On the Ground Kid strategies

Navigating the Edges of Intuitive Eating

/ Dr. Heather Kim, DO / Leave a comment
Stock photo Dreamstime

I woke this morning with this curiosity around the edges of my child’s eating.  Like many of you we use an intuitive model of feeding and eating ourselves.  We follow our child’s lead and expand what works and are thoughtful about what we bring into the house and work to set an example through our own food relationships.  Children’s texture tolerances typically grow developmentally with age and in alignment with their temperament.  Trying new food is a risk and some kids are simply going to be those adults who look at food risk and think nope.  They will have a smaller array of palate and there is nothing wrong with this when it is balanced with nutritional awareness.  So understand when I say navigating the edge, I don’t mean pushing a kid towards a culturally or familial idealized variety of eating.  I mean exactly this, staying curious.

What I noticed and why I am writing today is this:  I had retreated from the edge of my child’s eating.  As the head chef in our home, I had pulled back from the edges of variety because it was safe and I simply lacked energy to face the apprehensive, “Mom what is this?”  Any chef will tell you, seeing someone joyfully ravishing your food is worth all the gold in the world.  And when someone, even your own child acts like what you’ve cooked is poison, as a food artist this hurts at a level.  

So what I am wondering is this:  What if I can pull up and out of my need to please and occasionally (likely not every night or there will be a riot), offer something he’s never seen? What if in choosing to make this a conscious and mindful choice for us both we could have an entirely different result than the past? And letting my child know this risk I am asking of him is actually MY need as an artist, not that there is something inherently wrong with his eating.  Any food artist knows that cooking the same menu all the time gets BORING and a burnout can happen. 

So today I stand in this current truth:  As a mother, I have as much responsibility at my child’s edges as I do at his comfort level.    Rich and complex human interrelating requires knowledge of both these territories and the wobbly spaces in between.  I can tell you in even considering this experiment, there is a growing excitement in me as to what foods/dishes will represent this edge.

Toddlers and Tin Cans

/ Dr. Heather Kim, DO / Leave a comment

Sean Locke/ Istock

I have seen more horrific finger lacerations from improperly opened canned foods than I can count.  It happened again this week.  It’s usually the same story.  Mom is busy cooking dinner.  Curious toddler finds the recently opened can in the bin.  The lid is still partially attached.  Mother hears the child screaming as the initial laceration injury occurs. Then in the panic, as the can is pulled away, the attached lid severs the child’s trapped finger(s) further in what could be described as an incomplete degloving injury. The result is a deep peeling of the flesh from the surface of the digit analogous to the removal of a glove.  This week it was multiple fingers.  Sometimes they get lucky and it is only one.  As a health conscious family we do not eat a lot of canned foods but our Trader Joe’s coconut milk and cream both come in tin cans.  I am and I urge you to be very cautious in the disposal of these types of cans.  For the very safety conscious family I highly recommend the smooth edge type of can openers.  The one I linked to is only about 12$ on Amazon.  This takes all the worry out.  There is a slight learning curve to using it but once you get the hang of it there isn’t much of a difference from the regular can opener.  Another trick I employ when using a conventional can opener is to completely remove the lid.  Rinse the can and then carefully poke the lid (with a tool of your choice) to the bottom of the tin can before burying it in the recycling.  You’d basically have to use a knife to the lift it back up and out of the can.  The top edge is still sharp but the guillotine potential has been removed.  It is really the trapping of the finger between those sharp edges that causes the worst injuries.  Also remember it is important to teach your caregivers as well.  I found a tin can in guillotine confirmation that the sitter had opened.  If older kids in your household are opening cans I would highly recommend the smooth opening type tool.  It could save a finger or at least an unwanted trip to the urgent care.  

If you are ever faced with this type of injury.  Rinse the wound immediately and then apply pressure.  Keep the pressure.  Don’t be tempted to peek.  Small arteries can be involved.  Seek immediate care.  

Top 10 Items in my First Aid Kit

/ Dr. Heather Kim, DO / 4 Comments

first aid

Summer is here and in the pediatric urgent care I have begun to see more soft tissue injuries, broken bones and lacerations. While kids are out of school they have markedly more freedom to explore and with this they find creative ways to injure themselves.  It is important to have first aid supplies ready. I am going to share the top 10 items in my first aid kit and what I include for my family’s long trips away from civilization.  Please know the ready made first aid kits they sell in stores are overpriced and often fail to contain important items.

