Tips and Tricks in Adoption and Pediatrics

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Hair and Skin Care for African Children

Adopting an African-American child, or a child from Ethiopia or other African countries? If African(-American) hair and skincare is foreign to you, these resources can help:

  • Happy Girl Hair - LOVE this website by a local mom of two lovely twins from Ethiopia, one with tight coils, one with loose curls. Product reviews, and styling/braiding tips from simple to elaborate
  • Adoption Hair and Skin Care, an active, non-judgmental YahooGroup
  • Hair Matters, on RainbowKids
  • African Hair Care, on Creating a Family
  • "Does Good Hair Equal Good Parenting?"
  • Hair Rules, from Adoptive Families (also has Asian and Hispanic hair tips)
  • Chocolate Hair, Vanilla Care
  • One of our families recommends food-grade grapeseed oil for scalp and skin, as it's less fragrant than olive or coconut oil, and both cheaper/purer than the versions in the cosmetic aisle
  • Another family loves Alaffia shea/coconut hair lotion for longer/loose-curlier African-American hair, and recommend infrequent shampoo with daily refreshing: a bit of spray water, followed by this leave-in conditioner.
  • You may also find local hair salons or agency classes helpful for hands-on help

As many of our multi-racial clinic families have learned, the painful way, many adults in the African-American community will view how you do or don't groom your child's hair as a marker for how well cared for they are. Hopefully in a helpful well-meaning way, but even then it's a hard thing to hear. Besides, children need to learn how to care for themselves, often want to "fit in" with others of their ethnicity, and want to look beautiful (or handsome) with the curls and coils they've got. 

Seat Belt Buckle Guard

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Have a child with the fine motor skills to pop the childseat or seat belt buckle, but not the impulse control to refrain from doing so? Check out the Buckle Guard and Buckle Guard Pro (larger for modern seatbelts), also available on Amazon.

I love the fact that they're using a child-resistant medication cap to block access to the belt release.

Bleach Baths

Sounds horrible, right? Actually, dilute bleach baths have a role in a few pediatric conditions, so I thought I'd share instructions here.

For children with recurrent, sympomatic infections with staph bacteria, particulary MRSA, we use bleach baths, in conjuction with nasal treatment with Bactroban, to decrease MRSA colonization, and reduce infection risk. Here's a handy guide from the Infectious Disease specialists at Seattle Children's. As always, you'll need to check with your provider first, and the Bactroban is by prescription.

In moderate-severe eczema, especially with frequent bacterial infections or colonization (suspected when eczema patches are unusually red, cracked, painful, oozy/crusted), new evidence suggested that regular soaks in dilute bleach baths may decrease the bacterial burden on the skin, and associated inflammation. Check with your provider first, but here's how, from an excellent review article in Pediatrics by Krakowski et al.:

Explain to patients that their skin may benefit from "swimming in pool water." Then, give them these instructions for making a pool right in their very own bathroom.     

  • Add lukewarm water to fill the tub completely (about 40 gallons of water).
  • Depending on the size of the tub/amount of water used, add 1/4 to 1/2 cup of common bleach solution to the bath water. Any sodium hypochlorite 6% solution will do (for example, Chlorox liquid bleach); the goal is to make a modified Dakin's solution with a final concentration of about 0.005%.
  • Stir the mixture to ensure that the bleach is completely diluted in the bath water.
  • Have patients soak in the chlorinated water for 5 to 10 minutes.
  • Thoroughly rinse skin clear with lukewarm, fresh water at the end of the bleach bath to prevent dryness and irritation.
  • As soon as the bath is over, pat the patient dry. Do not rub dry, as this is the same as scratching.
  • Immediately apply any prescribed medications/emollients.
  • Repeat bleach baths 2–3 times a week or as prescribed by the physician.
The following restrictions apply:    
  • Do not use undiluted bleach directly on the skin. Even diluted bleach baths can potentially cause dryness and/or irritation.
  • Do not use bleach baths if there are many breaks or open areas in the skin (for fear of intense stinging and burning).
  • Do not use bleach baths in patients with a known contact allergy to chlorine.

Taking Your Medicine

Tips for taking your medicine. For not-so-nasty liquid meds, like tylenol:

  • For infants, syringe the dose in their back cheek pocket, and blow a quick puff of air in their face
  • Try putting the medicine in a nipple pulled from an infant bottle, keep your finger over the underside, and give them the nipple. Works well when they're asleep, too. You can buy fancier syringey versions of this, too, but why bother?

These are for dag-nasty medication suspensions, like tinidazole or clindamycin:

  • Try mixing with the flavored espresso stand syrup of your child's liking
  • Try mixing with single-serve Koolaid powder. In fact, one clever family gave a syringe of koolaid slurry without medicine to an older sibling, who ate it with visible relish. Then they handed the med plus Koolaid syringe to the patient, who slurped it down before realizing that we had given him modern medicine's bitterest, chalkiest, most foulest concoction.
  • If crushing a pill (like isoniazid, since the liquid form often causes diarrhea), try the above tips, or even better: scoop out the center of an Oreo's filling, and replace with crushed isoniazid. Yummers.

