Dr Anne is a proud mama of two beautiful babies.!!! She has a boy and a girl. I will post the names when they become official.
Thursday, February 28, 2013
Monday, February 25, 2013
Monday update February 25th
This week is very similar to last week.
Flu continues to be around but diminishing. It is still worth while for babies to get their 2nd shot this season. Once they have one season where they have had two shots they are considered "primed" and they will only need one a year in the future.
We are still seeing some vomiting and diarrhea. I did have two little patients who were dehydrated and needed IV hydration from the ER.
If your child won't keep down even little sips and seems very lethargic, they need to be seen.
We are still seeing tons of kids with colds and coughs. Many of these folks have a few days of moderate fevers. I wish I could tell you how long the cough lasts, but it is still lingering and lingering. If your child seems wheezy please give us a call.
For all you nebulizer users out there, if you have been using the same tubing for more than 6 months it is time to get a new set.
I have given the Noe Valley Walgreens a standing order to refill tubing for my patients. If it is one of the regular pharmacy staff members you should have no trouble ( tell them Nurse Judy sent you)
We have also seem lots of kids with ear infections. Many of these kids have had one and off colds for several weeks and have finally succumbed.
If your child has been congested and all of a sudden you are seeing a new onset of fever, fussiness or trouble sleeping, it is worth having those ears looked at.
I am still seeing lots and lots of slap cheek ( also known as fifth disease) There is often an on and off fever, rashy kid and red cheek. It is rare for this illness to get me alarmed ( although some kids can seem pretty sick with it)
Dr Anne is STILL PREGNANT!!
I will certainly have a different report for you by next week.
Stay well
Judy
Flu continues to be around but diminishing. It is still worth while for babies to get their 2nd shot this season. Once they have one season where they have had two shots they are considered "primed" and they will only need one a year in the future.
We are still seeing some vomiting and diarrhea. I did have two little patients who were dehydrated and needed IV hydration from the ER.
If your child won't keep down even little sips and seems very lethargic, they need to be seen.
We are still seeing tons of kids with colds and coughs. Many of these folks have a few days of moderate fevers. I wish I could tell you how long the cough lasts, but it is still lingering and lingering. If your child seems wheezy please give us a call.
For all you nebulizer users out there, if you have been using the same tubing for more than 6 months it is time to get a new set.
I have given the Noe Valley Walgreens a standing order to refill tubing for my patients. If it is one of the regular pharmacy staff members you should have no trouble ( tell them Nurse Judy sent you)
We have also seem lots of kids with ear infections. Many of these kids have had one and off colds for several weeks and have finally succumbed.
If your child has been congested and all of a sudden you are seeing a new onset of fever, fussiness or trouble sleeping, it is worth having those ears looked at.
I am still seeing lots and lots of slap cheek ( also known as fifth disease) There is often an on and off fever, rashy kid and red cheek. It is rare for this illness to get me alarmed ( although some kids can seem pretty sick with it)
Dr Anne is STILL PREGNANT!!
I will certainly have a different report for you by next week.
Stay well
Judy
Saturday, February 23, 2013
contagious?
When is someone contagious ?
( in other words, can my child go back to daycare?)
Some of my most
common questions revolve around when kids are contagious and when are they
ready to go back to day care or school.
There is rarely a simple answer. On one hand, of course we
want to be a responsible parents and not expose others to our sick child. On the other hand we want to protect our own
recovering child from going back too quickly where they may come down with
something new. In order to logically best make these decisions there are many issues that
we need to consider.
Some parents have an easy time taking time off and others
simply can’t afford to. It is naïve to think that these aren’t real factors.
One of the tricky thing is that many viral syndromes are
contagious a day or two before the kids show clear signs that they are ill.
Many kids may be a little fussier than usual. They might take a longer lap.
Perhaps they don’t eat quite as much.
Are those reasons to stay home from day care??? Of course
not!
The fact is, if you child comes home from school on Monday
afternoon and is sick that evening, most likely everyone there has already been
exposed and I am going to take that into consideration when we try to come up
with the most sensible plan on when they can return.
