Zika Virus: An Update

Aedes mosquito-01The Zika virus was first isolated from a Rhesus Macaque monkey in 1947 in the Zika Forest in Uganda (zika meaning “overgrown” in the Luganda language–gotta love useless trivia!); it was first isolated from a human in 1954 in Nigeria. It appeared sporadically along the equator in Africa and Asia for several decades until it spread to French Polynesia in 2013 and then to Latin America, Mexico, the Caribbean, and now the US.

Illness from Zika was rare until the pandemic began in 2007. The illness it caused was mild and self-limited until October 2015, when we began to see babies with microcephaly (very small brains) born to mothers who had been infected while pregnant. New evidence shows that these babies may also have eye abnormalities that will  effect their vision.

There have now been more than 1500 cases of microcephaly in Brazil; in the most severe areas the incidence has been as high as 1:100 births.  On August 15, 2016 a state of emergency was declared in Puerto Rico, where they now have 10,690 confirmed Zika cases, including 1,035 pregnant women. Currently, more than 500 pregnant women in the US have shown evidence of a possible Zika infection.

Symptoms

Zika is a flavivirus related to Dengue, Chikungunya, and West Nile encephalitis. It is transmitted by several species of Aedes mosquitos which can, after biting an infected human, infect another person. Transmission has also been reported through blood transfusions and sexual contact.

The newly infected person may not have any symptoms at all, or may develop symptoms of illness within 2 weeks: fever, a bumpy red rash, sore joints, and pink eye. Less common symptoms include aching muscles, headache, and vomiting. The illness itself is usually mild and self limited.

Treatment

There is no preventative vaccine available yet and no treatment, other than pushing fluids, resting, and treating the symptoms with acetaminophen (Tylenol). The ill person should not take aspirin, ibuprofen (Motrin, Advil), or naproxen (Aleve) until Dengue fever is ruled out, to avoid the risk of bleeding.

Where is it?

As of now, local transmission has been reported in more than 50 countries and territories. Current recommendations are that women who are pregnant, especially in their first trimester, do not travel to any of these areas. If they have to travel, they should do what they can to protect themselves from mosquito bites: wear long pants and long sleeved shirts, preferably treated with permethrin insect repellant; sleep in air conditioned rooms, screened in areas or with permethrin treated mosquito nets; and wear insect repellant, because these mosquitos are active during the daytime.

If you do travel to these areas and develop the symptoms of Zika after returning home, pregnant or not, see your doctor. Avoid mosquitos for the first few days, so that you will not be the source of spreading infection.

Men who have had Zika should use barriers during sex for at least 6 months after the infection; women for 8 weeks. Use of a barrier is recommended for at least 8 weeks after travel to endemic areas even if you have no symptoms.

As of today, we have had 1962 confirmed cases of the infection in the US, with 413 in Florida. Twenty eight of those were caught from local mosquitos. We have the Aedes mosquito along our southern coast and in southern California.

Prevention

In all likelihood the same measures we used to contain Denque in the US will contain Zika, but its spread is still possible. Taking precautions is certainly sensible.

  • Get rid of standing, stagnant water.
  • Clean up piles of garbage, because mosquitos love to breed in trash.
  • Put up or repair your window screens.
  • Spray.

Another possibility to limit spread of the infection is releasing GMO mosquitos with a lethal gene, to decrease the population of the bugs. When this was done in the Caman Islands the mosquito population decreased by 80%.

If you are pregnant, stay out of the endemic areas when possible. Take sensible precautions: clean up standing water and trash, put up or repair window screens, and wear insect repellant.

And keep an eye out for current recommendations from public health officials, because the places and numbers change daily.

DomesticatedMomster
The Blogger's Pit Stop

We Hold These Truths…

Young Teenage Girl Standing And Looking On Empty Picture Frame

Truth: all humans are created equal. We can sometimes distinguish ourselves by our actions in life, but to believe that one person is inherently better than another because of something they were granted unearned at birth–whether it be skin color, religion, sex, or bank balance–is to live in a juvenile world of fairy princesses. Such a world is not fair to our daughters, or our sons.