It's so nice when your child can get off of those nasty suspensions. Some meds (stimulants, for example) aren't even available as liquids or chewables, and the pill size can get pretty large. There are 4-5yo kids in our practice that have learned to swallow pills, and it does make life easier. No need to refrigerate, travels well, etc ...

Here are some tips for swallowing pills:

  • Practice with balled up pieces of white bread, from tiny to large, and have your child work their way up.
  • Have them place the bread, a tic-tac, a mini M&M, or the pill itself at the back or side of their tongue, then drink from a straw. The straw helps it go down without stressing as much.
  • Most capsules float, so lean forward when swallowing. Pills sink, so leaning back can help.

Change The Diaper Before You Sleep

I have no idea how many families this will actually help, but this one frequently lets my daughter sleep in 30-60 extra minutes. Which is solid gold. 

We finally got to the point where our 14 month-old daughter was "sleeping through the night" (which means, waking the typical 3-5 times per night but settling herself back to sleep). But she seemed to be waking with a bulging water balloon of a diaper, occasionally with leakage. Not good.

After getting over my irrational fear that even looking into her room would wake her, I finally girded up the courage to try changing her diaper before we parents went to bed. Given all the prebed fluids she is wont to take, it's often quite wet by that point. And guess what - she never fully wakes up, even if I have to flip her right-side up (I have since perfected the upside-down diaper switch). And she sleeps in. And doesn't wake to soggy pants. 

Life is good. 

Your child may not be quite the nocturnal urinator that ours is. Or is perhaps a lighter sleeper. But do try this if you think that morning wetness is a factor. 

Spiffy ID Bracelets

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Via ParentHacks comes a great idea for custom ID bracelets your kids might actually wear! Many of the young children we work with have an underdeveloped sense of stranger danger, and tendency to wander further than they should. It's important to have a safe amount of information on them should they get separated from you. Your cell phone numbers would probably do the trick, and these can fit on a trendy custom silicone bracelet. Plus, you can all wear matching family bracelets if you'd like to emphasize the family unit aspect. You can order as few as five custom bands, but make sure to order extras.

For those who can't stand having things on their wrists (that would include me), I've also had families use Tyvek tags or luggage tags worked through shoelaces. If you've come up with anything useful, please post below ...

Foster Care Transitions

My colleague Julie Gelo, a foster and adoptive parent in the double digits, shares these tips for helping children in foster care transition to an new family:

  • Have the current foster parent request photos of the new family to show the child frequently [or make a "transition book" using the custom picture book tip].
  • Ask what kind of laundry soap and fabric softener the new family uses and have the current family start to use them (or have the new family use what the current family is using for at least a while).
  • Have the new family send a blanket, stuffed animal, scarf, etc to the current family so that the child can start to use it now and take it to the new home with her.
  • I would have the new family attempt to use as many of the same comfort items as possible that are sent with the child and not be in a big hurry to change them over or to wash them.
  • Have the families exchange information on schedules, foods, soothing techniques, favorite music, favorite books, toys, and so forth. Are there certain lullabyes, games, and so forth that the child finds soothing or comforting? What do they use for eating utensils, does the child sit at the dinner table in high chair, or booster seat? As much information as possible that can be shared the better the transition.
  • In an ideal world I would have the transition last 3-4 weeks with short visits in the current home, then out in public with both parents there, then at the new home with the current parent present and so forth.
  • If that's not an option, make sure to have the exchange of information, use of photos now and in the new home to maintain connections, and the use of common items, smells, textures, foods, schedules and so forth.

To which I might add some more rudimentary ideas that somehow seem to get overlooked:

  • Unless the child is in immediate danger, moving a child without preparing them ahead of time is NOT a good thing.  By ahead of time, I mean well before the car is pulling up in the driveway. Losing a familiar family and home without preparation is truly traumatic.
  • Never ever never move a child by putting their things in garbage bags. Kids are literal, and "Your belongings are garbage to me" is hardly a nice message to send to a distressed child.

Slings and Things

I've had a bit of a complicated relationship with babywearing, as with many other things that can get taken somewhat seriously in this town of ours. The "attachment as lifestyle" trend goes a bit far sometimes, for me. Luckily, now that I'm a dad and get to experience it myself, things are less complicated: I love it, probably more than my daughter does.