If you are in a small share care situation, it is essential
to have a talk with the nanny and the other families involved to make sure you
are all on the same page.
I would suggest that you create a “sibling” relationship. This
simply means that you all accept that the kids are most likely going to get
each other’s mild illnesses.
If you plan on staying at home until your little toddler is
free from a runny nose, you will be waiting a very long time before you leave
the house.
Remember that some clear runny noses are not contagious.
Teething as well as some allergies can be the cause.
As far as common colds go, the average for kids under 2
years of age is EIGHT colds a year.
While I would like to keep my youngest and most vulnerable patients
free from viral syndromes and colds as long as possible, exposure to these
common viruses is in fact developing the immune system. At some point they are
going to have to deal with some mild illnesses. It is a rite of passage.
Typically if I have a child with a fever over 101, a new case of diarrhea, or a brand new green
mucousy cough or cold it is worth keeping them home for at least a day to see
what is coming next.
If your child has an infection that is being treated with
antibiotics, we generally consider them no longer contagious after they have
been on the medication for more than 24 hours.
There is never any assurance that can be given that your
little one is “ not contagious”
Use your best common sense. When in doubt avoid contact with
anyone who is vulnerable. This would include newborns, or someone with a
compromised immune system.
Tuesday, February 19, 2013
Weekly update February 19th
We are seeing a little bit of everything.
Most of the visits have been kids with the cough/cold/ fever.
We had a few new cases of flu last week but that is surely slowing down.
There seems to be more wheezing this week.
We are seeing lots of conjunctivitis and ear infections
There are some cases of tummy bugs. More kids seem to be vomiting with this. I haven't seen quite as much diarrhea.
Some of the vomiting kids had a one day high fever and then seem better.
There is some strep throat out there so if we have a fever that is lasting for more than a day, along with vomiting ( no diarrhea) I want to check them for strep.
BABY UPDATE:
Dr Anne is 37 weeks and counting. No babies yet. I will keep you in the loop.
NURSE JUDY CLASS UPDATE:
I have one spot left in my "managing your kids illnesses" class this Wednesday night.
My next "NEW BABY boot camp" is March 2nd ( Saturday morning)
I have room for 2 more couples.
That class is also great for folks on their second time around. It is easy to forget all that newborn stuff when you are used to a big kid who can tell you what's on their mind
For more info or to sign up for any classes email nursejudynvp@gmail.com
Stay well and warm!
Nurse Judy
Most of the visits have been kids with the cough/cold/ fever.
We had a few new cases of flu last week but that is surely slowing down.
There seems to be more wheezing this week.
We are seeing lots of conjunctivitis and ear infections
There are some cases of tummy bugs. More kids seem to be vomiting with this. I haven't seen quite as much diarrhea.
Some of the vomiting kids had a one day high fever and then seem better.
There is some strep throat out there so if we have a fever that is lasting for more than a day, along with vomiting ( no diarrhea) I want to check them for strep.
BABY UPDATE:
Dr Anne is 37 weeks and counting. No babies yet. I will keep you in the loop.
NURSE JUDY CLASS UPDATE:
I have one spot left in my "managing your kids illnesses" class this Wednesday night.
My next "NEW BABY boot camp" is March 2nd ( Saturday morning)
I have room for 2 more couples.
That class is also great for folks on their second time around. It is easy to forget all that newborn stuff when you are used to a big kid who can tell you what's on their mind
For more info or to sign up for any classes email nursejudynvp@gmail.com
Stay well and warm!
Nurse Judy
Friday, February 15, 2013
Fever tidbits
To get on my email list and have these tidbits sent to you directly ( along with class schedules and updates) just pop me an email to : nursejudynvp@gmail.com and I will be happy to add you
All about fevers.
Fevers turn on the body immune system. They are one of our protective mechanisms
Many fevers can actually help the body fight infection.
.
