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



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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