I do my best to not do the "I'm babywearing, how attached am I" look that sometimes goes with the wearing of the baby. And I try to maintain some sense of my own style (which does not generally include being draped with bolts of indigenous fabrics) while I do it. And thus, I bring you my own idiosyncratic list of fave slings and things:

Adjustable Pouches

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Our favoritest, most versatile babywearing device has been an adjustable fleece pouch, from Kangaroo Korner. Works great for facing-in infant snuggles, facing-out kangaroo hold, sidelying, and my favorite, the hip carry. The sherpa fleece is snuggly, just warm enough, and stretches just right. Bonus for me: no rings, no big tails of fabric. But for those of you that can work that look, I hear ring slings are fabulously versatile, and great for breastfeeding. And for those who like being tied up, the Moby Wraps sure are popular.

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Soft Structured Baby Carriers

These let you carry a baby, toddler, even preschooler facing-in, either on your frontside or back. You can adapt them for hip carry, but it's kludgey. They hurt my back a lot less than Baby Bjorns, and are more snuggly and nap-tastic. The Ergo carrier is the easiest-to-find version of this, and it works great for lots of people. We struggled with the fabric choices (they all looked a bit "I wear hemp" for me), and wound up with a Yamo baby carrier, in fabu red surf fabric, from Israel via German Ebay. Yes, people get that crazy about their baby carriers. But we sooo love it. To find people even more nutty about their babywearing than I, go to the TheBabyWearer reviews and forums. The reviews are excellent, and the "for sale or trade" section is hopping.

Hip Carriers

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Our daughter ended up feeling that a hip carry was a nice compromise between snuggling in and facing out. And so along came the Ellaroo Mei Hip carrier, in a luscious array of organic fabrics. You can do this carry with a pouch or ring sling, or the Ergo-type carriers, but this one is both easy and comfortable. Ellaroo also carries more traditional Mei Tais, not to mention Guatemalan-fabric slings and wraps.

And that's what we're rocking so far ... I hear these really come into their own when you've got two kids. For toddler adoptees, the soft structured and hip carriers are a great choice, as they comfortably handle bigger kids. I hope you find one (or more) that suits you and your child. But remember - it's still OK to put them down from time to time. How else will they learn to sit/crawl/walk?

Please post your own favorites below. However, you may end up in trouble with my wife if you end up inspiring yet another carrier purchase.

The Life Aquatic

zissou.jpgOur daughter Drew is quite the water baby, so this summer is all about aquatic adventures in the Puget Sound area. Here are some of our faves, but please leave yours in the comments! 

Magnolia "Pop" Mounger Pool

This is a great municipal pool, with really warm toddler pool, and a bigger pool and fun water slide with no height requirement! Get there at the beginning of the session, as there are a lot of popmongers out there on weekends.

Renton Aquatic Center

This is a fabulous town alternative to big water parks, and it's right off of 405, so pretty easy to get to. Wave pool, a lazy river, toddler splash and spray structure, and two most excellent water slides. Get there early, and the later sessions are less crowded. But hardly any lines if you get in!

Greenlake Wading Pool

A Seattle classic. Let us know your other favorite wading pools below.

Wild Waves

Loud, crowded, and not cheap. Look for coupons, the season pass is a good deal for addicts, and lucky Microsoft employees get a major deal with their Prime Card. If you go on off-days, and your children tolerate chaos, there are some excellent rides here. The pirate-themed splash and climb structure is major fun for younger kids. My favorite rides are the Zooma Falls bumper tube experience, and the semi-hidden 2 slides with big drops behind the zipwire. Under new management as of 2007, haven't been there yet, so we'll see how things evolve.

Mountlake Terrace Pool

Our favorite indoor pool - a great choice in the non-summer months. Excellent soft-bottom toddler play area, and a neat little lazy river. And a Jacuzzi!

We also hear Bainbridge has a aquatic center, similar to Mountlake Terrace's, and that there's an excellent Spray Park in Auburn. Where else should we go?

What Produce to Buy Organic

Here's a nice way to spend your organic dollar wisely. The hard-working analysts at the Environmental Working Group have compiled an updated listing of pesticides in produce. You can download a handy wallet guide to the "dirty dozen" and "cleanest twelve", and save serious kishkash on conventional onions and avocado while making sure to buy most of your favorite fruits organic. Just look at the worst two - how do you like them apples? Of course, if you've got the means, it does the environment good to buy them all organic. They've got a fascinating full dataset of all 43 fruits and veggies as well.

For those too busy to click through, here's what you need to know:

The Worst (Buy These Organic):

  1. Peaches
  2. Apples
  3. Sweet Bell Peppers
  4. Celery
  5. Nectarines
  6. Strawberries
  7. Cherries
  8. Pears
  9. Grapes (imported)
  10. Spinach
  11. Lettuce
  12. Potatoes

The Best (Lowest in Pesticides):

  1. Onions
  2. Avocado
  3. Sweet Corn (frozen)
  4. Pineapples
  5. Mango
  6. Asparagus
  7. Sweet Peas (frozen)
  8. Kiwi Fruit
  9. Bananas
  10. Cabbage
  11. Broccoli
  12. Papaya