Fevers that are associated with most viral syndromes and infections do NOT cause brain damage. Our brain's thermostat will not allow a fever to go over 105 or 106.
Only body temperatures higher than 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car.)
There are many methods out there for measuring a fever. I don't feel the need to invest in any expensive thermometers. I am quite happy with a digital underarm reading. The important thing is that however you take it, your thermometer seems accurate. Test it on other family members and take your child's temp when they are healthy to make sure you trust it.
One of my favorite brands is Becton Dickinson. These are reasonably inexpensive on Amazon and have been reliable in my experience.
If you have one of the new ear or temporal scanning gadgets, feel free to keep using that. Sometimes their "high" readings seem a little higher than I believe. Don't let this freak you out.
If your infant is under 8 weeks of age we want to be notified of any fevers, however there are a few common causes..
*over bundling....
Seriously, some times the babies come in with 10 blankets wrapped around them.
Please don't do that. The best rule of thumb is giving them one layer more than you are wearing.
If your baby was indeed over bundled, get some of those layers off and re take the temp in about 10 minutes to see if they have cooled down.
*dehydration....
Sometimes if moms milk isn't in yet, babies can be simply dehydrated and need to get some fluids. This is the time that you need to squirt some milk or formula directly into your baby's mouth. You can use a syringe or a dropper.
More often than not the elevated temperature will normalize fairly quickly.
If there is no obvious cause for an elevated temperature, and it doesn't resolve within 30 minutes your baby needs to be evaluated. Giving a fever reducing medication to a newborn should only be done under strict guidance from your pediatrician.
For any child older than 2 months, as long as your child is active and happy, I generally don't feel the need to "treat" a fever unless it is over 101.5 or so.
Parent's often ask me, "When do we need to worry about a fever?"
I am always much more interested in your child's overall mood and behavior than I am in any specific number on a thermometer.
I am way more concerned about the lethargic, whimpering child who has a 99 temperature than I am the singing child with 104.
But, here is the Nurse Judy's rule about fevers:
If the fever is over 102 ( It doesn't matter how you measure, just be consistent)
*Treat with proper dose of Acetaminophen or Ibuprofen
*Do a tepid bath or place cool compresses on the forehead, insides of elbows and neck
*Get them drinking. Really, any type of fluid will work.
Little sips at a time are fine. Breast milk is always a great choice if you have it.
Popsicles and ice-chips are good for older kids
*re check the temp in 45-60 minutes
If it is STILL over 102 and hasn't budged at all, that is a fever that I am concerned about.
It is time to get your child seen.
When children are in the process of spiking a fever, it is not uncommon for them to tremble and look shaky.
On the other hand, one of the more frightening aspects of a fever can be a febrile seizure. About 4% of children will have these.
Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm.
If your child is having a seizure they may have large jerky motions and their eyes may roll back.
Your job is to stay calm. Make sure their airway is open. It is perfectly reasonable to call 911
Once your child has had even one febrile seizure we tend to be more aggressive with fever control and will treat even a low grade fever. It is important to talk with your doctor about this so that you have a plan in place that you are comfortable with.
Most kids grow out of the seizures by the time they are 5 years old.
As I mentioned before, a fever by itself doesn't alarm me.
If the fever is accompanied by a very fussy child, I want them seen so that we can figure out what is going on.
Most of the time, if a fever lasts for more than 3 days, I consider it time to have a look so that we can make sure there isn't an infection source ( like ear infection, urinary tract infection, strep throat or pneumonia)
This month we are seeing lots of flu. Many or our patients have fevers that are lasting 5 days.
Because there is so much of this going around I am relaxing my "3 day rule" If the kids seems like they are 'managing' ( drinking, peeing, easy breathing, consolable, fever responds to meds) I am okay watching them for another couple of days
Temp° conversions
98.6° F =37.0° C
99.5° F=37.5° C
100.0° F=37.8° C
100.4° F=38.0° C
101.0° F=38.4° C
102.0° F=38.9° C
103.0° F=39.5° C
104.0° F=40.0° C
105.0° F=40.6° C
All about fevers.
