Toddlers and Tin Cans

Toddlers and Tin Cans

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

Top 10 Items in my First Aid Kit

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


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.


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.


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.



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.


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.


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.



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.


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.


Epsom Salt Baths

Epsom Salt Baths


Epsom salt (Magnesium sulfate) is one of the most inexpensive natural healing agents that one can buy at the grocery store.  This is a timeless treatment that my own grandmother used for a laundry list of ailments and injuries during the 98 years of her life.  I am a member of an amazing Facebook group called the Crunchy Moms of SA.  You can bet if someone asks a question to the group about a regular sick kid a following comment will mention Epsom salt baths.  I love intuitive medicine. In addition, I have this science nerd that lives in my head and always wants to know well now how does that work exactly?

It is very interesting that for more than a century folks have claimed a detoxification effect from Epsom salts.  Recently there has been much debate about the data on the common methylation defects that are emerging from the human genome project, specifically on the many MTHFR SNPs.  These folks, myself now included, have many associated vitamin defects.  These single nucleotide polymorphisms can lead to any combination of calcium, magnesium (Mg), zinc, N-acetyl cysteine (NAC), glutathione, iron and vitamins B1, B2, B12, D and folate deficiencies.  Methylation is not only important for our vitamin synthesis.  It is one of the bodies main avenues of detoxification and to make matters worse many of these vitamins act as co-factors and regulators in the processes.  Way back in 1992, Molecular and Cellular Biology published an article where Mg deficient rats had significantly elevated inflammatory markers (IL-1, IL-6, TNF-α) and went on to develop significant cardiac lesions.  Current research has expanded the role of magnesium as anti-inflammatory and immune modulator.  So what does this gobbledygook have to do with Epsom salt and your kid?

For a kid with a typical short-lived virus (fever <72hrs) and its associated acute cytokine driven inflammation an Epsom salt bath can provide a safe anti-inflammatory effect via magnesium’s effect on the cascade.  For a kid with any combination of MTHFR SNPs and an impaired ability to clear drugs this type of bath is a safer way to gently bring down a temperature and relieve the suffering of inflammation.  Also there is the extra bonus that the bit of magnesium absorbed can safely bring them towards better cellular levels and immune function.

I like the skin as a barrier and filter for supplementing children.  Oral supplementation is tricky and often requires bloodwork to be done properly.  Where in a bath the skin acts as a filter so that too much magnesium is not absorbed too quickly causing side effects or disrupting calcium balance.  Adults are to add 1-2 cups of Epsom salt to a bath and to soak for 10-20 min.  A small child is to use proportionately less.  I usually recommend a measured  ½ cup to a full bath.  Using too much Epsom, too little water, staying in too long, or doing this too often can result in lethargy and diarrhea.  I want to add this warning. Though many of us already have learned the hard way not to put a kid with diarrhea in any sort of bath, for first time parents trust me don’t do it.  A shower is a better choice.  Especially do not put them into an Epsom salt bath as the absorption of the magnesium will worsen the diarrhea.  Magnesium is a well-known laxative.  For children under 1 year of age I would consult with your provider.


My grandmother passed away this past year.  I can feel her presence as I write this particular blog.  The same woman that taught me the incredible beauty of maternal intuition and common sense also taught me to question everything.  This article is very much in her honor.

Food Delight

Food Delight


Over the past years I have met many different children and their families who have found eating to be an adversarial part of their lives.  As someone who truly loves food (maybe even too much) I feel for these children and their families.  Eating is an valued act in many cultures. Unfortunately eating issues are complex.  Often many factors have led to a child not enjoying eating.  Chronic allergies causing food to lose flavor, anaphylaxis leading to the fear/awareness that food can kill, gut dysmotility, gut inflammation, sensory integration issues, trauma from a choking event and these are just a few on a mountainous list of reasons why a child may not enjoy eating.  Children often out of fear will become extremely restrictive in their eating.  As a parent with nutrition knowledge it is terrifying to watch your kid eating the same three foods day after day.  Meals become stressful for everyone involved.  Food delight is eventually lost for all involved.

I have recently been coaching on this concept of food delight as a likely healing pathway.  I would argue that food delight has been lost for many Americans as a whole.  The concept of savoring each bite of our supper seems absurd in our busy lives.  I was reading Thich Nhat Hanh’s Savor: Mindful Eating, Mindful Life and came across what he calls The Apple Meditation (chapter 2).  Even with my own mindfulness practice I can tell you I cannot remember the last time I actually savored an apple.  When he suggests to smile at the apple prior to biting in I actually laughed out loud.  But why do I find this hilarious?  Is this revered teacher being ridiculous?  Or is it that my own American lifestyle has me too busy to slow down and find the pleasure that is available to me in the beauty of the apple itself and in each bite I take?  What is my relationship with pleasure in general?  Eek.  Cricket. Cricket.

Pleasure and enjoyment are absolutely contagious.  This way of creating desire is what the entire American advertising industry is based upon.  The folks in the commercials aren’t just bored with their new phone or car.  They are loving every second of it.  So that we might as well…

My simple theory is we can all benefit from more food pleasure.  More mindfulness can provide actual enjoyment if we stop ourselves long enough to create space for the experience of eating.  Food pleasure is contagious even to the most picky of eaters.  Make food that is beautiful and delicious to you and your family.  Show pleasure when you eat and describe what you are experiencing to your child.  They may not jump right onto that broccoli but I bet you will at least have their attention when you begin describing the pleasure you get from its funny shape and brilliant green and the crunchiness.  Man…now I want some broccoli.  I’m telling you.  Ham it up.  It’s ok to be over the top with this.  It’s ok to feel totally silly.  But if your picky eater starts adding foods to their favorite three by you having fun and enjoying yourself wouldn’t it be worth it?

The apple in your hand has the body of the Cosmos.

-Thich Nhat Hanh

ebook available for download at the San Antonio Public Library







TCM Mother-Child: A personal experience

TCM Mother-Child: A personal experience


In Traditional Chinese medicine (TCM) there exists a concept called mother-child.  This is the idea that a mother and a child cannot be dealt with separately with regards to their health.  Beyond pregnancy, beyond the original physical bond between mother and child there is the continued existence of mixed qi (chi or vital energy) for many years.  This mixing of energy is true for anyone who comes in contact with a young child but as mothers we have a particularly powerful influence over the health of our children.  When I first read about this concept it hit me hard how we have entirely missed this simple common sense principle with Western pediatrics.  Likely because it is difficult to test and there is no money to be made with the results.  But if you are willing to make this jump, that a mother’s energy can affect a child’s health on an intuitive basis, a world of healing can open to both physician and mothers alike.  I’m up writing this tonight because I believe this principle blended with other holistic concepts helped us stave off an illness.

In TCM Children are susceptible to external pathogens much like they are in Western medicine.  I will use this recent pathogen as an example.  Julien (my 4 year old) woke 2 days ago with sore throat and fussiness.  Our nanny has had something similar prior to him and so have loads of kids I’ve seen at work.  Clearly there is a physical virus at play.  My first impulse was to soothe his pain with ibuprofen but as I have learned from my study of TCM this is one more thing an already deficient body must clear and so I made him warm tea with honey and boosted him with Gaia Kids Immune Support.  With TCM the most common reason a pathogen takes hold rather than being expelled is that the child is somehow qi deficient.  We had just taken an exciting camping trip and came home wore out.  So I gave him a warm breakfast and kept him more bundled than usual to prevent further invasion from the cold weather that had come in.  With the concept of mother-child I have learned that I have the ability to donate qi (healing energy) to my suffering child.  I can do this by snuggling, reading, singing and simply being present and nurturing.  Of course I had to go to work but I encouraged the nanny to do the same.  Cue the crushing feeling of leaving my sick child to go to work.

So today I was off work and J started to develop a low fever.  Where normally we would lay in bed and watch shows snuggling we had very minimal television.  TCM states that TV drains kids.  Again these are things that we may all know instinctively but I have never seen them applied to a viral illness.  So no TV, no ibuprofen, instead we just read books and did some light drawing and importantly we snuggled and took a nap!  I had to bribe him as he is NOT a napper.  Throughout all of this I stayed focused on the concept of giving to him with the purpose of healing/boosting him up.  I laid with him and gently rubbed his back and interestingly he told me that it was helping him feel better.  He sweated intensely during his nap and woke up fever free.  Then his dad surprised us and came home early from work and poured more love into him.  Julien had been missing him intensely since the short vacation ended.  My husband is a resident.  Kids of residents can always use extra qi/loving.

According to TCM as parents we can actually donate energy (qi) to our children when they are deficient to help them heal…if we have extra.  There are times in our lives where we are so depleted that we can barely function ourselves let alone have extra for others.  I’ve been there as well. There is no perfection in mothering.  There is simply this moment wherever we are.  It isn’t as though prior to studying TCM I would have simply ignored my sick child.  Awareness is powerful though as well as intention.  My clear intention was to pour qi into Julien for healing purposes and to boost his own.  In the end there is no doubt that he has immunity to this strain of virus.   However thanks to TCM I now have a better framework of what immunity is and how I can play a conscious part in it for my child’s health.



Bronchiolitis: The Cough that Won’t Quit

Bronchiolitis: The Cough that Won’t Quit


Cough and colds plague this time of year.  At our practice bronchiolitis has been the main diagnosis the past two months.  This is an illness that comes every year.  Despite causing more deaths annually in young children and the elderly it gets less attention in the media than influenza because there isn’t a safe or cost-effective vaccine available for the general population (currently a subgroup of high risk premature infants are vaccinated for RSV only).  Terrifying right?  Yet a second grader with this illness may look like they have allergies with no fever and play normally!  If your school-age child has a runny nose this time of year please be cautious with contact with young infants.  I often hear Moms declare their child has allergies as the kid coughs their brains out spraying virus everywhere.  Just because a child doesn’t have a fever doesn’t mean they are not contagious.  To Moms of young infants keep your guard up.  Wear your babies.  Don’t let school-aged kids kiss them or touch their faces or hands.  You’re not being a jerk.  You’re acting as a part of their immune system.  To breastfeeding moms don’t wean in the winter if you can help it.  Just wait until spring when this bad boy has passed us by.  If planning a pregnancy make a summer baby!  It’s a safer time of year to be tiny.

Often what we see this time of year is a mixed picture of some typical respiratory viruses. Let’s focus on the illness called bronchiolitis.  Ie the cough that won’t quit.  It is the manifestation of one of typically three respiratory viruses (parainfluenza, respiratory syncytial virus and human metapneumovirus).  They make their way into our respiratory tracts this time of year causing few symptoms in those who have been previously inoculated (young school children, older pediatricians, teachers, Moms) and causing moderate to severe symptoms in those who have never danced or forgotten how to dance with these guys (young infants, teenagers, elderly).  Your typical second grader is a pro with this illness.  They likely will have no fever and appear to have some mild allergies.  That same viral syndrome in a young infant can result in a stay in the hospital for respiratory distress or 103+ fevers in a 3 year old.  Those prone to inflammation such as children with histories of wheezing and/or eczema are also vulnerable to more severe expression.  At baseline these children have a tendency towards the inflammatory pathways and this type of illness causes marked inflammation to the smaller airways (bronchiol-itis) which is where the name comes from.  These kids get an amplified inflammatory response which results in worse than average bronchospasm.  Also these kids have slightly thicker phlegm at baseline which can result in respiratory plugging and also make them more prone to secondary bacterial infections such as ear infections and pneumonias.  When we attempt to support a child with this illness it is all about the the phlegm.

Such a gross word right?  Phlegm.  Make it your friend.  When your child is sick with bronchiolitis/cold symptoms this is who you are working with to heal your child from the inside out.  Down in our respiratory tracts there are these fingers that are working to slowly lift gunk up and out of our lungs (cilia) via the phlegm.  Now if your secretions are like glue it makes their job a lot harder.  If the snot is thin and fluid their work is much easier.  The body will heal the cold.  My goal with my own child is to avoid antibiotics unless absolutely necessary.  Secondary bacterial pneumonia and ear infections which could require their use are more likely to form in thicker phlegm because the immune system has a harder time getting to where the bad guys are at.  Think of the native immune system rushing in with their Hummers but they get stuck in deep gooey mud.  This is how most cold medicines/antihistamines make things worse.  In an attempt to dry up the secretions they end up making it thicker and screw over our native immune response.  The body is trying to flush itself of the bad guys.  That’s what the copious snot is for!  It is also your friend.  Now if you are an adult and you HAVE to go to work feel free to keep your nose from dripping on others.  For kids, leave it alone.  In fact augment the runny mess with warm teas (no honey for friends <1 yr old).  As you sip them down your esophagus they warm and thin the phlegm in the adjacent trachea.  We use something my son calls “stink tea.”  In the winter this is actually something he drinks daily.  It is a mixture of steeped cinnamon sticks, raw honey and Gaia Kids Defense tincture.   Diffusing essential oils such as Breathe (Respiratory Blend) by DoTerra will help to loosen the secretions and even has some antimicrobial benefits as well.  My patients all use and swear by Vicks.  I don’t fight it but suggest to use it only on the soles of the feet with socks over top.  Even with expensive EOs it is better to avoid sensitive skin areas on children.  The soles of the feet are a great place to start.  Humidifiers, nasal saline/Nose Frida suction, warm baths/showers, less dairy/gluten, chicken noodle soup, avoid sweets…do you see the common denominator to what your grandma was thinking?  That’s right it’s phlegm maintenance.  There are many natural anti virals as well but they deserve their own blog!  More coming I promise.

For most kids this phlegm based approach will get them through.  Fever will break usually in <72hrs however the cough with this illness can be severe and last over 2 weeks! No they will not sleep well.  Occasionally they will cough until they vomit.  Don’t panic it will go away eventually.  Also remember to remind your sleep-deprived self next year will be better with this new hard-earned immunity!  Remember though there are the subgroups that do poorly no matter what a parent does.  If your child is having difficulty breathing, fever >72hrs, issues with feeding seek immediate care.  If your child has a history of asthma hope for the best but prepare for the worst.  Have your emergency medicines filled and ready.  Good luck out there.  Be well.

Fever is a Friend (if you’re a T cell)

Fever is a Friend (if you’re a T cell)

Fever (temp>100.4F) is an appropriate response to foreign invasion by the body.  Some kids rage.  Other kids simmer.  I spend a lot of my time in clinic working to reassure not only patients but co-workers as well that fever is not in itself dangerous.  It can be an important indicator of disruption and useful for both diagnosis and healing.  I have intuitively had mixed feelings which resulted in reservations about using Tylenol (acetaminophen) since I started practicing medicine.  This intuition was shaped by personal trauma in almost losing my little brother to the toxicity of this drug.  Glutathione is an important intracellular antioxidant.  Tylenol eats this stuff up.    This is the last thing we need when we are ill.  That being said small, well-timed doses are different than using max dose Tylenol around the clock throughout an entire illness.  The body can regenerate glutathione if a kid had a healthy diet before they became ill.  I have parents that start treating kid’s “fever” the second they hit 99F.  Which results in more doses than any liver should have to accommodate.

Ibuprofen has its risks to immune function and the kidneys as well.  But when a child’s fever is terribly uncomfortable or even more dangerous the child is not drinking fluids due to lethargy from super high temps, fever control can be an excellent adjuvant to their care.  I like that ibuprofen is an anti inflammatory because much of the discomfort we feel when we are ill with fever is due to the inflammatory changes in the body.  Yes, inflammation is another normal reaction of the body to invasion but too much is downright uncomfortable.  Again it is about judicious dosing and careful use.  If you are going to make the body clear a substance make it worth it.

Many parents ask me at what temperature is a fever dangerous?  If you have a normal functioning brain your body will not go higher than ~107.  Febrile seizures are not normal.  They occur in persons who are susceptible and often have family histories.  And even as scary as they are simple febrile seizures are not dangerous.  Complex febrile seizures are a different animal often occurring in folks on the spectrum of epilepsy.  And with epilepsy illness lowers seizure thresholds.  People with epilepsy often know to adjust their seizure medicines when they are ill because of this phenomena.  But again this doesn’t apply to a regular kid.  So no.  Your kid will not seize with a high fever unless they have a type of seizure disorder!

Fever duration is much more interesting than how high it gets.  For some beautiful reason most viruses cause about 72hrs of fever.  Almost like magic.  There’s a few outliers but for the most part if your kid runs fever for <72hrs they are fighting a virus and will clear it.  This applies to kids over 6mos.  Lil babies are different and warrant a look over by a provider as their immune systems are still trying to figure themselves out and their blood brain barrier is more permeable than an older kid.

Ideal body temp for our CD8+ T cell (our innate good guys) kill mode is about 101.5F.  So rather than trying to get your child to normothermic this is a good number to aim for with your dosing.  If your child is happy, warm and drinking fluids then just leave them alone.  Let their body do the thing it is trying to do which is super efficiently killing bad guys!  A cool cloth to the forehead feels good.  A cold bath does not.

Fever >72hrs or fever associated with lethargy, inconsolability, urinary symptoms, or obvious skin lesions should always be checked out by a provider.  Or if your intuition is telling you something more is going on here…always trust that.  Sitting at home alone in fear sucks.  Been there.  Even if the trip results in reassurance listening to your own intuition is paramount.  Intuition and fear get tangled up sometimes.  More to come on that another day.