There’s always a gap between when we identify a potential danger and when we confirm it and update our environment to make things safer (removing it from the market, having safer alternatives available, or legislating change). And it tends to be the things that are in this in between phase that attract the most attention and questions from my friends.

Ever since I spent a summer in college nearly 20 years ago working with Dr. Leo Trasande I became interested in the science around bisphenols and phthalates. He wrote an excellent book (with a relatively scary title), “Sicker, Fatter, Poorer: The urgent threat of hormone-disrupting chemicals to our health and future… and what we can do about it” in 2019. His book goes deep exploring many chemicals which have consequences to human health including bisphenols and phthalates. You may have heard about these before, but what do you really understand about them?

Bisphenols have been used in polycarbonate plastic containers - baby bottles, sippy cups, and water bottles and additionally in resins that coat the inside of cans. Bisphenols are also synthetic estrogens and at high levels can inhibit thyroid hormone binding. So many things are now BPA free but it’s a whole class of compounds and other BPs are out there. Phthalates are a group of chemicals that makes plastic soft and flexible and used to bind scented personal health products like cosmetics. Phthalates also inhibit and disrupt thyroid function. 

We are all exposed to these all the time. Everyone has detectable levels of these chemicals, so what can we do about this? First I would say, let’s not panic. These chemicals have been around for decades and while they likely do have an impact the impact is subtle and most notable on a population level. Your one elevated exposure isn’t going to give you hormone instability. But it’s more notable when all of us have some exposure that at a population level we might see impacts add up over time. So it’s still important to address.

For you and your family, planning for next week it’s best if we approach this problem constructively. We can think about where in our life the highest exposure / consumption of these chemicals may be, and then let’s think about structured changes that we can make to have a reasonable impact on our family’s consumption. 

This is where content from Consumer Reports can be invaluable. They have done impartial research, testing products to help you understand the risks of certain products (ie. which foods tested to have the highest levels). I know without this data I would have assumed that my microwave bags of veggies that I’ve used for weekday meals would be worse than say canned tuna, but this is part of why data can inform and power decision making. Turns out that tuna swim in polluted waters and those cans are lined with BPA making tuna one of the higher risk products. The goal is not to consume zero BPA or phthalates - frankly that’s impossible - but to be aware of where your highest consumption lies. 

Then you can also make some common sense changes in your family behavior to reduce your total exposure. 

• Use glass or steel food storage containers

• Don’t heat plastics in the microwave or dishwasher

• Reduce consumption of fast food and high fat foods where levels are highest

• Choose kitchen tools that less likely to impact food (ie. reduce use of plastic cutting boards, using plastic bowls with hot foods, silicone bags instead of plastic disposable ones)

• Choose fragrance free cosmetics/soaps/cleaners because they have lower levels.

The most practical example of this for me has been in the school water bottle choice. Honestly, the price tag of some of these fancy stainless steel water bottles, that are really nice, can be hard to stomach. However, if you think about the volume of exposure your child might have to daily drinking out of this many times a day for a year, if you invest in the safest option there it’s likely to have a high impact.

The truth is, that even the most vigilant consumer will still be exposed to these chemicals often. However, once organizations like Consumer Reports do the testing, identify the risk and advocate for us, bigger change can happen when organizations like the FDA change the rules governing products. In 1999, Consumer Reports first raised concern about BPA in baby bottles and in 2009 consumer reports tested some foods calling on government agencies for change. In 2012 the FDA banned BPA from baby bottles and sippy cups. Consumer Reports then followed up to confirm in 2023 that bottles are free of these chemicals (sharing lists of popular products indeed free of contamination) and called attention to places where there may still be opportunities to improve.  

I’m curious to hear from you - has this been on your radar or is it new information? This post has been on my mind to share for almost a year, which made it a no brainer for me to say yes when Consumer Reports offered to sponsor it. The thoughts are all my own, but if you’d like to explore a membership with Consumer Reports, gain access to their 10,000 product reviews and support further advocacy work they do please click here for more details (and $10 off).

Now that my kids are back in school, I’m hoping to get back in the routine of posting and get all the podcasts I recorded when researching my book up and in the wild. If you have topics you’d like me to tackle definitely let me know in the comments.

Listen to the episode to hear us discuss:

1. How fear-based marketing often targets parents and causes consumers to pay more for things that aren’t necessarily safer or more nutritious

2. How her daughter served as her inspiration to start Food Science Babe

3. What red flags people can look for to help them identify misinformation

4. Tips on how to navigate the anecdotes and information found in large support groups such as those on Facebook

Check out Erin’s Instagram @foodsciencebabe to learn more about food science and safety and see what myths Erin has disproved.

If you like this episode, you can read more about these topics in Advanced Parenting. Whether you like to read by kindle, hardcover or audiobook you can buy the book or request it from your local library to learn more. Chapters most relevant to this episode include 3 and 5.

I really appreciate the gentle parenting influencer content- it provides helpful reframes, tools and scripts. So many parents I know view these folks as their gurus guiding their parenting, one of their most important responsibilities, in the best direction.

However, I hear from parents all the time that some of these techniques don’t help. The bedtime routine gets endless extended, the limits are fewer and harder to enforce, and the parents are way overextended.

It’s not that the techniques are bad or the parents aren’t “doing it right”. The problem is about the dose. At its core gentle parenting leans into the attachment with the parent and the parent helps the child to emotional coregulate. It’s a beautiful thing, but it doesn’t come for free.