When I was growing up, sexism was acceptable and assumed. It was displayed out in the open without shame, because obviously women were not equal to men. We weren’t strong enough to be bosses, couldn’t do math, and we made decisions based on emotion rather than fact. Daughters were expected to be mothers, teachers, or nurses.

Young women today tell me that no one is sexist anymore, but it has not been extinguished so thoroughly. It simmers beneath the surface, creeping unnoticed through our subconscious. This election brought it bubbling to the surface.

A woman I know took me to task years ago for saying how ridiculous I thought it was to have a president who couldn’t pronounce the word “nuclear.” She told me that I needed to have more respect for the office that he held, even if I hadn’t voted for him. That woman, this week, said on the internet that Hillary Clinton was a “rat-faced whore.”

How is it possible to contain those two thoughts in the same brain and not notice the imbalance? Deeply held, unconsidered prejudice.

Amy Richards said, “the last time most of us had a powerful woman in our lives, we were children and she was our mother.” We have no picture in our heads of what a powerful woman should look like. We expect the impossible of every woman–she must be pretty, personable, useful, bright, successful–so we apply that in the extreme to a woman who is breaking down walls. Then we stir in a little jealousy because who does she think she is to accomplish so much more than we did? As Ms. Richards added, “we punish her for excellence and success.”

The State Department and the Senate Intelligence Committee made mistakes in Benghazi, and four people died. Investigation into the incident found many at fault; the report mentioned Clinton one time. She did, however, assume responsibility, because she was  Secretary of State.

97 people died in  20 embassy attacks when George Bush was president. Only one was ever investigated at all.

The recent email scandal occurred because Clinton used her private account for official business, rather than a State Department account. This was common practice at the time, and indeed both Colin Powell and Condoleezza Rice did the same, as did the head of the CIA. No-one has called Colin Powell a criminal and demanded that he be jailed.

The anger toward this one woman is out of proportion, an extreme overreaction caused by beliefs instilled in our brains when we were still too young to reason.

I understand that people do not want to vote for someone just because she is female. We want our children to grow up in a world free of bigotry, not just reverse its direction. But I hope that they do not refuse to vote for her out of unconscious sexism. We are not obligated to vote for a woman simply because she is a woman; we are obligated to not blindly swallow the lies people spew out of a rancid sea of prejudice, because we have daughters.

To fairly evaluate a female presidential candidate we need to see past the overlay with which prejudice has painted them; we need to allow a strong woman to be a positive thing; and we need to look at actual facts.

Dig in. Think. Then Vote.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Rashes

little cute girl near the pool with a circle for swimmingWhen the days warm up, pediatric offices see a lot of summer skin problems. Kids aren’t often ill during the summer, but they do get sunburns, bites, jellyfish stings, and rashes.

Sunburn

No one thinks about sunscreen on that first glorious sunshiny day, so sunburns are usually our first evidence that summer is here. Remember to use sunscreen, of course, and don’t forget to reapply it every hour.

If your child does burn, give ibuprofen immediately – it helps with the inflammation and can actually reduce the depth of injury. Use aloe generously: it lessens the pain, moisturizes the skin, and helps heal the damage. If the burn is bad, call your doctor. Prescription steroids and burn creams will help.

Bug Bites

Bug bites are also very popular in the summer, from mosquitos, fire ants, yellow flies, and fleas. Insects inject toxins into children’s skin when they bite; how much a particular child reacts depends on how sensitive he or she is.

Cover up little arms and legs when you can, especially if you are going to be outdoors around twilight. There are excellent clothing treatments available that will keep bugs away and last through several washings, protecting your child indirectly.