  1. Liquid Benadryl

  2. Decent tweezers

  3. Bacitracin ointment

  4. Peroxide/alcohol mix

  5. Epsom salt

  6. Ace wrap *velcro type

  7. Telfa

  8. Coban

  9. Hibiclens

  10. DoTerra Lavender Essential Oil

1.benadryl

Benadryl liquid (generic is fine) is top of my list especially if we are going back country. Blame my likely too early exposure to My Girl that awful movie where the little girl dies from an anaphylatic reaction to bee stings. Literally if someone could have immediately gotten a teaspoon of Benadryl into her she might have lived.  Anaphylaxis happens more often today than it ever has in the past. The risks are real but the immediate treatment if you don’t already carry an EpiPen is oral diphenhydramine.  If you can’t figure out the dose remember this: 1 tsp for a little kid and 2 tsp for a bigger kid is a great place to start.  2tsp is equal to one adult 25mg capsule if that helps you to do the emergency calculation.  I got stung by a large black scorpion deep in the back country of the Grand Canyon and Benadryl made a nice difference in my ability to breathe easier.  I still got sweats and nausea but at least I could breathe.

2.tweezer

Good tweezers made the list from another fun story of my own life in which I had taken the four year old hiking at Enchanted Rock State Park.  Despite my best efforts of telling him to stay on the trail he meandered off.  I heard such a shriek that I thought for sure he had been bitten by a snake.  Instead he turned back towards me and looked like a pin cushion.  God bless the Texas Prickly Pears.  I had my Swiss Army knife and if you have ever had to use the tweezers from it to pull thousands of microscopic cactus spines from a screaming kid you will understand why “good tweezers” made my top 10 list.

3.baci

I am not crazy about Neosporin nor triple antibiotic ointment.  My husband is sulfa allergic and triple contains a sulfa antibiotic and so we don’t carry it.  Also kiddos can be sensitive to the Neomycin component of Neosporin.  A safer bet is plain Bacitracin.  This is a narrow spectrum OTC antibiotic ointment that does a great job on the typical skin flora invaders.  This will not help MRSA.  So if you have a known MRSA+ history best to carry Rx Mupirocin.

 

4.alcoholPeroxide

I carry a tiny little squirt bottle of 50/50 peroxide and rubbing alcohol to sterilize equipment like my tweezers and in the summer time to help ear canals.  In my Swimmer’s ear blog I discussed that this condition is preventable but you have to clean the ear canals right after swimming.  I have witnessed many a river camping trip ending in the urgent care with painful rotten ear canals.

 

5. salt-on-wooden-spoon

Epsom salt.  Yes I actually carry it in a zip lock bag.  Foot puncture wounds do well to be soaked immediately.

6.acewrap

In the old days Ace Wraps had these miserable toothy clips.  Now days they are equipped with Velcro (ie hook and loop) closure systems.  These are inexpensive and worthy item to have in your kit. Can also be used as a tourniquet/compression above an arterial bleed. Familiarize yourself with wrist and ankle wraps as they are most commonly injured extremities.  Learn how to check for perfusion in the extremity you wrapped.  https://www.youtube.com/watch?v=WwhFALn7DN4

7.telfa

Telfa or non-adherent pads are way better than band-aids for dressing open wounds.  The last thing you want to do is accidentally peel off the healing that the body has already done.  It is also incredibly painful to remove sticky band-aids from a flesh wound.  But you may be thinking, how is this going to stay on an active kid?  You hold it on with Coban.

 

8.coban

Coban is amazing. This stuff is flexible (great over knees) and sticks to itself like Saran Wrap. Plus it comes in many fun colors. Best price is Walmart for this and most of these items. You wash the wound with your Hibiclens and flowing water, air dry then add a bit of bacitracin ointment to the Telfa pad/wound and then cover the area with Coban to hold it all in place.  Works amazingly well and is super easy to change/remove.

9.hibaclens

Hibiclens does not sting yet it really works.  That is why I love this soap.  Studies have shown that wounds cleaned with fresh fast moving water and soap do better than any other form of torture a parent can come up with.  I swear by this stuff.   We use this as prep before suturing large open wounds.  No child has ever complained to me about this soap.  We also use it for soaking ingrown toenails prior to procedures.  A small bottle is sufficient as a little bit goes a long ways.