The Rhino who swallowed a storm is a children’s book is about supporting children after natural disasters and trauma, speaks about a Rhino holding in all their emotions as if he’s holding in a storm. It reminded me of a parent gentle parenting, swallowing up all their children’s angry, sad or dysregulated energy to provide them with peace. There’s clearly a cost or at the very least a limit to what parents can accept before they lose their temper.

When a parent doesn’t have a break or a parent has many children and other work (paid or unpaid) they have to attend to, it’s overwhelming and nearly impossible.  You simply can’t do everything all the time. When parents swallow too much they yell or lose their temper, and they deviate from the gentle parenting scripts because they can no longer maintain their regulation. Most parents can only tolerate so much of our children’s distress until we snap, raise our voices and say something not so gentle. Or we try to cope with it by laughing at our children’s distress or sarcasm which invalidate their experience.

The other problem is that if we coregulate with our children helping them through every single one of their difficult moments they don’t build the skills to regulate themselves and they don’t build the emotional resilience, self esteem and skills that comes from being more independent.

So what is a parent to do? Part of gentle parenting not often talked about is picking when to get involved. Imagine an emotional thermometer, like the ones posted in some preschools. 0-3 the child is happy and in a groove, 4-6 there may be some tension, and above 7-10 the child is really upset. We want to encourage is for children to try to work through things on their own, 4, 5, 6, even 7.

This sounds easy right, but it’s not. In expressing confidence about our children’s ability to tolerate being upset, we feel uncomfortable. Perfect example, my daughter woke up early Saturday wanting her screen. We don’t do screens before breakfast. She sulked, she pouted, she stomped, and she called me mean. And I acknowledged it and just kind of ignored it, offered some distraction because it was like a 6 or a 7. 

Not giving in and not negotiating was the right move because I got to finish my workout and I didn’t compromise my limit. The problem is it was actually more work than giving in. It’s very difficult to just accept your child being upset and uncomfortable to hear them whine, fuss, or experience uncertainty or boredom.

It’s so uncomfortable that Ferber, Weissbluth, and tons of other sleep experts have written thousands of pages about how it’s OK to give a child a moment to self sooth through their distress. Crying it out (not for everyone! This newsletter is not about infant sleep!) is so hard on parents, but parents who get through it often feel “done”. Unfortunately the same skill, holding space to allow your child to struggle through something will help them learn how to handle tantrums, homework, and friendship struggles independently too.

So what do we do? One thing we can do as parents is acknowledge where we stand with distress tolerance. Some parents can make easy dinner conversation through a child refusing to eat what’s been offered, and other parents have a really hard time. When you acknowledge that tolerating your child’s distress is hard in certain situations you can then better plan for those situations and scaffold yourself and your children towards success.

We can also increase our skills at tolerating distress. Dialectic behavior therapy has become very popular to treat many mental health conditions like anxiety and borderline personality disorder. Dialectical Behavior Therapy (DBT) and the skills it teaches are useful for everyone, so useful that over the past ten years more and more people are thinking we should teach all high school children these skills. One core cluster of skills within DBT is distress tolerance and by practicing these skills we can presumably better cope with our distress around us.

In years of working with parents I’ve become more and more interested in how parents can build their distress tolerance. Intense exercise, mindfulness, deep breathing, progressive relaxation and other skills can make a meaningful difference in how much a parent can hold space for their children to figure something out on their own. Tolerating our children’s distress and swallowing their storms more efficiently enables us to set limits without losing our temper.

All to say with toddlers, I have started talking to parents about distress tolerance when we talk about tantrums. Because building parents resilience facilitates and enables parenting, gentle or not.

Chime in the comments to let me know your thoughts on this topic.

I was so happy to connect with lawyer, mother of 3, and one of my favorite authors, Eve Rodsky, for this episode. In her book, Fair Play, Eve developed a system that helps families divide up the household work more equitably. 

We discuss:

1. The story behind how Eve developed the Fair Play system and why she wrote the book

2. What unseen labor is and how women are doing an unfair share of it in the home

3. How womens’ time is seen different and less valuable than mens’ time

4. Real life examples for how the fair play system has helped families

5. The possible role of healthcare providers in advancing the fair play system

To learn more about the Fair Play system you can check out Eve’s book Fair Play: A Game Changing Solution for When You Have Too Much to Do (and More Life to Live). You can find Eve on Instagram and learn more about her and her work on her website. I’m also a big fan of her book Unicorn Space, and you might say that writing a book has been my unicorn space.

If you like this episode, you can read more about these topics in Advanced Parenting. Chapters most relevant to this episode include 6 and 9.

Happy Thanksgiving! When I reflected back on this year, you are definitely a big thing I’m thankful for. It’s mind-boggling what a privilege it is to have all of your parents, grandparents, teachers, and all child-caregivers looking to me for content to help you help support the children in your lives. This year in particular, launching Advanced Parenting, seeing it read by people who needed the support and translated into Korean and Chinese, has been amazing. I hope you have gotten a chance to read it too!

I have been a little quiet on instagram and social media , but I miss interacting with you all. I’m going to get the newsletter and content going again in the next few weeks so drop me a line and let me know what you’d like to hear about.