Fevers turn on the body immune system. They are one of our protective mechanisms
Many fevers can actually help the body fight infection.
.
Fevers that are associated with most viral syndromes and infections do NOT cause brain damage. Our brain's thermostat will not allow a fever to go over 105 or 106.
Only body temperatures higher than 108°F (42.2°C) can cause brain damage. Fevers only go this high with high environmental temperatures (e.g., confined to a closed car.)
There are many methods out there for measuring a fever. I don't feel the need to invest in any expensive thermometers. I am quite happy with a digital underarm reading. The important thing is that however you take it, your thermometer seems accurate. Test it on other family members and take your child's temp when they are healthy to make sure you trust it.
One of my favorite brands is Becton Dickinson. These are reasonably inexpensive on Amazon and have been reliable in my experience.
If you have one of the new ear or temporal scanning gadgets, feel free to keep using that. Sometimes their "high" readings seem a little higher than I believe. Don't let this freak you out.
If your infant is under 8 weeks of age we want to be notified of any fevers, however there are a few common causes..
*over bundling....
Seriously, some times the babies come in with 10 blankets wrapped around them.
Please don't do that. The best rule of thumb is giving them one layer more than you are wearing.
If your baby was indeed over bundled, get some of those layers off and re take the temp in about 10 minutes to see if they have cooled down.
*dehydration....
Sometimes if moms milk isn't in yet, babies can be simply dehydrated and need to get some fluids. This is the time that you need to squirt some milk or formula directly into your baby's mouth. You can use a syringe or a dropper.
More often than not the elevated temperature will normalize fairly quickly.
If there is no obvious cause for an elevated temperature, and it doesn't resolve within 30 minutes your baby needs to be evaluated. Giving a fever reducing medication to a newborn should only be done under strict guidance from your pediatrician.
For any child older than 2 months, as long as your child is active and happy, I generally don't feel the need to "treat" a fever unless it is over 101.5 or so.
Parent's often ask me, "When do we need to worry about a fever?"
I am always much more interested in your child's overall mood and behavior than I am in any specific number on a thermometer.
I am way more concerned about the lethargic, whimpering child who has a 99 temperature than I am the singing child with 104.
But, here is the Nurse Judy's rule about fevers:
If the fever is over 102 ( It doesn't matter how you measure, just be consistent)
*Treat with proper dose of Acetaminophen or Ibuprofen
*Do a tepid bath or place cool compresses on the forehead, insides of elbows and neck
*Get them drinking. Really, any type of fluid will work.
Little sips at a time are fine. Breast milk is always a great choice if you have it.
Popsicles and ice-chips are good for older kids
*re check the temp in 45-60 minutes
If it is STILL over 102 and hasn't budged at all, that is a fever that I am concerned about.
It is time to get your child seen.
When children are in the process of spiking a fever, it is not uncommon for them to tremble and look shaky.
On the other hand, one of the more frightening aspects of a fever can be a febrile seizure. About 4% of children will have these.
Febrile seizures are scary to watch, but they usually stop within 5 minutes. They cause no permanent harm.
If your child is having a seizure they may have large jerky motions and their eyes may roll back.
Your job is to stay calm. Make sure their airway is open. It is perfectly reasonable to call 911
Once your child has had even one febrile seizure we tend to be more aggressive with fever control and will treat even a low grade fever. It is important to talk with your doctor about this so that you have a plan in place that you are comfortable with.
Most kids grow out of the seizures by the time they are 5 years old.
As I mentioned before, a fever by itself doesn't alarm me.
If the fever is accompanied by a very fussy child, I want them seen so that we can figure out what is going on.
Most of the time, if a fever lasts for more than 3 days, I consider it time to have a look so that we can make sure there isn't an infection source ( like ear infection, urinary tract infection, strep throat or pneumonia)
This month we are seeing lots of flu. Many or our patients have fevers that are lasting 5 days.
Because there is so much of this going around I am relaxing my "3 day rule" If the kids seems like they are 'managing' ( drinking, peeing, easy breathing, consolable, fever responds to meds) I am okay watching them for another couple of days
Temp° conversions
98.6° F =37.0° C
99.5° F=37.5° C
100.0° F=37.8° C
100.4° F=38.0° C
101.0° F=38.4° C
102.0° F=38.9° C
103.0° F=39.5° C
104.0° F=40.0° C
105.0° F=40.6° C
Monday, February 11, 2013
Monday update February
It feels like the worst of the flu seems to be slowing down a bit. We still have a few cases showing up but not as many.
My largest volume of patients and calls have been the basic cold/ cough/ fever. Quite of few of these folks are developing ear infections and conjunctivitis.
The tummy bug is still active. Please check back on the January posting Tummy bugs 101 for management tips.
This round seems to have a day or two of miserable vomiting and a moderate fever. This is usually followed by a couple days of diarrhea. Careful management of the diet and adding probiotics has helped minimize this.
Slap cheek is here for sure. Also know as fifth disease, this comes around a couple times a year. It is very contagious, but I mostly look at it as a 'right of passage" everyone is going to get it at some time or another.
Some kids seem fine other than a bright red, chappy cheek. Others are quite miserable and have all sorts of odd rashes and high fevers that come and go over the course of a couple weeks.
Most adults have immunity from getting this as a child, but if you are pregnant and might be exposed, please check with your OB.
Dr Anne is at 36 weeks!! No babies yet.
Our office will be closed next Monday for the holiday weekend.
Have a healthy week
Judy
My largest volume of patients and calls have been the basic cold/ cough/ fever. Quite of few of these folks are developing ear infections and conjunctivitis.
The tummy bug is still active. Please check back on the January posting Tummy bugs 101 for management tips.
This round seems to have a day or two of miserable vomiting and a moderate fever. This is usually followed by a couple days of diarrhea. Careful management of the diet and adding probiotics has helped minimize this.
Slap cheek is here for sure. Also know as fifth disease, this comes around a couple times a year. It is very contagious, but I mostly look at it as a 'right of passage" everyone is going to get it at some time or another.
Some kids seem fine other than a bright red, chappy cheek. Others are quite miserable and have all sorts of odd rashes and high fevers that come and go over the course of a couple weeks.
Most adults have immunity from getting this as a child, but if you are pregnant and might be exposed, please check with your OB.
Dr Anne is at 36 weeks!! No babies yet.
Our office will be closed next Monday for the holiday weekend.
Have a healthy week
Judy
Saturday, February 9, 2013
Noe Valley Pediatrics Email
It has come to my attention that not everyone has the Noe Valley Pediatrics Email address.
For all my blog readers, here it is NVPEDS@gmail.com
This address is monitored by the Nursing team.
Charity, Jen and myself check the email throughout the day during business hours ( and some of you know that I sometimes check it after hours, but you can’t count on that)
I do, however, have a love hate relationship with email.
It is not because of all the photos that we get of poop, rashy butts and mucous. ( and oh heavens you can not believe the photos we get)
The problem is when the email is used inappropriately
My worst email nightmare was most certainly the one that went
“Hey Nurse Judy, my child_____ is having some trouble breathing and I am really worried”
Please Please Please don’t do that.
The email is great for NON Urgent issues. The phone calls will always take higher priority and on a busy day we may not get to the email until later in the day. If you are having a serious emergency you need to call 911!
Another thing email is not good for is answering complex issues.
Unless you have a very simple question, we are probably better with a phone chat.
My best rule is that if you think it will take me more than 3 sentences to fully give you an answer , email us the question and the best time and number to reach you and one of us will get back to you
As scary as it may seem ( especially right before lunch....) The email is great for photos. There are times that we can actually figure out if something is worrisome and needs to be seen by looking at the image.
If you are sending us a picture, it is helpful to give us a call first so that the front desk staff can pull out your chart and let us know that there is an email waiting.
There is no doubt that email is great for simple non urgent questions and communication..