 

10. lavender

I travel with lavender essential oil.  In reality I travel with more EO’s but this one made my top ten for the first aid kit.  This stuff has great anecdotal evidence for everything from bug bites/bee stings, allergies to abdominal cramping.  It is also a great gentle cleanser. The 2007 data in the NEJM regarding Lavender causing precocious puberty should be approached with some careful consideration.  Indiscriminate use of any EO can be harmful as they are powerful medicines in their own right.  Especially one that has known estrogenic effects.  However, small scrupulous use on a bee sting is very different than slathering a young boy’s body (ie entire surface area) daily with lavender lotion.

 

Swimmer’s Ear

/ Dr. Heather Kim, DO / 1 Comment

July is here and summer is in full swing and swimming is a must!  As summer begins we start to see a lot of kids with ear trouble.  Swimmer’s ear is the common name for an infection/irritation of the external ear canal due to bacteria in the pool, river or lake we’ve been swimming in.   Sometimes the irritation is simply due to the dryness that occurs to the sensitive skin of the ear canal.  Ever notice how the skin on your legs can get dry after a dip in a chlorinated pool?  The same thing can happen to the delicate skin of our inner ears. Swimmer’s ear can range from being a slightly uncomfortable itch to a downright painful problem for our kids and ourselves.  Prevention really is worth a pound of cure on this ailment.  A simple and effective way to prevent a severe external ear infection is cleanse/dry the ears with a 50/50 mix of rubbing alcohol and hydrogen peroxide.  I tested this on Julien (4yro) thinking that he’d be the most sensitive in our household.  Julien had water trapped in his ear canal from swimming and I knew this concoction can help dry ears as well.  He was so happy and thankful that I tried it on myself and it burned me like crazy! Turns out I have the most sensitive ears in our family.  I was running around the house holding my ears as he stared at me.  Further proof that we are all unique.  For me and the other ear sensitive folks out there I like to cleanse my ears with peroxide alone and have gotten good results.  The only way you’ll know what works for you and yours is to experiment.

 

 

The way that you get the drops into the ear is to dip a clean Q-tip in your chosen cleansing drying agent and then apply each end to your respective ear canals once.  As the bubbling or the burning in my case subsides I recommend that a small amount of virgin pressed coconut oil  (antiviral/antibacterial) be applied the same way to another clean Q-tip and the canals be moisturized.  Remember the dry legs after swimming?  Your ear canals can be as well.  Especially after applying a drying agent.

Ideally this regimen would be performed after each time you go swimming.  Who has time for that right?  For kids that have chronic issues with swimmer’s ear, it’s better in the long run to make time. Since we don’t have any chronic ear issues this season, we simply use this procedure for trapped water sensation.  Works like a charm!  For myself I’ve noticed there is a preliminary ear canal itch that is an early indicator that my ears are in danger.  If I use the mix even once a day for 1-2 days as soon as I notice the itch I’ve been able to stave off bigger infections.  And with the coconut oil added to the regimen I was actually able to treat a pretty nasty river external ear infection in myself.  If none of this is helping go to the pediatrician or your doctor.  Or if you know me personally come over and we can take a look together!  Happy swimming and happy 4th of July.

 

***Update*** We recently had an impressive swimmer’s ear at our house and successfully treated it with apple cider vinegar mixed in a 1:1 ratio with warm water.  I used a 5mL medicine syringe and then just applied 3-4 drops to ear ear with a 1 minute wait after drops were applied.  Then using the blow dryer on the COOL setting dried ears completely.  In 24hrs we had mild improvement.  By 48hrs we had significant improvement in both pain and appearance of the ear canal!  Just another DYI healing approach.

Natural Mosquito Defense

/ Dr. Heather Kim, DO / Leave a comment

Trying to figure out how to defend against mosquitoes naturally has been an ongoing experiment at our Texas home.  Thanks to a ton of rain this spring we’ve been able to do plenty of testing. Skin So Soft by Avon has been studied head to head against DEET and has shown itself to be ~85% as effective.  It just needs to be reapplied if you are outside longer than 1-2 hours.  Skin So Soft bath oil (***not the bug spray kind they sell at stores as it contains other types of chemicals that the EWG is unsure about) is the base of my current mosquito mix.  It stinks and mosquitoes hate it which makes me pause and wonder what is in this stuff?  But then my next thought is whatever it is cannot be worse than the neurotoxic effects of DEET on a small child.  My child has super sensitive skin and this oil has never even caused him a rash and does seem to soften his skin.  Now days I boost my SSS (skin so soft) with an essential oil mix.  I had originally started using Nature Shield a few years ago after reading reviews of a woman who successfully used this blend on a trip to a malarial area of  India.  Her review and thousands of others were super positive but it simply did not work alone for us.  I’ve also tried countless herbal/natural mixes from Central Market.  None worked.  They smelled nice and the mosquitoes seemed to actually like them too.  SSS is super oily and so to help make the mixture more pleasant to wear I cut it with witch hazel.  This also makes it easier to spray.

 

 

Mosquito Defense Spray Recipe

1/2 c Skin So Soft Bath Oil

1/4 c Witch Hazel

10 drops of Nature Shield

3/4 c distilled water (if the mosquitoes are awful you can keep it more concentrated)

shake well and spray.

I usually apply it to my hands and blot it onto his face to prevent getting it in the eyes.

 

fan

This spray combined with the wind method has really kept our mosquito bites to a minimum this year.  My husband found out that mosquitoes cannot land nor bite in winds >5mph.  That is not much of a  wind which explains why with even with a slight breeze the mosquitoes are much less of a nuisance.  We use carefully placed fans in our play areas which have really helped keep the skeeters off and it feels nice in the hot Texas summer.  I plug in the fan on our back porch to keep them off while I’m washing the dog or hanging out laundry.  Noisy but they work.  If we are outside at skeeter feeding time (early am/dusk) we usually do wear linen pants or cotton tops to help as well.  At my age I like the added sun protection on my arms when I’m working in the garden.

Another important fact about mosquitoes is they don’t have much wanderlust.  So clearing out any standing water in your own yard and encouraging neighbors to do the same can help keep the population lower.  It’s worth a walk around after a rain to check planters and other containers for standing water.

So in conclusion standing water prevention, DIY skeeter spray, wearing linen and your own wind are the most effective and totally natural ways to avoid skeeters this summer!

Email questions or comment below about any of these strategies.  Look forward to seeing you outside!

 

 

Outdoor Kid Cleaning Station

/ Dr. Heather Kim, DO / 1 Comment

CYMERA_20160619_105512 (1)

This is a photo of my hot tub.  Yep.  Into this simple and sleek design we can actually cram our entire family (2 adults and a kid).  We use Epsom salt so that as the water cools we can run a hose to drain the water onto my roses (they like the Magnesium in the Epsom salts).   The most immediate reason this particular hot tub came into existence in my yard is because our 1951 indoor bathtub is super shallow.  Not awesome for soaking much other than your bum.  I believe in the soaking method for relieving muscle aches and relaxation.  So I began researching online and found some seriously inspiring versions of the Cowboy Hot Tub.  (Google it.  You will be amazed at the variety.)  The deeper roots of this concept of outdoor backyard washing belong to my maternal grandmother Hazel.

Hazel raised eight kids on a farm in Wisconsin.  By the end of chores, bailing hay, gardening and playing her kids were happy and filthy.  It was not uncommon for her to run warm water from the milk house to a wash tub outside for the kids to bathe on summer nights.  In my era (as she raised me some as well) it was often a small baby pool filled with bubbles.  In my farm kid mentality it is completely normal to have hot water plumbed outside.  It’s how you wash the milkers, pails and your dirty kids so they don’t mess up your white tub.  So as soon as we moved into our home here in urban San Antonio I had a handyman come and plumb a hot water faucet outside.  It cost me about 75$ and some super weird glances from the guy I had hired.  Then I found this particular cattle tank on Amazon for about 125$.  This may sound like a huge investment but when I build a fire on a winter night and fill this baby up and soak I could be at the finest resort in the world.  Stars overhead with some great Indian Temple Incense burning.  Heaven.  Wait…this is not the point of this blog.  This is a pediatric tub!

In all seriousness having a warm fun place to wash a filthy kid helps us to relax a little about them getting dirty.  Let me say this more authentically.  It helps a type-A Mom like me let go a little about mud, sand, dirt, stickiness etc. all the necessary gooeyness that is part of a thriving childhood.  And all the water that would have gone down the drain on my kid’s bath has been reclaimed for watering flower beds.  Gold star for conservation!