While it may be cheesy, Thanksgiving does give us an opportunity to talk to children about giving thanks. While there is a lot of difficult news in the world and a lot of struggles being a kid and being a parent, we have so much to be grateful for. Tell your children what you’re thankful for and ask them what they are thankful for. It’s also a chance to make children feel loved and intrinsically valued - to pause and be grateful for something unique and specific about your child- their sense of humor, their enthusiasm, or their hugs. I know I am grateful for the pitter patter of little feet running around my home.

One medical thing I’ll share is that RSV season has started.

I am a big fan of Beyfortus, the new preventive antibody product for infants, and I encourage everyone with babies this winter to get it as you are able, particularly before your child is 11 pounds as it is much harder to find over that weight due to the increased dose required. I also strongly recommend that pregnant women and grandparents consider whether they might be eligible for RSV vaccination as well. It’s not too late for the flu vaccine too!

Now perhaps you’re busy shopping today. So I’ll share my favorite links I’ve curated over on amazon - favorite books, toys, and gear. Including one of my all time favorite toys for 4-10, in my clinic even adults can’t keep their hands off these. These are affiliate links and over the years we’ve donated about 4000$ to various charities supporting children’s health. I know next on my to-do list is to think of my holiday shopping.

I’ll be back soon with another podcast episode!

In this episode, I talk with Jon Rosenshine, the Associate Head of School at Windward School which specializes in teaching kids with dyslexia and other language-based learning disabilities. Jon also has experience as a parent of a child with dyslexia.

Listen to the episode to learn about:

1. The journey of Jon’s son with dyslexia who was diagnosed at age 4

2. Possible early signs of language disability parents can look out for

3. The different methods for teaching children to read

4. The social-emotional effect of learning disabilities on children

If you are interested in learning more about the Windward School in New York, head to their website. 

If you like this episode, you can read more about these topics in Advanced Parenting. Chapters most relevant to this episode include 3, 8, and 10.

Children are more susceptible for a few reasons. First physiologically, children breath faster and have a higher metabolic rate than adults which requires more ventilation. This means that pound for pound children receive a higher dose. Children’s airways are smaller and their immune systems less mature, making them more likely to have short term respiratory complications when the AQI is over 150.

On the bright side, poor air quality is not a new problem though the pollution from wildfires does seem to be slightly worse than urban pollution experienced in many parts of the world chronically. What’s important to understand is that this is not just right now or just in NYC. Wildfire season has become common place on the west coast and the Canadian wildfires are expected to continue all summer though NYC air should be improving tomorrow.

The short term risks relevant to children are mostly respiratory both asthma and increased risk of viral upper respiratory infections following smoke exposure. We do not have a lot of data about the long-term effects of wildfire smoke exposure from regular people (mostly it’s people like firefighters with more extreme exposures).

With this in mind, here are my suggestions to help your family stay safe and minimize the impact of the smoke on your health.  

• Monitor your AQI! It shows up in most weather apps or here.

• Keep your windows and doors closed when the AQI is over 150.

• Use an air purifier, upgrade your ventilation to use HEPA filters, or short term use a box fan and a filter.

Keeping your indoor air as free of smoke particles as possible is important. Air purifiers with HEPA filters and a large fan can help eliminate harmful particulates and odors in the air. 

Here is a list of recommended air purifiers on NYT Wirecutter. I use the Coway Airmerga AP-1512HH Mighty at home.

• Get your child’s asthma under control 

If your child uses a controller medication (such as flovent, budesonide, symbicort or advair) sometimes, recently or in winter, I would also use it when AQI>150. 

If your child has more significant asthma you may may want to increase the controller medication or use albuterol during this time, ask your doctor.

• Bath when you get home and consider using saline nasal spray or a neti pot to reduce the particulate matter in your upper respiratory tract.

• Wear a mask for walks outside 

If you are going outside, I recommend wearing a mask (KN95, N95) to reduce your exposure to the particles in the air, especially if you’re exerting energy—even at a walking pace. 

• If possible, don’t exercise outdoors and avoid exercising indoors while the air is still hazy and/or you can smell smoke. 

A lot of people are asking if exercising indoors is ok. And if your air quality is like mine—hazy air and you can smell smoke—I think it’s probably better not to. One option is to strength train instead (presumably cardio is a higher ventilation change). 

This can be explained by basic math. If our ventilation in a minute is about 12 liters at rest, when we are exercising it goes up to 100 liters. So if you are exercising outside while the air is polluted with smoke you will breathe in a lot more debris. 

* * *

If you follow along on instagram, you know I have an air quality monitor from IQAir, while it’s interesting to monitor and it’s helped me learn about my ventilation, I don’t think it’s really necessary. I’d encourage you to use those funds towards an air purifier or better HVAC filters instead. Especially because this probably won’t be the last bad air quality day…

I was on morning television here in NY to talk about this today. Check out the spot here.

Do you have any other questions? Share them with me in the comments or DM me on Instagram. I’ll do my best to answer them either on social media or in a follow-up newsletter. 

Stay safe,

Kelly Fradin

Hannah Heck is a mother of 4 and a lawyer, who now does advocacy and public policy work in the areas of education and kids with special needs. 

Hannah’s oldest child is a 12-year-old boy named Teddy who has Down syndrome. Hannah was so kind to share glimpses into her family’s life and talk about what it’s been like for them to navigate the challenges they’ve faced related to Teddy’s diagnosis. 

In this episode, we discuss:

1. How Hannah, her husband, and other family members processed the diagnosis differently

2. The importance of allowing others to process in their own way and time

3. How Hannah managed to attend law school while having a child with special needs and other young children to care for

4. How Hannah and her husband find balance in their life all of the things they are told they “should” be doing (early intervention, therapies, classes, etc) with the other things their family values (bonding time, family outings, fun activities, etc)

5. What it’s like for Hannah’s 3 younger children to have a sibling with Down Syndrome

6. How she helps Teddy’s classmates and other children learn and talk about others with differences

These topics are something I focus on in my book, as parents used to just be on their own to figure it out. But now they can learn from Advanced Parenting a strategy and framework for out to promote their own child's independence. Order the book here!

If you like this episode, you can read more about these topics in Advanced Parenting. Chapters most relevant to this episode include 1, 2, 7, 11.

Instagram: haircutsandhandstands

I’m so grateful for every gift of support you’ve offered me. Whether you bought the book, shared a post online, or told your friends about something you learned from my work… from the bottom of my heart, thank you! 

The book is resonating with a wide range of audiences and I’m grateful to the various publications and podcasts that have spotlighted the book, including:  

• Next Big Idea Club

• ParentData with Emily Oster

• The Puberty Podcast

• KOIN6

• KTLA 5 News

This journey has been a humbling and deeply gratifying experience. I always hoped my work would resonate with the target reader and having parents cry with me about feeling seen at book events has been so rewarding. I’ve learned a lot along the way. One of the biggest lessons I’ve learned? You really can’t do it all. 

This is something I talk about in the book (Chapter 12 FYI!), particularly the discomfort of asking for help when you need it the most. Often this means prioritizing the urgent and most important things and letting the “bouncy balls” drop, knowing that they’ll bounce right back up with little harm done. 

On this point… as a HUGE thank you for your support, I’m offering exclusive access to my “How to balance your family’s priorities” workshop as a limited time gift with every purchase of Advanced Parenting. In this workshop, I share tips on how to prioritize with all the family’s needs in mind, while cultivating joy and happiness in the process. It really can be win-win if you have the right tools at your fingertips! 

SAVE YOUR SPOT

Thank you again for making Advanced Parenting a success. I’m so grateful for the community that this work has enabled me to foster. It’s good to know that as parents and caregivers we are not alone 💛

If you’re looking for non-book related content aboud children’s and parenting, I’d encourage you to check out these two recent posts which may help you worry less. 

Until next time, 

Kelly 

I was happy to connect with Dr. David Stukus, a pediatric allergist and director of the Food Allergy Treatment center at Nationwide Children’s Hospital in Columbus, Ohio. Dr. Stukus wrote a textbook called "Allergies and adolescents: Transitioning towards independent living." In this podcast episode we talk about how to help kids become more independent in managing their chronic health conditions.

Topics we cover include:

1. The importance of including children from an early age in decisions around their medical care

2. The best way for parents to discuss the child’s condition with them – what to say, what not to say, and when to say it 

3. When and how parents can help their children learn to self-manage

4. The need for parents to adjust with each developmental stage their child goes through

These topics are something I focus on in my book, as parents used to just be on their own to figure it out. But now they can learn from Advanced Parenting a strategy and framework for out to promote their own child's independence. Order the book here!

If you like this episode, you can read more about these topics in Advanced Parenting. Chapters most relevant to this episode include 3, 5, 8, and 13. 

Instagram: allergykidsdoc

To celebrate this exciting day, I’ve dedicated today’s newsletter to you, the parents for whom I wrote the book. For those of you who feel overwhelmed by what they face, I hope that this book can be a living resource that you can turn to, no matter the challenge you face. 

Below is an excerpt from the Introduction, happy reading and thank you so much for your support! 

ORDER YOUR COPY

An excerpt from the Introduction of Advanced Parenting: Advice for Helping Kids Through Diagnoses, Differences, and Mental Health Challenges. 

One sunny day in 2014, I was riding the New York City subway back from the Children’s Hospital at Montefiore, where I was working as an attending in the pediatric complex-care group. Our group of pediatricians, nurses, social workers, and care coordinators supported children with severe medical conditions. Only children facing a severe, life-limiting condition such as an organ transplant, congenital heart disease, or chronic respiratory failure requiring long-term use of a breathing tube or ventilator could qualify for the program. We also accepted children who had two less-severe medical conditions—we wouldn’t take a child with just inflammatory bowel disease or just cerebral palsy, but if your child had both, it was likely that they would need our support. For the family’s convenience and continuity of care, we also took care of these children’s siblings.

This day had been a tough day in a tough week, and a hospitalized patient was not improving. Her underlying genetic disorder and associated medical comorbidities had led to malnourishment. Her poor nutrition had led her to have difficulty with the healing of the skin surrounding her feeding tube, her feeding tube troubles were worsening her malnutrition, and she had just gotten a cold, limiting our ability to do much of anything until her fever subsided and her need for supplemental oxygen decreased. At an hour-long meeting, in which I worked with her family to help coordinate her care, there had been raised voices and tears as they grappled to understand why this was happening, why now, and how to make the best plan with conflicting input from the surgeons, nutritionists, gastroenterologists, and others involved in the case. 

A New Field

I appreciated having time to decompress and process the day on the way home from work. This day I sat on the subway, scrolling through social media and rethinking my work with this family and how I could do more to help them, when a friend from my neighborhood called. At just age two, her son had been diagnosed with asthma after several colds involving extreme wheezing. She was struggling to understand why this was happening, why now, and how to make the best plan with input from her husband, mother-in-law, pediatrician, and new pulmonologist. My first thought was that mild asthma is easy compared to what I do day to day with really sick kids. Still, as I talked through things with her, I could not ignore the similarities in these families’ struggles.

These children were in wildly different places—one was hospitalized and threatened with admission to the ICU, and the other was at the playground; each experienced entirely unrelated problems, one with a genetic diagnosis and one more likely triggered by environmental factors—and yet the parents were coping with similar stress. How could they process their situation, make sense of it, and move forward? I knew I could help them both. I could help them understand and research what they faced, find resources that they needed to make decisions with confidence, and put together a team approach to be proactive and preventive in the future with their child’s health.

But at the same time, I thought, this work does not fit within a fifteen-minute visit or a message sent through a health-care portal. I wondered why the systems weren’t set up to better support these families. 

Parenting is hard. Because we care so deeply for our children, as parents we want things to be perfect. As a parent, you want things to go as planned. You want to be prepared for every developmental change and anticipate your child’s needs to properly support them. But parenting is even harder when things do not follow a typical trajectory.

When your child deviates from the typical developmental pathway or when they are struggling with their physical or mental health, everyday challenges become much more intense. The fear and the uncertainty can be overwhelming. For parents raising children with these additional needs, there seem to be, oddly, fewer resources. While parents are drowning in parenting content and consuming it at an all-time high, most parenting advice is geared toward average children facing typical challenges, from getting a baby to sleep to helping a teen with their nascent independence.

Why is it that we leave so many parents adrift for what is, for many, the hardest part of their lives? Historically, families with children with health challenges have faced stigma. Though we are thankful to live in a more inclusive society, and though we know that nearly one-third of children experience chronic medical conditions, the available resources haven’t caught up. 

There is a growing awareness that some parents need access to additional caregiving skills—advanced parenting skills that can help them support their children through a challenge. 

Advanced Parenting 

LEARN MORE ABOUT THE BOOK

Thank you for your support and encouragement, I couldn’t have done it without you! 

P.S. Found this helpful? Share with your friends and loved ones to remind them that they’re not alone! And they have tools and strategies at their disposal if they know where to look! [Hint: Advanced Parenting!]

For this episode I am joined by Virginia Sole-Smith, a journalist and mother to a daughter with a rare type of Congenital Heart Defect (CHD) called hypoplastic left heart syndrome. Usually CHD is diagnosed prenatally or at birth, but in the case of Virginia’s daughter, Violet, it wasn’t detected until she was 4 weeks old. Violet is now 9 years old and doing well. 

In this episode, Virginia tells the story of Violet and their family’s experience with CHD. You’ll hear Virginia talk about:

1. The struggles their family faced during Violet’s first 4 weeks of life before she was diagnosed

2. How she and her husband coped with stress and how it’s affected their relationship

3. How Virginia has dealt with feelings of grief and guilt

4. Violet’s experience with early intervention and therapy

5. How having a child with CHD impacted Virginia’s second pregnancy

6. How Virginia and her husband talk to their daughters about Violet’s condition

If you’d like to hear more about Virginia’s experience, you can subscribe to her newsletter Burnt Toast on Substack or check out her books, The Eating Instinct, out now, and her upcoming release, Fat Talk: Parenting in the Age of Diet Culture, a “fearless and game-changing addition to the conversation about kids, food, and weight,” which comes out in April 2023! Virginia can also be found on Instagram @v_sole-smith

My new book Advanced Parenting will be out April 11, 2023. It is now available for pre-order!

If you like this episode, you can read more about these topics in Advanced Parenting. Chapters most relevant to this episode include 1, 8, and 9. 

A morning launch at The Corner Bookstore, Tuesday, April 11, from 8.30-10 am. A conversation with Lindsey Robertson, LCSW at The Connection, Wednesday, April 12, from 6.30-7.30 pm. (Childcare is provided with advanced registration!)

I hope to see you there!

Upcoming Advanced Parenting Workshop 

Every family has moments where the parents disagree or the kid is fighting with the mom. And it's not because someone's right or wrong, it's because they have different perspectives and different priorities. Mindfulness about all the different priorities can help you to be more thoughtful about the balance you choose. 

In my upcoming “Balancing Your Family’s Priorities Workshop,” I’ll be giving you advice on how to reconcile these priorities with confidence. I’m offering this as a free gift with every purchase of Advanced Parenting. Simply pre-order your copy to save your spot.

SAVE YOUR SPOT

Below, I share a personal story about why taking a holistic approach to your child’s needs can help them thrive. I’d love to hear what approaches have worked for you or what you find most challenging when it comes to balancing your family’s priorities. Share in the comment section and I’ll do my best to address these in the workshop! 

Learning what matters most

When I was first diagnosed with cancer at age four, my parents tearfully sat me down. They explained my diagnosis and told me a bit about what would come: procedures, chemotherapy, and radiation. But as a four-year-old, only one thing mattered to me. Amidst this very serious and stressful conversation, I grew wide-eyed and asked, 

“But I can still play, right?” 

To understand how a challenge will affect your child, you first have to understand where they are and what matters to them most. For my family, as I was going through the appointments, surgeries, and chemo schedule, prioritizing my play was paramount. They knew the open hours for the hospital playroom and used toy-store trips strategically to bribe me through painful or unpleasant parts of my challenge. 

However, my needs were just one part of the family's needs. My mom had just signed up to go to school at night on top of her full-time job. My dad was living a few hours away to take advantage of a job opportunity that meant increased income for my family. We didn’t have family nearby who would help take care of me, so they had to make decisions about what would give and what wouldn’t. My mom wanted to try to make her plan to study for her MBA at night work, because in the long run it would be good for all of us. 

Understanding all the perspectives and needs of your household can feel like peeling back layers of an onion. Sometimes you may need to be clear and selective about what your priorities are so that you can make necessary choices. Most parents instinctively keep their child’s priorities centered to anchor their thought processes. 

But to make the best choices, you have to balance your child’s needs with those of the broader family too—the parents, the siblings, and any other household members. Every family has multiple balls in the air. Some are bouncy balls and if you drop them the show will go on. But others are glass and require more attention to keep intact. 

Some of these particularly tough choices have difficult but necessary solutions. I’ve worked with countless families who had to make hard decisions around a parent’s job. In one case, the mother of one of my patients could not stay with her daughter in the hospital because if she missed more work, she would lose her job, and if she lost her job, she’d lose the family health insurance. 

But outside of these obvious, important, urgent priorities, there is a whole spectrum of other priorities. Some for you, some for your co-parent, some for your children, some for your work, friends, or other family members.

While their health is essential, one of your most important jobs as a parent is to help your child identify and protect their priorities. I will help you develop and hone this important advanced parenting skill in my upcoming workshop - I hope to see you there!

GET YOUR INVITE

Thank you for your support! 

Since I first started promoting my new book, Advanced Parenting, online, I’ve received a huge wave of support from many of you, and in return I’d like to say a huge, warm thank you. The “Balancing Your Family’s Priorities” workshop is just a small way to show my thanks for your early support by pre-ordering the book. 

I love the community we’ve built on instagram, facebook, and substack and still find time to read every single message even if I don’t always get a response. I am always learning from considering your perspectives.

And I’m really excited to read all the messages you send with your thoughts about the book, what you’d like to see more of, and even what messaging just doesn’t feel quite right to you. I wrote Advanced Parenting to be a resource that any parent or caregiver can reach for to find the answers you can’t readily find online, at school, or in the doctor’s office, and your feedback helps to refine the kinds of information I share. 

This book - and the content I share about it - is for YOU, and I’d love to hear what’s resonating with you most. 

PS. Don’t forget to save your spot for the workshop! More details to come soon! 

If this newsletter resonated with you or made you think, please consider pre-ordering the book and sharing with any friends or family who may be interested. Pre-orders are SUPER important for the success of new books and I want as many parents as possible to be able to learn from the information I share.

Thank you for your continued support, encouragement, and constructive feedback! 

I was so happy to connect with Dr. Pooja Lakshmin MD, a psychiatrist whose focus is on women’s mental health. Pooja is also a writer who is a frequent contributor to the New York Times and her book titled Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included) was recently published! She is also the founder of Gemma, the first EdTech platform focused on women's mental health, impact and equity. In this episode we talk about parental burnout. 

We discuss:

1. The definition of burnout

2. How to recognize burnout in yourself or others

3. Why parental mental health is important

4. What to do if you’re struggling with burnout or difficult emotions such as grief

You can find Pooja on Instagram @poojalakshmin, and for more information on Pooja and her work, you can check out her website. 

My new book Advanced Parenting will be out April 11, 2023. It is now available for pre-order!

If you like this episode, you can read more about these topics in Advanced Parenting. Chapters most relevant to this episode include 1, 6, 9, 11, and 13. 

Caitlin’s son Calum was diagnosed with Leukemia when he was 3. She shares the story on how her son was diagnosed and what their family’s journey with childhood cancer has been like.

You’ll hear Caitlin talk about:

• The symptoms and tests leading up to her son’s diagnosis

• What it was like to parent a toddler with special medical needs as well as her other younger child

• How she and her husband took on different roles and worked as a team

• The support she’s had from family, friends, and community through this journey

• What life has been like since her son finished treatment

Caitlin can be found on Instagram @BigTimeAdulting where she has over 658,000 followers. She shares her experience with motherhood, including all the hard and messy moments, but with a dose of humor and dance.

My own experience having cancer made me who I am today, a doctor who has a deep understanding of the way in a child’s condition can impact everyone in the family profoundly. Advanced Parenting: Advice for Helping Kids Through Diagnoses, Differences, and Mental Health Challenges, is a passion project born out of my personal experience combined with more than 10 years of supporting families as a pediatrician.

My hope is that it will help fill the gap for all those parents who walk out of doctors offices or school conferences and think what do I do now?

It’s time for at least one resource on the parenting shelf that acknowledges that most kids face something whether it’s food allergies, developmental delay, asthma, diabetes, ADHD, dyslexia, prematurity, constipation or one of 100s other things.

A story you might relate to 

Recently talking with everyone in my community about the forthcoming book, there have been a lot of conversations that go like this. 

Friend: How wonderful that you've made a resource for those parents, I'm sure maybe I might know some parents who have that sort of tragedy on their hands and will really need this support.

Me: Ah yes. But remember how you had that parent teacher conference where they suggested speech and occupational therapy for your son? Remember how you called me after trying to figure out what to do? 

Friend: Yes, that was so helpful thank you. I just felt so confused after that meeting and we spun out all week as parents trying to decide what to do next. Was it really a big problem or was the school just giving us grief?

Me: That's the kind of advice in the book. Also remember how xxx could not get her son to take medication for that infection? Or how xxx could not figure out how to talk to her daughter about her dyslexia? These are the sorts of things in the book.

Who is this book for? 

When I began considering writing Advanced Parenting, I thought about helping a family with a problem. Some challenges families face feel like problems - chronic allergies and asthma, a heart defect that needs a repair or a behavioral disturbance that needs to be controlled to prevent injury.

There’s another group of parents and caregivers who will find this book useful. Your child may struggle with anxiety, hyperactivity, autism, learning disabilities, or a genetic diagnosis. I need to make plain that viewing these conditions as “problems” needing “fixing” propagates stigma. Our society, including people like me, have a deeply ingrained ableism where we assume that people with disabilities are somehow “less than”. Just as racism or sexism, ableism leads to harmful stereotypes and systems of exclusion. 

Some differences are part of who we are and some of our differences should be welcomed and embraced rather than fixed. We may still need a plan or support to navigate our own path forward when it deviates from the default standard plan, but we are seeking to live and thrive with the diagnosis rather than fix it.

You are not alone 

Regardless of where you are, it’s important you understand that you are not alone.

It could be that the local doctors and the nearby school have no experience with a child like yours, and you may not know anyone who has ever had to do the things you now do. But, like in the story above, perhaps you’ll see that many if not most parents face a challenge that requires these additional advanced parenting skills. 

It may be that you are facing growth hormone deficiency and another child has developmental delay and plagiocephaly (a flat head) requiring a helmet, but you both have to do research to process the ever-changing body of knowledge on the condition. You both have to help support your child coping and gaining skills and independence in their own care. You have to figure out how to work with the school, sports, and babysitters, and continue to support your other children if you have them. While on the surface these children may seem to be fighting very different battles, at a deeper level we are all facing similar dynamics. 

For other families your challenge may be common, maybe something like asthma, but the way you are experiencing the challenge may not feel common. Maybe your child is struggling to cope with the trauma of a scary episode, or you struggle to reconcile the unpredictability of the condition with the rest of your life. Your experience of this common condition is unique to your family and often the standard advice or the fifteen-minute visits with your doctor doesn’t get to the place where you need the most help and leaves you feeling inadequately supported in making the best plan for your child. Advanced Parenting is intended to fill the gaps. 

What would you like to know?

Any questions about the book? Any sneak peek content you’d like to see? Let me know in the comments, I really appreciate and value your feedback!

Please preorder and share with any friends or family who may be interested! Pre-orders are SUPER important for the success of new books and I want as many parents as possible to be able to learn from the information I share.

Thank you for your support and encouragement, I couldn’t have done it without you! 

I’ve been so busy gearing up for my book launch, and one portion of that has been starting a new collaboration with Psychology Today. I was invited to contribute because Advanced Parenting touches on so many themes relevant to mental health. My first post I’ll share below focuses on how to decide if your child needs professional help for their mental health symptoms. Some of the future content will talk about how a chronic condition impacts a parent’s mental health and affects family dynamics.

We know that children commonly experience mental health distress. The recent Youth Risk Behavior Survey showed that nearly 60 percent of teenage girls experienced persistent sadness and 25 percent have thought of attempting suicide. Before the COVID Pandemic, we would commonly say that one in five children met the clinical criteria for a diagnosis such as depression, anxiety, or ADHD. Unfortunately, only 20 percent of these children got the evaluation and treatment they needed. 

Some of this gap is due to systemic problems. We can’t, as individual pediatricians or parents, snap our fingers and have access to affordable, accessible, high-quality child therapists and psychiatrists. But what we can control is the decision point for when we pursue a formal diagnosis and consider whether treatment will help.

Let’s use the example of anxiety. Josh and Lisa have a child, Annie, who has always liked things just so. When she was a toddler she would not wear certain fabrics or colors. She was selective about the foods she ate. She would often melt down about changes to the routine or new birthday parties. She had some trouble separating from her parents for babysitters, and when starting preschool, Josh and Lisa had to sit in the lobby of the school for a few weeks longer than the other parents.

But Annie is doing pretty well. She has friends and is a bright little girl hitting her milestones on time and always getting a positive report at parent-teacher conferences. She sometimes has trouble falling asleep but generally gets enough sleep and eats a varied enough diet that she doesn’t require a nutritional evaluation.

This is often the story that we tell ourselves as parents and we tell our doctors at our physicals. But this information is not enough or us to decide if Annie needs an evaluation or to consider treatment. We have to scratch a bit deeper to understand what life is like for Annie and her parents to make a good decision.

When I help parents to think through these decisions, often my questions cluster around understanding the burden and impairment from the symptoms.

The day-to-day burden of Annie’s mental health concerns falls on her but also on the rest of her family.

• How much time do the parents spend daily reassuring and encouraging Annie to participate in school and her activities?

• How long does it take to get Annie to bed each night? 

• Does Annie complain about tummy aches or headaches often? 

• Does she have meltdowns or tantrums on a regular basis?

Understanding the impairment from her symptoms is important, too.

• Are there activities in which the parents want Annie to be able to participate but she has been unable to because of anxiety? For instance, birthday parties, camp, or playdates?

• Have Annie’s family members missed out on things they wanted to do because of her strong preferences?

It’s not a parent’s job to distinguish between whether the symptoms their child is experiencing are part of their temperament or part of a diagnosis. It’s very difficult to do so—a child’s temperament isn’t going to change and is part of who they are. Some children are strong-willed, sensitive, or spirited and can be a challenge to parent, and some children will have a diagnosis of anxiety, depression, or ADHD. 

But when a child and a family feel the burden of mental health symptoms that limit their everyday ability to enjoy their life, it’s time to get an evaluation and consider treatment. It’s impossible to evaluate a child independently from understanding the context of their life—often it’s not just their symptoms but the fit of their symptoms within their family and school lives. That is knowledge that only a parent has and can share. The truth is that whatever the root cause of the child’s symptoms, evidence-based therapies like PCIT, CBT, and DBT can help children and parents gain skills to feel better. 

If you don’t think your child needs professional help after considering this, great. But the fact that you clicked through this article makes me think there may be something there. Just as parents encourage their children to gain literacy and numeracy skills, we can also encourage our children to gain social and emotional skills so that if things do escalate in the future, they are prepared to cope.

Consider whether your child can hit these milestones, and, if not, maybe explore ways to help them:

• Can your child name feelings (sad/mad/nervous) in others?

• Can your child name their own feelings?

• If your child can recognize feeling bad, have they learned any strategies (rest, deep breathing, positive self-talk, etc.) to help?

• Does your child know whom and how to ask for help?

If your child has good coping and self-regulation skills, great! The next step is to look at their social and communication skills, because we know supportive relationships are protective factors:

• Does your child have a few close friends? 

• Does your child know how to maintain healthy friendships?

• Does your child know how to be a supportive friend to others?

While we think of core parenting skills as ensuring children are fed, rested, and clean, most parents need these next-level, advanced parenting skills. Whether your child has a diagnosis or a need for formal mental health support or not, as a parent you need to know what’s out there and when to ask for help. This work is challenging, but when it’s done well, it has enormous value to your family and your children. If it feels like a lot, it’s because it’s complex and it’s hard, but remember, in thinking through this you aren’t alone. The goal of my book and this blog is to try to help fill this gap, but know your pediatricians, schools, and communities are full of people who are there to support you in your parenting journey.

While we’re talking about mental health, this week I was also interviewed about how parent’s anxiety about their children’s coughs and colds has increased since COVID-19 began spreading. Check it out here.

If you have suggestions or requests for future newsletters please let me know in the comments!

Vaccines are so polarizing. And before I get into the questions, I will highlight that I appreciate the hesitancy of the media in discussing this. In the US, we are still way under-vaccinated with the primary covid vaccine series.

• 11% of 6mo to 5 year old children have received at least one dose.

• 39% of 6-12 year old children have received one dose.

• 58% of 12-17 year old children have received at least one dose.

Why is vaccine uptake so low? Enough children (millions!!) have received the vaccines and demonstrated that their safety is very certain. But the continued hesitancy to me seems to be because of the prolonged delays in approval most children had COVID before they had the opportunity to be vaccinated, decreasing the drive to pursue vaccination.

We know that protection from severe COVID and long COVID induced by infection or by vaccination doesn’t last forever and is incomplete. So there is no doubt in the scientific community that everyone should get the primary series of COVID vaccination. Whether or not your child has had COVID, the baseline vaccine series decreases their odds of getting it again, of a severe course, of long COVID and of infecting others.

The controversy is whether young healthy people (under the age of 55) should boost with the currently available bivalent booster tailored towards newer variants of COVID vaccines.

Paul Offit (Paul A. Offit, MD | Children's Hospital of Philadelphia ) wrote an opinion piece ( Bivalent Covid-19 Vaccines — A Cautionary Tale | NEJM ) expressing that he does not think this strategy makes sense. Paul Offit runs the vaccine education center at CHOP and is an internationally recognized expert in immunology and firmly pro-vaccine. So why is he recommending we slow our roll?

The bivalent booster given to individuals with prior vaccination seems to add little protection against newer variants. The theory is that the immune system reacts to the shared portion of the target that it’s already “imprinted on” rather than the new bit which we hoped would solicit a reaction. It does induce some new-variant specific immunity but the current studies suggest it’s not a lot and it may not to last. Future variant boosters could be designed differently- with a higher dose or potentially without the original variant being included to make them more effective.

He is not saying that the variant specific boosting is “over” in fact he explicitly states that our prior exposures whether from the vaccine or infection or a combination (best!) have protected us from severe outcomes from the current variants relatively well. This may not be true of future variants. But hopefully we can learn from this experience to be prepared for targeted boosters if necessary in the years to come.

The week after this article came out another study was released showing benefit of the bivalent boosters 1 month after vaccination in adults over 55 (Bivalent Omicron BA.1–Adapted BNT162b2 Booster in Adults Older than 55 Years | NEJM).

So do bivalent boosters help or not?

• We know they are safe and definitely don’t hurt. They may help some especially if it’s been more than 6 months since the last dose/infection.

• If you are high risk, any help is probably meaningful.

• Otherwise for low risk people or people recently infected or boosted, the help is relatively marginal though we may learn more about this over time.

What did I do?

• My husband and I got the bivalent booster a few months ago. I am glad we did because we had the vaccine right when it came out and our last dose had been 9 months ago.

• My son got his third dose of Pfizer in August, because he also got the first 2 doses essentially right away and it had been 9 months. