

We were hopping in here today following the 3 day weekend. I am seeing lots of kids with fevers that have been lasting about 3 days. many of these have been followed by a rash once the fever is gone. We are seeing lots of kids with colds, coughs and ear infections. I still have a few kids with the remnant of hand foot mouth virus. Nothing much else to report. Have a healthy week. Judy

Monday update May 21st

We saw way more well child check ups than sick visits today, so perhaps we are moving away from the Winter illness season. We are having a lot of allergy complaints. There are plenty of folks with congestion, mild coughs and gooey eyes. We had several positive strep throat tests today. I have a few kids out there with a moderate fever that has been lasting four days. If there is a fever lasting for more than 3 days with a fussy kid then I absolutely want them checked out. IF however, they are consolable, eating and sleeping well and seem to be dealing this this, I am okay watching them for a few more days ( especially if it is early in the week) Stay well Judy

Flu update/ nurse judy classes

We have seen some confirmed cases of Influenza type B in the office. There are reports of one school where as many as 40 of the children have had this recently. Our patients are presenting with aches, low energy, fevers 102-103, sore throats and some congestion. The worst of it has only lasted about 3 days. I do not believe that this particular strain was covered by a flu shot. It is a little unusual to be seeing this so late in the season. I will keep you informed it the situation becomes more interesting I have scheduled my next several classes. June 9th 10Am Saturday morning is the Safety Class. This class includes, head injury, burns, poisons, pet safety, child proofing, choking rescue. June 13th 7:30 pm Wednesday evening is the Illness class. This class gives guidelines for when to worry about an illness, We review coughs, colds, tummy bugs, fevers, rashes common viral illnesses, etc etc etc. June 20th 7:30 pm is the Solid foods class. This class answers any questions about feeding your child, how to start, nutritional info, changes in bowel movements, how to read a growth chart etc etc etc. classes are $20/person small groups, RSVP needed nursejudynvp@yahoo.com or www.nursejudy.net There seems to be a new format with the blog spot..I am still getting used to it so forgive the jumbled look of the posts. I also just saw and old comment with a question about slap cheek. You can see the response by clicking on comments

Monday update May 14th 2012

I hope that all the mom's out there had a nice mother's day. We are seeing an increase in coughs and colds this week. I am seeing quite a bit of wheezing. Allergies are flaring and we have lots of conjunctivitis out there. For kids over one, It is worth seeing if claritin/ bendryl or Zyrtec help clear up the eyes. If an antihistamine helps then we are likely dealing with an allergic issue and anti bacterial eye drops are probably not necessary. With kids under one, many times goopy eyes come as a package along with an ear infection, so if they are fussy we probably want to take a look at them in the office. We have some kids with several days of moderate fevers, some positive strep throats and still some cases of Hand Foot mouth hanging around. Stay well Judy

Monday update may 7th/free car seat check

I hope all of you are enjoying the nice stretch of weather. Of course when that thermostat goes above 75 degrees, I know I am going to get calls about rashes. I have seen several types of rashes today. *Straight forward heat rash has the kids looking pretty rashy all over. It calms down within 24 hours once they have have been inside and cooled down. * Viral rashes, these come with or without fevers. I am still seeing hand foot mouth. As I mentioned last week some of the blisters are lasting several weeks. The kids have not been all that miserable. I am seeing a few cases of Slap cheek as well. *Eczema tends to flare up when kids are gorging on all these wonderful berries. This will be a dry red patchy rash that especially loves the insides of the elbows and the area behind the knees. The area right by the anus is often very red. We are seeing plenty of coughs and colds. There are a few cases of strep throat. I have heard reports that there may an odd strain of summer flu heading this way, but I haven't seen it. The city is offering a free child safety seat workshop to the first 25 folks who call. 581-2445 if you are interested. As your child grows it is always a great idea to have someone who knows what they are doing, check and make sure you are using the care seat correctly. stay Well, Judy

Monday update April 30th

The phones are non stop and the appointments are booking up very early in the day. That being said, most of the illnesses are mild to moderate...nothing too scary out there. I am seeing the remnants of hand foot mouth. Those blisters are hanging on for a while. We are giving kids the all clear to return to day care and school if they are fever free and feeling reasonably happy. I may have spoken to someone today with a baby with slap cheek. That is another seasonal that comes along in the spring. Usually when I start seeing it it comes in waves. I will update if I start seeing more or it. We are seeing plenty of coughs and colds. There have been a few cases of roseola or similar virus syndromes ( that is the several days of high fever...okay looking child, then the fever goes down, out comes a rash all over the body and the kids are crabby) I am seeing quite a few cases of conjunctivitis, as I mentioned last week most of those are going away on their own. Half of the time when we have a fussy child with gooey eyes they also have ear infections, so that is something to keep in mind. Stay well, Judy

Getting rid of expired medication

This Saturday, April 28th, from 10am to 2pm, is National Prescription Drug Take-Back day , where collection sites around the country will be collecting and safely disposing of EXPIRED OR UNUSED MEDICATIONS. This is our chance! You can find collection sites and more information through this link: http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html (it looks like a few police stations, including the Mission and Ingleside Police Stations, are the sites in SF.). Please help keep old medications from contaminating groundwater by taking advantage of this opportunity for safe disposal! According to the Recology/ sunset scavenger web site several pharmacies will also accept your unwanted or expired ( non controlled) medications on an ongoing basis.. www.sunsetscavenger.com/hazardouswastemedications.html

Monday Update April 23rd

We are still seeing lots of hand foot mouth. ( It gets top billing for the week) Some of my patients are starting off with a fever and some vomiting for a day or so before the spots come out. Some of the lesions are hanging on for more than a week. We consider the kids okay to return to school or daycare once they are fever free for over 24 hours and feeling okay. If they are utterly miserable and not eating much, I would rather they stay home(even if they are fever free). If they are happy as can be and seem well except for lingering blisters...send them to day care. One of my loyal blog readers suggested that I refer any further questions about hand foot mouth to a lengthy post about it back in October 2011 ( check the archives) We have seen an upsurge in conjunctivitis this week. It may be from allergies. Some of the cases have resolved without the use of eye drops. If the discharge from the eye is really green and yellow then it is more likely that the drops are necessary. We have seen a normal amount of ear infections, a few kids with diarrhea, typical coughs and colds and a bit of a flare up in my wheezers ( also possibly from the warm weather and high pollen count). Of course when the weather hits the 80s we see plenty of cases of heat rash.. With the warm weather we have also seen a few tick bites.. Make sure you check your kids head to toe ( including the hair and ears) after any hiking expeditions. Check car seats as well. We are starting to fill up with check ups. If your child is due for their annual exam or has any camp forms that need to be filled out, do yourself a favor and call well in advance so that you can be assured of a convenient slot with your primary doctor. Stay well Judy

lots of hand foot mouth

I didn't add hand foot mouth to yesterday's post and it certainly deserves a mention.
It is actually making the news this week with word that a nastier than usual strain is floating around.
Most of our patients who have it are dealing well with fairly moderate cases( not to say they aren't miserable..but they are avoiding the need to go to the ER)
The cases we are seeing have LOTS of spots on the butt, scattered blisters on feet and hands ( sometimes elsewhere on the body), fevers and mouth sores.
Sometimes we can't easily see the mouth sores, but the kids are fussy and don't want to eat normally. It is worth taking a look in the mouth to see what's what.
Fussy kids may need round the clock tylenol/ advil to keep them comfortable enough to stay hydrated. For those refusing oral meds, a tylenol suppository comes in very handy.
Cool creamy and soft foods are generally tolerated the best.
For kids over a year 1/2 teaspoon of benedryl mixed with 1/2 teaspoon Maalox squirted in the mouth( okay to swallow) is helpful for mouth pain.
Glyoxide is also great for any mouth lesions ( OTC from any drugstore)

Oatmeal baths and calamine lotion are fine to do as well.
Feel free to call me if you are worried about your child...
Judy

Monday update April 16th

The phones felt a little more like spring and less like winter today.
The most common illness we have seen is strep throat. There is quite a bit of it around.
Any sore throats with fevers should be checked.
We are also seeing a moderate amount of coughs, colds and odd rashes.
There is a mild little tummy bug out there.
Stay well
Judy

Nurse Judy Class Schedule for April and May

I have 4 of my classes scheduled in the coming month


Illness class: April 28th Saturday morning 11:00 am

Knowing when to worry is something that all of us need help with. This class answers questions about fevers, rashes, common viral illnesses and anything health related that is on your mind
( all ages)


Safety class: May 2nd Wednesday evening 7:30 pm
Learn how to deal with little emergencies ; includes basic first aid, head injuries, Burns, poisonings, choking rescue and child proofing tips
(all ages)


Parenting class: May 9th Wednesday evening 7:30 pm
problem solving tips, effective consequences and creative rewards, parenting pearls, bedtime issues
( older than 2 years)


Solid foods class: May 23rd Wednesday evening 7:30 pm
Information on feeding your baby from how to start through transitioning to table food, included nutritional needs, bowel movement changes, and understanding the growth chart

( 4 months-15 months)

Classes are held in the Noe Valley Pediatrics waiting room ( Open to public)
$20/person sliding scale available
classes range from 90-120 minutes
small groups..RSVP required
nursejudynvp@yahoo.com
www.nursejudy.net

April 9th monday update/illness class this week

There is a lot of mild to moderate stuff floating around right now. Nothing too scary.
In the office today mostly we are seeing a lot of coughing.
There are patients with some 101-103 fevers that are lasting about 3 days.
We are seeing some hand/ foot/ mouth with a lot of mouth involvement and miserable kids. They are getting over the worst of it in a day or so.
I have a couple kids out there with diarrhea that has been hanging on for a couple of days.
There is a lot of strep throat out there. Sore throats that come along with fever and not a lot of congestion should be checked.

I have an illness class this week 4/11 at 7:45. Still a few spots left if you are interested shoot me an email.

Stay well
Judy

Tuesday April 3

We are still seeing lots of colds and coughs, but luckily that pesty stomach bug seems to have left us all alone for awhile!

On a more interesting note, a more severe form of the Hand, Foot and Mouth virus has been reported in San Francisco in the last few months. We saw two of these cases in our office today. 

With this strain of the virus, adults are more likely to become infected and the rash is less predictable. While still typically harmless, if you suspect you or your child has Hand, Foot and Mouth please give us a call so we can review it with you individually.

Hand, Foot and Mouth is a common viral infection that typically starts with a fever lasting 2-3 days and then causes ulcers (blisters) in the mouth, especially on the tongue and on the sides of the mouth. In addition, most children will develop small, thick-walled water blisters (like chicken pox) or red spots on the palms, soles and webs between the fingers and toes. Some children develop blisters or red spots on the bottom. This virus mainly occurs in children age 6 months to 4 years.

With this new strain out there - we'd like to know if you or your child show any signs of Hand, Foot and Mouth. If so, please give a call (as the Division of Communicable Diseases is tracking this as well.)

Stay well!

Jennifer (in for Judy)

Monday March 26th

There are a lot of fevers going around.
We have seen many kids with ear infections so if your child is fussy with the fever It is worth taking a look in the ears.
Many ear infections will go away on their own, however once in a while an untreated ear infection can cause the eardrum to rupture ( you will see drainage from the ear if this happens) frequent ruptures can lead to hearing loss.
If we are suspicious about an ear infection it is always a good idea to look.
An ear infection that has a high fever and a miserable kid is usually worth treating.

We are still seeing cases of RSV and Flu.
I have some reports of mild vomiting and diarrhea.

I had to cancel my illness class last week and MIGHT reschedule for this week on Wednesday evening the 28th if there is enough interest with such short notice
If you are interested email nursejudynvp@yahoo.com

Stay well
Judy

Monday March 19th

Wow, what ISN'T going around?!
We are seeing a lot of kids with a very persistent colds and coughs. In some cases, this illness has been lingering for 2 weeks or more
With the sicker looking or very young patients we are testing kids and coming up with positive results for both RSV and FLU.
The flu has had fevers lasting for a week in some cases.
If you or your child has been diagnosed with the flu, it is somewhat reassuring to know that the week long fever isn't necessarily something to worry about.
If your child has not been evaluated five days of fever is the longest I would want to let you wait before being seen.
We are seeing some strep throat and some hand foot mouth
We have been seeing some fairly nasty cases of croup.

stay well
Judy

solid foods class correction

Someone kindly pointed out that I have an error in an earlier post.
My next solid foods class will be March 31st ( Saturday morning) at 10:30 am
The illness class is March 21st (Wednesday evening) at 7:45 pm
There is currently a bit of room left in both classes
email nursejudynvp@yahoo.com to reserve a spot or ask for more info

March 12th update

Flu is here.
We have seen both type A and type B showing up in our flu tests.
Interestingly the kids with type B have been vaccinated, so this years strain didn't quite match.
These kids do have high fevers and are very low energy. The fevers have lasted for 5 days or so. There is some sore throat and congestion. Most of the concern has been about the fevers lasting so long, otherwise the kids haven't seen sick enough to cause too much concern.
We are still seeing RSV. RSV is everywhere. Most of the folks with it are presenting with just a really rotten cold and cough, Some of our patients ( of all ages) have been just slammed with it and have ended up in the hospital.
There is also the basic cold and cough out there which has presented with a lot of watery red rimmed eyes. This has gone away with nothing other than typical symptomatic treatment.
I still have some kids out there with diarrhea, but that is significantly decreased..
Dr Hurd worked the after hours clinic this weekend. She reports seeing a few cases of hand/foot/mouth and lots of sore throats.
stay well
Judy

Friday update/ next classes

I will be out of the office next week, so I am going to do a Friday update and will post again on the 12th.
This week we have seen a lot of strep throat.
I have some cases of hand foot mouth.
There is a cough that lingers for weeks.
RSV remains prevalent and we have had several babies hospitalized with it. ( they are doing okay)
We are finally seeing a slow down of the diarrhea, although some of the patients are having a hard time shaking it.
Typically with the diarrhea, they may be done with the virus but have a very sensitive and irritated gut. Time will fix this, but for those of you plagued with this, stay on the gentle non dairy diet, probiotics are helpful. Benefiber is also useful.

My illness class has 2 spots left. It will be held on March 21st at 7:45 pm
I just scheduled my next solid foods class..that will be March 21st ( Sat morning) at 10:00 am..reservations are needed. nursejudynvp@yahoo.com
have a healthy week
Judy

Monday update February 27th

Since we will actually be on KRON today at 5pm talking about current Norovirus epidemic, I will start today's update with diarrhea.
I think that the calls about the tummy bug are subsiding but there are still some cases out there.

Rotovirus is typically the most common cause of diarrhea in young patients. By the time we get to the age of 5 or so, we usually have some immunity to many of the strains. recent studies are showing a 25% decrease in rotovirus cases since the vaccine came out several years ago.
Norovirus hits the older kids and adults. It can survive on surfaces for several hours, which helps it spread easily. good hand-washing is key to prevention.
Most of the time it lasts about 3 days. It may last longer in the younger kids.
I suspect due to the large numbers of adults and older patients hit with this recent onslaught, that it is Norovirus that we are dealing with.
Most of these patients have some vomiting, several days of loose stools, tummy aches and some low grade to moderate fevers.
If you or your child has diarrhea that comes along with bloody stools or high fever, then a bacterial infection should be ruled out.
If we have ongoing gassy, STINKY stools then at some point we will want to rule out Giardia or other parasites
Aside from the tummy bug...
We are also still seeing quite a bit of RSV
We have had LOTS of conjunctivitis.
There is a fever/ cough virus out there
We have had 2 positive flu tests to date.
They both had Type B strains of the influenza.

Stay well
Nurse Judy

frequently asked questions about the arsenic issue

Thanks to one of our mom's out there for furnishing me with this info to share!

Q: Which types of baby formula should I be worried about?
A: Our researchers tested two toddler formulas on the market that use organic brown rice syrup. Please see http://abcnews.go.com/Health/Diet/arsenic-organics-rice/story?id=15642428#.T0LIEXlW18F, http://video.msnbc.msn.com/nightly-news/46420960/#null, and http://articles.boston.com/2012-02-17/health-wellness/31065888_1_arsenic-levels-rice-syrup-baby-formula. Both products contained amounts of total arsenic that are above **10 parts per billion (ppb), the legal standard set by the U.S. EPA for public drinking water, and amounts of inorganic arsenic that are equal to or greater than this regulatory limit. See, http://water.epa.gov/drink/contaminants/basicinformation/arsenic.cfm

Q: What are the risks from ingesting these products?
A: The risks to an infant or young child who drinks these products for a relatively short period of time are not well-studied. Chronic life-time exposure to arsenic (for example from drinking private well water containing arsenic levels at 10 ppb and above every day), does result in increased risk for bladder, skin, lung and liver cancers, heart and respiratory disease. Very little is known about exposure to low doses of arsenic for short periods of time, but scientists at Dartmouth and other universities are currently studying the health effects of dietary exposure in infants and children.

Q: What can we do?
A: To be cautious, switch to a product that does not contain brown rice syrup. Please consult your pediatrician before you make this change. ( we say please switch!!!!!)

Q: I gave this formula to my child for two years—what should I do?
A: Arsenic does not accumulate in the body so when your child is no longer exposed to arsenic it will leave his/her system in a day or two. Long-term health consequences are unknown because previous studies have not examined childhood exposure at doses equivalent to levels found in these formulas. Scientists at Dartmouth and other universities are studying the potential health effects of dietary exposure to arsenic in infants and children.
To ensure that your children are not exposed to arsenic from other sources, make sure to have your well water tested. If you have additional questions about potential health effects and sources of arsenic, consult your pediatrician and a registered dietician.
The UK Food Standards Agency states that “as a precaution, toddlers and young children between 1 and 4.5 years old should not have rice drinks as a replacement for cows’ milk, breast milk, or infant formula.” The Food Standards Agency represents the UK Government on food safety and standards issues in the European Union.

Q: Should I get my child tested for arsenic?
A: No. Arsenic does not accumulate in the body, and the body normally excretes arsenic in the urine within one to two days of exposure. This is why scientists at Dartmouth are most concerned with long-term exposure. If you have a private well, you should test your well for arsenic to minimize exposure.

Q: Should I be worried about Cereal/Energy Bars?
A: Some of these products contain rice or brown rice syrup, both of which may contain arsenic. We tested 29 bars (multiple brands) of the hundreds of cereal/energy bar products on the market. Of those 29 products, our results showed that the amount of inorganic arsenic in each bar depends on the size of the bar, the concentration of total arsenic, and the percentage of total arsenic that is in the inorganic form. Eating 2 - 3 of the larger bars (approximately 70 grams) per day could contribute 10 micrograms of inorganic arsenic to your diet. If you examine the ingredient list and consider the weight of the bar, frequency and quantity consumed per day, you can make an informed choice.
************************************************************************************************
**In 2001, the EPA set 10 ppb as the legal standard for public drinking water for adults, but it determined the public health goal should be 0 ppb. The EPA set the legal standard based on human adults; it does not account for the low body weight of infants and the corresponding increase in arsenic consumption per pound of body weight. This 10 ppb standard was set as close to the public health goal (0 ppb) as possible, considering cost, benefits and the ability of public water systems to detect and remove arsenic. According to the EPA and many scientific studies, people who drink water containing arsenic in excess of 10 ppb over many years could experience skin damage, problems with their circulatory system, and may be at an increased risk of getting cancer and heart and respiratory disease.
For more information about arsenic and health, please consult these reliable independent sources:
o The World Health Organization produced a 2010 report titled: “Exposure to Arsenic: A Major Public Health Concern.” http://www.who.int/ipcs/features/arsenic.pdf

o The latest U.S. CDC/ATSDR public health statement on arsenic, published in 2007, recognizes inorganic arsenic as a “human poison.” http://www.atsdr.cdc.gov/phs/phs.asp?id=18&tid=3

Lots of stuff out there

I hope that some of you managed to have a good weekend.
Many of our patients and families are still plagued by the tummy bug that is out there.
I am tempted to say that the kids with diarrhea that is lasting longer than a week may have Norovirus. We know that it is very prevalent out there with some schools and day-cares closing for a few days.
This information doesn't do a whole lot for us except reassure us that time WILL fix this.
Please check in with us if your child has diarrhea vomiting symptoms IF
*you are concerned about possible dehydration
*your child seems to be losing a significant amount of weight
*the symptoms have been lingering for more than 3 weeks.

See earlier posts for tips on treating

We also have a lot of RSV out there. More than one baby was hospitalized with this this weekend ( happily they are doing quite well and are now home)

There is an illness that comes with a high fever.. I am still gathering data on this one as more folks come down with it.

I haven't been able to come up with many hard facts about the arsenic issue.
In general please don't lose any sleep over this, but do change your habits to avoid further exposure until we know more.
Currently I can only assure you that Similac is not impacted by this, I don't know for sure about the other organic formulas yet.

We had another parent post a comment last week with a question about Tylenol and a link to asthma.
Looking into that, it looks like that was a very poorly done study without any real clinical statistics to back it up.
In general it is best to avoid any medication unless it is needed, but if your child has fever or is very fussy from teething or discomfort, I would be fine giving appropriate doses of Tylenol or Advil ( Acetaminophen/ Ibuprofen)

I will chime back in if there is anything nutty going on this week.
Judy

Arsenic in Baby formula/ Friday update

I am trying to find out more info about the reports of arsenic in baby formula.
What I can currently tell you is that I have been assured that Similac organic formula is NOT affected by this and does not use the ingredients that are being questioned.
As soon as I have more info, I will update.

We will be closed on Monday in honor of Presidents day.
As always the after hours clinic will be available to take care of your needs.
We will be back on Tuesday.;

We had our first positive flu test...Influenza has arrived. I will update when I have a better sense of what this particular virus is looking like. Every year tends to have some variations.
Have a good weekend
Judy

fevers out there

I am wondering if we are possibly starting to see the flu.
I now have several patients with lots of congestion and high fevers ( 102-103). The Mucous tends to be mostly clear. This batch of kids are fairly unhappy and so far we are on day 3 of the fever, so I don't know how long it lasts yet.
We haven't tested any of them for flu but may start if other kids keep this up. At this point my 3 day fever rule is still intact.
If your child has a high fever that is on the 3rd day and they have NOT been evaluated yet, I would like to have them seen. ( unless they are absolutely happy, eating with easy breathing..in which case they get an extra day or two.

Judy

new class for parents of young babies

Attention parents of our youngest patients.
By request I will be starting a new class for parents of babies under 3 months.
This class will deal with colic, new born rashes, baby poop, cradle cap, sleeping tips, thrush, cord care blocked tear ducts etc.( in other words anything that is on your mind)
sleepy babies will be most welcome at this class.

If there is enough interest I will try to schedule the first one sooner than later, otherwise look for it in March.
If you are interested email me at nursejudynvp@yahoo.com and I will try to find a mutually convenient time

Judy

Monday Feb 13th

Our patients are still plagued by
* the stomach virus ( the numbers are down a bit so far today but it is still out there)
* coughs and colds that have moderate fevers ( 101) associated with them
* LOTS of wheezing going on
*all sorts of odd rashes


There are several events that I want to let you know about.

UCSF school of dentistry is offering free dental to children 4-17 on Saturday February 18th over at 707 Parnassus from 9-3. no appointments are needed but I would get there early if this is something you are interested in.

SF Birth and Baby Fair is hosting a Free Car seat check over at the sports Basement on Bryant street on Saturday February 25th.
Google the SF Birth and Baby fair and click from the site to make an appointment

Healthychildren.org is also a fun website to check out. They have all sorts of answers to all sorts of questions.
SFkids.org is another good site that has lots of suggestions for great activities to do with your kids

It is preteen vaccination week.
All kids going into middle school next year need to be up to date on the TDaP vaccines.

stay well
Judy

Tylenol dosing information

I have been getting a lot of questions lately about correct Tylenol dosing. In the effort by the companies to make things simple, things have gotten awfully confusing.
What used to be known as concentrated infant Tylenol drops ( 80mg/1 ml) is no longer supposed to be available. Most of what is being sold is now Tylenol suspension ( 160 mg/5 ml)
Okay moms and dads..It is time to brush off your math skills.
In order to make sure that your child is getting the proper dose regardless of what form you have, from now on we need to focus on how many milligrams of medication your child should get.
Somewhere on the label it should say how many mg there are per ml.
milliliters are standard units of measurement. There are always 5 ml (milliliters)in a teaspoon.
How many milliGRAMS there are in a milliliter will vary from medication to medication.
Once again, In the case of Tylenol the most popular concentration is now 160mg/5ml but please take a moment to find that info on the label ( it might be small) just to be certain.
the proper dosing for the 160/5ml concentration will be as follows

5-8 pounds 40 mg 1/4 teaspoon 1.25 ml
9-10 pounds 60 mg 1/3 teaspoon 1.7 ml
11-16 pounds 80 mg 1/2 teaspoon 2.5 ml
17-21 pounds 120 mg 3/4 teaspoon 3.75 ml
22-26 pounds 160 mg 1 teaspoon 5 ml
27-32 pounds 200 mg 1 1/4 teaspoon 6.25 ml
33-37 pounds 240 mg 1 1/2 teaspoons 7.5 ml
38-42 pounds 280 mg 2 teaspoons 10 ml

Tylenol doses can be repeated every 4-6 hours as needed.
If your baby is under 6 weeks it is essential that you report any elevated fever or significant fussiness rather than automatically treating with Tylenol or Advil.

Upcoming Nurse Judy class schedule

Here is the schedule of upcoming Nurse Judy classes



Solids foods class
February 11th 10:45 am (Saturday morning)
This class is geared for parents of children from 4 months until 15 months. It covers all the aspects of starting solids, nutritional information and tips for picky toddler eaters
Topics range from how interesting your child's poop can get with various foods, to understanding how to read a growth chart to track their heights and weights

Safety Class
February 25th 10:00 am ( Saturday morning)
This class is appropriate for all parents. We focus on accident prevention but teach how to deal with emergency situations
This class covers head injuries, falls, basic first aid, burns, poisoning, child proofing, safe pet interactions and CHOKING rescue

Illness class
March 21st at 7:45 pm ( Wednesday evening)
This class is appropriate for all parents. Recognize and learn what are appropriate levels of concern and how to deal with a wide range of illnesses. We will discuss fevers, rashes, coughs and colds, tummy bugs and common viral syndromes

classes are typically 90 minutes

My February Parenting class is full, but this class deals with parenting tips for parents with children over the age of two ( tips are useful for all ages) In this class we talk about appropriate rewards, consequences, tantrums, problem solving, bedtime, mealtime etc....
If you have at least 4 people interested ( best with similar age kids) contact me to set up a class
( parenting class is 2 hours)

Classes are held in the Noe Valley Pediatrics waiting room - you do not need to be a patient of NVP to attend. Cost of the classes is $20/per person. sliding scale available.
RSVP required nursejudynvp@yahoo.com


more info at www.nursejudy.net

Monday February 6th

This week coughs and wheezing are the biggest complaints. We are still seeing RSV. ( see previous posts for more info about this)
We are still seeing lots of vomiting kids with diarrhea so that is still getting an honorary mention. We have actually had a few of our patients end up in the ER to get some IV hydration. Hooray to the parents who recognized that it was appropriate to take the kids in (significantly low energy and decreased urine output should get your antenna up)
We have complaints of sore throats but all the strep tests were negative today.
We have had no positive flu tests yet, but there have been a handful of kids with fever and aches.
Stay well
Judy

Monday update for January 30th 2012

The tummy bug is still my biggest offender this week.
We have dozens of patients and parents afflicted with this one.
You can expect a few days of vomiting and diarrhea. Some patients have fever with it.

There is a cough and cough making the rounds as well. We are still seeing RSV. The wheezers abound and we have our nebulizers humming in all of the exam rooms throughout the day in here.
There are lots of older kids with sore throats. About half of them are strep.

stay well
Judy

Monday January 23rd /solid foods class scheduled

The Tummy bug is really making the rounds.
This one is several days of vomiting with diarrhea.
Many of the parents are getting this as well and some of the kids have spotty, blotchy rashes as part of the package.
We are seeing lots of strep throat
The coughing seems to be back. We are still seeing the RSV virus.
I have heard some reports from ER's that there have been some flu tests positive for type A, but I am not considering the flu "season" to have made it's presence felt yet.

My next solid foods class will be held on February 11th at 10:45 am
email nursejudynvp@yahoo.com to reserve a spot.

Tuesday january 17th/ Yikes!!!

I am not sure if it was due to the 3 day weekend or the volume of sick kids, but today was nuts in here. ( the little power outage this morning did not help)
We are seeing lots of strep throat.
There seems to be a high fever with a congested cough ( I think Viral)
The stomach bug is still very active. Warning Warning, quite of few of the parents are coming down with this one. ( also likely viral)
Many of the kids with the tummy bug also have an odd spotty rash.
I believe I am seeing some cases of slap cheek.
I know of at least one case of chicken pox out there

If something is viral, there is less of a chance that we can do anything other than assist you in offering supportive care.
With fussy kids we do like to listen to the lungs and look in their ears just to be sure.

With winter illnesses in full swing we appreciate your patience.
The wait for a phone call might be longer than usual.
Please let the front desk know if there is any urgency involved.
Although the schedule was full early on I have double booked a few patients who I felt needed to be seen. Of course that unfortunately makes the waits a bit longer for everyone and for that I apologize.

Winter is here..it got here right before the rain....
Judy

three day weekend

The office will be closed in honor of MLK birthday (so no one get sick)
The after hours clinic is available for you if you need it.

If there are any patients out there who have grown out of their nebulizers and you want to declutter your house, we would be happy to put them in our "loaner" neb closet.
Enjoy this weather while it lasts
I will check in on Tuesday with an update of what is going around
Judy

January 9th 2012

The coughs seem to be quieting down a bit this week.
There are lots of kids with the mild tummy bug out there. It seems to clear within a few days on the tummy bug protocol
*avoid dairy except for breast milk or yogurt
*BRAT diet..bananas, rice, applesauce, toast, crackers, pasta, boiled chicken...bland and starchy mild foods
Probiotics are very helpful
Stay hydrated with pedialyte, gatorade, coconut water
Dehydrated kids are really low energy and not peeing...those kids need to be seen. Otherwise small sips of fluids until the vomiting stops and then slowly advance the diet. We are not worried if they are off of their food for a few days, it is all about the fluids.

We are also seeing lots of strep throat. Typically these kids have fevers without congestion.

I am also seeing plenty of ear infections and goopy eyes.

Stay well
Nurse Judy

Happy New year

2012 is starting off with the same illnesses right where we left off.
There is still RSV sweeping the neighborhood.
We are seeing all sorts of coughs, colds and fevers.
Many of the colds have led to ear infections.
There are lots of kids ( and parents) with sore throats, about half of them are strep positive.
There is a tummy bug out there but it is pretty mild and has lasted about a day or two.
Stay well,
Nurse judy