If your child is older than 2 months, use insect repellant with DEET on exposed skin, even though it’s nasty. It works and it’s a whole lot better than getting insect borne encephalitis. 10% DEET lasts about 2 hours; 30% lasts about 5 hours. Don’t use anything stronger than 30% on a child. Don’t reapply in the same day, and do wash it off when you go back inside.

Creams with pramoxine or calamine will help with itchiness. Cortisone creams help itch and also swelling and redness, but can only be used a couple of times a day. If there are lots of bites, an antihistamine by mouth will also help with swelling and itch.

Never use antihistamine creams (benadryl is the most common), because children can react to the topical antihistamine and actually get worse instead of better.

Bee stings

Bee and wasp stings are treated much the same way, after making sure to remove the stinger and apply a cool compress (and yes, Grandma’s idea about the wet mud does help).

Poison ivy, oak, and sumac

If your child is a forest dweller, he or she will at some point get poison ivy, oak or sumac. These plants produce a poison called urushiol in their sap and leaves, causing redness, itch and blistering.

The severity of this reaction also varies depending on your munchkin’s sensitivity. My brother’s eyes would swell shut if someone burnt it a block away; I could pull it up and throw it away with no reaction.

Wash both the child and his or her clothes as soon as possible. No lounging on the furniture! The toxin can stay on surfaces for months. Once the toxin is either absorbed into the skin or washed off, the rash is no longer contagious. Blister fluid does not contain urushiol.

The rash will develop first where the most toxin was deposited, in streaks and patches. It can spread for a week or so to the areas where less toxin landed, then take another two weeks to clear.

If the rash is mild, you can treat it at home with cool compresses, baking soda or oatmeal baths, the same creams you used for those pesky bug bites, and that antihistamine by mouth. See? Grandma was right again.

If the rash is not mild, or your child has it on their face, around their eyes, or on their genitals (and how did that plant get there?) call your doc. We can put them on steroids, which help enormously.

Jellyfish stings

If you harbor a small mermaid or man in your home, she or he may get stung by a jellyfish. There are some extremely dangerous jellyfish, so if your child has any trouble breathing, is weak or nauseated, has pain away from the sting, or has sweating, cramping, or diarrhea, call your doctor immediately.

If it is a simple sting, first remove the barbs by scraping it with a towel or a credit card. Don’t rub. Put suntan oil or salt water and hot sand on the sting; heat will deactivate the poison.

Do NOT wash the sting with fresh water – it will make the nematocysts (poison sacks) explode and release more poison into the skin. Your child will scream and not love you anymore. Put only fluids with lots of particles in them on the sting: sting-away, vinegar or steak sauce, for example. Ibuprofen will also help the pain and inflammation.

Allergic rashes

Last, we see allergic reactions to everything from sunscreen to henna tattoos to jewelry to pool chemicals from fun in the sun. Kids with sensitive skin or eczema will rash out in the summer from the heat, humidity and sweat.

By now you can probably sense a common theme (or you could just ask Grandma): give your itchy red bumpy child a cool bath with mild soap. Moisturize and apply topical steroids or give antihistamines by mouth.

If any of this doesn’t work, call me! It gets lonely in a pediatric office during the summer when all the kids are healthy.

DomesticatedMomster
The Blogger's Pit Stop

Summertime Injuries: Preventing the Scary Stuff

safety signSafety is not simple. There is no clear division between “this activity will be safe,” and “this activity will injure my child.” We could wrap our children up, keep them indoors, and not allow them to play with anything remotely dangerous—but then we would have a child who is lonely, overweight and really bored…who would get into trouble and injure themselves… Or not get in trouble and develop diabetes, heart disease and knee problems from obesity.

Kids need to be active, and summertime brings many interesting opportunities for exercise, adventure and injury.

Wouldn’t it be great if some doctor type person would tell you what activities were the most likely to bring ER bills into your life?

Oh, wait… That’s me! So:

The most common causes of accidental death are gunshots, motorized vehicle and bike accidents, drowning, poisoning, and fire. Drowning, MVAs, bike accidents, and trampoline accidents are all more common in the summer, when kids are out of school.

Water Safety

Drowning is every pediatrician’s worst nightmare. It is currently the fifth leading cause of accidental death. An average of 700 children drown each year: about 2 each day. Most are under 4; 80% are male. For every death, there are 5 more children who drowned but survived, commonly with irreversible damage to their brains.

Infants and toddlers drown in bath tubs, buckets, toilets – it only requires is about an inch of water, just enough to cover their nose and mouth. Older children drown in pools, rivers, lakes, and oceans.

Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket. All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. The story I have heard over and over is, “We were right there, just talking, but nobody noticed anything until we realized he was gone.” Keep your kids in sight, and don’t let yourself get distracted. Be especially careful at the end of the day, as the water empties and people are gathering up their belongings and leaving. Children will want to swim just a minute more, or will attempt to go back for that last toy floating in the water.

Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming.

Sign your kids up for swimming lessons, even if you are afraid. A middle schooler or teen will never admit to their friends that they don’t know how to swim. They will fake it, sometimes unsuccessfully. Don’t, however, trust a young child to remember his or her swimming lessons when they need them. If they are startled or scared, they will forget everything they learned and just sink to the bottom.

Know what to look for. In real life, drowning does not look like it does in the movies. It is possible to miss someone drowning right in front of you if you do not know what you are seeing. They do not shout for help and wave their arms. They tire, and panic. A drowning child might never make a sound, but quietly slip under the water. An older child might keep themselves above the water for a while, but their head might be low in the water, with their mouth at water level, or perhaps with their head tilted back. Their eyes might be blank or closed. They will sometimes hang vertically in the water without paddling their legs, or appear to paddle with no purposeful movement. A drowning person is very easy to miss if you are not vigilant; and easy to help if you are.

Somebody should know CPR—why not you? Your local fire department or hospital will have classes.

Swimming is a necessary skill, fun, and excellent exercise; it is also a time for close observation and care.

Motorized Vehicles

The other motorized vehicles—ATVs, dirt bikes, snowmobiles, and Sea-Doos—are also commonly out in the summer. They are the perfect storm: they go fast, have no outside framework, roll over easily, and the only things that keep them from crashing are your children’s foresight, common sense, and trained reflexes. The United States averaged 23,800 dirt bike crashes requiring emergency room visits every year between 2001 and 2004; these numbers go up as dirt bikes become more popular. Don’t. Really, just don’t. You do like the kid, right?

Bikes

Bikes come out of the garage when the weather warms up and the roads are not covered in ice. And yes, the dorky bike helmet is an excellent idea.

Thousands of children are injured or killed every year due to bike accidents, frequently right near their homes. In 2010 alone, there were 800 deaths, 26,000 traumatic brain injuries and 515,000 emergency room visits after bike accidents.

Asphalt is not soft, even right next to your house. When a car hits a child, the child flies through the air. The heaviest part of the child—the head—lands first.

Make them wear the dorky helmet, on top of the head please, covering the top of the forehead, and tied snugly under the chin, not dangling on the back of the head. Hang it on the bike handlebars when not in use so that it is the first thing on and the last thing off. Keep a big lock handy so that if you catch them on the bike without the helmet, you can lock it up and they can walk for a week. Sorry kid, that was the rule and you knew it. There is no need for any argument.

Please don’t buy a bike two sizes too big. Your child will fall off. Children should be able to place the balls of their feet on the ground while their rump is on the seat, and their whole foot should be flat when they are standing over the crossbar. An extra bike or two over the years is cheaper than a broken child.

Trampolines

Trampolines are a huge source of income for surgeons and orthopedists. If you would like to make them poor, don’t buy a trampoline. If you have one, please be careful. Most trampoline accidents occur when there is more than one person on the trampoline, especially when they are not the same size. The smaller one goes flying or is fallen upon. Safety nets and pads are better than no safety nets and pads.

On second thought, forget I said all that. Let’s go back to no trampolines. Kids break bones, damage their kidneys, and hurt their heads and spines.

Children will at some point injure themselves because they need to be free to run, swim, and climb monkey bars and trees. Try not to obsess over scraped knees, a goose egg on the forehead, or a few stitches. Everybody gets those, and your children will find a way. Concentrate on the risks that will kill them or seriously injure them: motor vehicle accidents, drowning, fires, poisonings, and gunshots. Don’t go out of your way to buy things that will hurt them, such as trampolines and ATVs. Make it so they have to get creative if they want to injure themselves. Creativity is good, right?

Domesticated Momster
The Blogger's Pit Stop

The Trickle Down Theory of Bigotry

kids with instruments-01Enough.

I  know it’s been an interesting ride. We’ve never seen a political candidate like Donald Trump before. He gives vent to the inner two year old, the child who knows he’s better than anyone else and doesn’t let logic, truth, or empathy get in his way. He wants what he wants, and he will say and do whatever it takes to get it – classic two year old behavior. Watching him is like spending a day at the circus.

The problem is that he is a bully, a liar, and a bigot – traits which spit in the face of American ideals like equality, opportunity, and freedom of speech – and our children are watching. When our children see us supporting him for the highest office in the land, they might reasonably believe that we think bullying, lying and bigotry are acceptable.

They are not.

In a speech on caucus day in Cedar Rapids, Iowa, Trump told his audience that he would pay the legal fees of followers who beat up protesters at his rallies.

After two brothers in Boston who beat up a homeless Latino man said that they were inspired by Trump’s anti-immigrant message, Trump suggested that the men were well-intentioned and had simply gotten carried away. A two on one well intentioned beating?

Last November, Trump supporters attacked an African-American protester who was chanting “Black lives matter.” They hit him, knocked him down, and continued to kick him after he was on the ground. Afterwards, Trump suggested that their behavior was justified. “Maybe he should have been roughed up,” he was quoted, “It was absolutely disgusting what he was doing.”

Hmm.

It reminds me of the sixth grade bully, gathering his friends behind him to beat up the unpopular kid, then trying to shift blame to the victim.

The Washington Post wrote that “Trump in this campaign has gone after African Americans, immigrants, Latinos, Asians, women, Muslims and now the disabled.” He physically mimicked Pulitzer Prize-winning journalist Serge Kovaleski, who suffers from arthrogryposis, a congenital joint condition that affects the movement in his arms.

Can you imagine sitting in the Principal’s office, hearing that your child had done such a thing?

How are we to explain to our daughters that brains, talent and hard work are more important than breast size when the man we are considering for president says that “it really doesn’t matter what the media write as long as you’ve got a young, and beautiful, piece of ass.”

Last, most of us agree that teaching our children not to lie is an important part of parenting. Mr. Trump’s truth rating on the Pulitzer prize winning site Politifact is 2%.

According to the Southern Poverty Law Center, teens in Merrillville, Ind., at the predominantly white Andrean High School recently chanted “Build a wall” at their counterparts from predominantly Latino Bishop Noll Institute during a basketball game. Similarly, fans of Elkhorn High School in Wisconsin chanted “Donald Trump, build that wall!” at a girls’ soccer game against Beloit Memorial High School, whose team is largely Latina or black.

A survey of 2000 K through 12 teachers done by Teaching Tolerance reported an increased anxiety level and an upswing in bullying, harassment and intimidation among kids inspired by the appalling misbehavior throughout this campaign.

A kindergarten teacher in Tennessee wrote, “a Latino child—told by classmates that he will be deported and trapped behind a wall—asks every day, “Is the wall here yet?””

The “trickle down” theory of bigotry and bullying. If my parents admire this man, and this man says that Mexicans are rapists and women are disgusting animals, then it must be all right for me to think that also.

Most of us do not dream of our children growing up to be bullies and bigots.

Dr Martin Luther King said it better than I ever will:

The ultimate weakness of violence is that it is a descending spiral, begetting the very thing it seeks to destroy. Instead of diminishing evil, it multiplies it. Through violence you may murder the liar, but you cannot murder the lie, nor establish the truth. Through violence you may murder the hater, but you do not murder hate. In fact, violence merely increases hate. So it goes. Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that.

So, enough. Remember the basics: respect for our fellows, equality, honesty, justice…

Your children are watching.

Domesticated Momster

Top Ten Tips for Summer Vacation Success

skateboarder-01School’s out! Time for the Family Vacation. So how do you have fun without going insane? I, of course, have my top ten tips:

10. Pack a simple medicine kit: don’t waste a day of vacation at the doctor’s office, refilling the prescription you forgot at home. Take:

  • any prescription meds your child sometimes needs, even if they haven’t used them in a while (asthma and allergy meds come to mind)
  • frequently used over-the-counter stuff: acetaminophen or ibuprofen, an antihistamine, insect repellant with DEET (the other stuff really doesn’t work, and insect borne encephalitis is unpleasant), sunscreen, and hand sanitizer
  • basic first aid supplies (band aids, gauze pads, tape, antibiotic ointment, cortisone cream, alcohol, tweezers, scissors, thermometer)

9.  Write out a budget before you go. I know, I am a fun sucker, but it has to be done. Know how much money you have and where you plan to spend it. Give the kids an allowance for souvenirs. They will be more careful with money they consider their own, and they will not be constantly asking for things. “Can I have that?” can be answered with “Sure, it’s your money. But are you positive that is where you want to spend it? There might be something better later…” Also, knowing how much you yourself have to spend will save you stress and regret later.

8.  Keep to healthy foods most of the time. (Here I go, sucking out the fun again!) Kids will have more energy, feel better and have a better attitude if they are nourished. And it’s cheaper. Have a basket of fruit available, some whole grain crackers, cheese, peanut butter, popcorn – food with nutrients. Don’t waste valuable vacation time sitting in the drive thru line and arguing over food.

7.  Keep to established routines when you can. Bring along a book for that bedtime story, keep bed time the same, set aside time for their bath. Kids don’t always deal well with change, and vacations are all about change. A few familiar routines will help them feel less stressed. And a full night’s sleep is an absolute necessity if you don’t want an emotional wreck for a kid.

6.  Keep an eye on the little ones. You are in a different environment with new dangers. Distractions abound. Kids on vacation get lost, or get into Grandma’s meds or the local pool. Check out my summer safety tips.

5.  Find interesting things to keep their brains busy. Bored kids whine, and then they find their own version of interesting things. Have a stock of books, games and videos for the car. Bring a journal for them to write in, and art supplies. Explore the area you travel to – Google it before you go. See the sights, hit the museums, find the local artists and craftsmen. Check out ideas to abolish summer boredom.

4.  Keep your own mind open to new and different ways of doing things, so that your kids will do the same. Kids internalize their parent’s judgments, and they will close down their minds and wipe possibilities out of their lives if that is the example you set.

3.  Keep them physically active as well. A tired kid is less stressed, sleeps better, and is not sitting around thinking of ways to get into trouble.

2.  Keep stress to a minimum. Use a GPS if you’re driving: arguments with the navigator have ruined many a vacation. Keep your expectations in line with the actual possibilities, to avoid disapointment. Don’t overschedule – leave time for that relaxing hike and to have a conversation over dinner. Stay within your budget – your hindbrain will know you are overspending and your stress will mount. Stressed out people snap at each other and cannot enjoy time or family.

1.  Align your vacation with your priorities, then toss out the rest. What are the goals of this vacation? Relaxation, family time, memories, enrichment, joy? Plan the vacation and activities that will get you there, and don’t let exhaustion, stress, and fear get in your way. Don’t stop at Uncle Joe’s house if you know he will stress you out; don’t vacation with those friends who overspend or forget to pay their half of the bill. Don’t worry if the kids are getting dirty or if your Aunt Judy wouldn’t approve. Just say no, open up, and relax.

And have a fantastic vacation!

4th of July Safety: Tips from the Doc

safety signSunshine, water, and fireworks. What else could you need? To avoid the ER afterwards!

Oddly, most 4th of July injuries actually have nothing to do with fireworks, and everything to do with parents being so busy that they are not as watchful as usual. Sports are more dangerous when we want to impress cousins. Teenagers tend to get more reckless during a celebration, and young children sneak away quickly.

Most injuries are from everyday activities and household objects made dangerous by the craziness. So,…

Top Ten things that will land you in my office after the fireworks:

1.  Drowning: The 4th is all about water. Every year pediatricians see drownings and near drownings on the 4th. Never leave any child alone for even a moment near open water, whether it is an ocean, a bathtub, or a water bucket.

All it takes is one moment of inattention for a child to slip away. If there is open water, you need to be within touching distance and focused on your child. Pools should be fenced in and closed off with a self-latching gate at the end of the day, and all the toys should be put away. Life vests are fabulous for a parent’s mental health and relaxation (swimmies and floaties are not life jackets). Life preservers and a shepherd’s crook should be placed obviously nearby wherever kids are swimming. For more tips on water safety, check out my summer safety tips.

2.  Fireworks: I know, it’s obvious, but it had to be on the list. Please leave them to the professionals. It’s not worth months in the burn unit and doing physical therapy.  No-one thinks it will happen to their kid, until it does.

3.  Choking: Toddlers will put anything in their mouths. This means that everybody needs to pick up his or her stuff. Items over 1¼ inch in diameter are generally safe. Items smaller than 1¼ inch can go straight into their gut or lung. The most dangerous items to swallow are button batteries and magnets; the most dangerous to choke on are grape sized (older children’s toys, hard candy) or stretchy (balloons, plastic bags, marshmallows). Clean up!

4.  Allergic reactions: Holidays provide a banquet of things to irritate children’s allergies. Plants, foods, cigarette smoke, bonfires and other people’s homes and pets come to mind. Avoid them if your child has allergies.

5.  Fires and electrical injuries are especially common during holidays. Decorations can be flammable, candles and fires are commonly nearby. Frayed and loose wires easily start fires. I have had an astounding number of children run through banked campfires after dark. Block them off please!  Keep your eyes open for dangers.

6.  Poisonings: The one I see most is an overdose on Grandma’s meds. At Grandma’s home they are left on countertops; at your home they are in her purse. A left over drink is also a common way to poison children. A little alcohol can drop a child’s blood sugar and throw him or her into a coma.

7.  Alcohol inside the grown-up: does this really need explanation?

8.  Dehydration/Food poisoning: Watch their intake. It’s hot and the kids are running around in endless circles. Bring lots of water (the stuff mother nature made for you, not the stuff with caffeine and sugar added). Food left out in the heat for hours can grow things that cause vomiting and diarrhea. If you don’t know where it came from and how long it’s been there, don’t eat it.

9.  Scarce common sense: If it doesn’t seem safe, don’t let people pressure you into it. Make them wear that bike helmet! Trampolines and motorized vehicles (Sea Doos, dirt bikes) are never a good idea.  Feel free to let watching your kids take precedence over seeing Uncle Joe’s trophy or Aunt Mary’s vacation photos. “He’ll be fine” doesn’t make him fine. Keep an eye on him.

10.  Politeness: Feel free to be rude and head for home when the kids get tired, if a situation feels out of control, or if your child is being exposed to something you aren’t happy with. Use the munchkin’s youth or fatigue as the excuse for you to head home, relax and read a bedtime story.

The point of celebrations is to solidify relationships and give hope for the future. Focus on family, rejoice in the day and be careful.  Keep plans simple, pick fewer things to do, and do them together. Be safe and stay healthy.