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