Hopefully this Gmail address won't have the same spam issues that we had with our old yahoo address ( how many times can someone be mugged overseas without getting pretty demoralized!)
Have a healthy week
Nurse Judy
For all my blog readers, here it is NVPEDS@gmail.com
This address is monitored by the Nursing team.
Charity, Jen and myself check the email throughout the day during business hours ( and some of you know that I sometimes check it after hours, but you can’t count on that)
I do, however, have a love hate relationship with email.
It is not because of all the photos that we get of poop, rashy butts and mucous. ( and oh heavens you can not believe the photos we get)
The problem is when the email is used inappropriately
My worst email nightmare was most certainly the one that went
“Hey Nurse Judy, my child_____ is having some trouble breathing and I am really worried”
Please Please Please don’t do that.
The email is great for NON Urgent issues. The phone calls will always take higher priority and on a busy day we may not get to the email until later in the day. If you are having a serious emergency you need to call 911!
Another thing email is not good for is answering complex issues.
Unless you have a very simple question, we are probably better with a phone chat.
My best rule is that if you think it will take me more than 3 sentences to fully give you an answer , email us the question and the best time and number to reach you and one of us will get back to you
As scary as it may seem ( especially right before lunch....) The email is great for photos. There are times that we can actually figure out if something is worrisome and needs to be seen by looking at the image.
If you are sending us a picture, it is helpful to give us a call first so that the front desk staff can pull out your chart and let us know that there is an email waiting.
There is no doubt that email is great for simple non urgent questions and communication..
Hopefully this Gmail address won't have the same spam issues that we had with our old yahoo address ( how many times can someone be mugged overseas without getting pretty demoralized!)
Have a healthy week
Nurse Judy
Monday, February 4, 2013
Monday Update February 4th
We are seeing lots of all the typical winter woes.
My most common complaints have been the kids with the basic cold/ cough/ mild-moderate fever illness.
The fevers have been gone within 3 days but the cough can linger for several weeks
There is active influenza in our office and out in the community.
I am seeing more type A than type B, (likely because the shot seems to be protecting against strain B and many of our patients are protected)
The flu patients look SICK. They are low energy and have body aches. There is always a fever and most of the time they have some cough and congestion. The fever may last 5 days, if it is any longer than that they need to be seen.
There are lots of kids with conjunctivitis.
Ideally we will take a look at them to get a firm diagnosis.
There is some strep throat around. High fevers with no congestion make me want to rule this out.
There is some slap cheek out there. Theses kids will have on and off bright red cheeks and some of them seem to have mild hives. This may or may not come with a fairly high fever. This comes and goes for more than a week.
At this point we are still wanting to look at these kids, but if I keep seeing loads of the same presentation, I will probably slow down about bringing them in.
...and now for the fun news!!! Dr Anne is at 35 weeks and counting.
She is feeling fine and thanks everyone for the well wishes.
Stay well,
Judy
My most common complaints have been the kids with the basic cold/ cough/ mild-moderate fever illness.
The fevers have been gone within 3 days but the cough can linger for several weeks
There is active influenza in our office and out in the community.
I am seeing more type A than type B, (likely because the shot seems to be protecting against strain B and many of our patients are protected)
The flu patients look SICK. They are low energy and have body aches. There is always a fever and most of the time they have some cough and congestion. The fever may last 5 days, if it is any longer than that they need to be seen.
There are lots of kids with conjunctivitis.
Ideally we will take a look at them to get a firm diagnosis.
There is some strep throat around. High fevers with no congestion make me want to rule this out.
There is some slap cheek out there. Theses kids will have on and off bright red cheeks and some of them seem to have mild hives. This may or may not come with a fairly high fever. This comes and goes for more than a week.
At this point we are still wanting to look at these kids, but if I keep seeing loads of the same presentation, I will probably slow down about bringing them in.
...and now for the fun news!!! Dr Anne is at 35 weeks and counting.
She is feeling fine and thanks everyone for the well wishes.
Stay well,
Judy
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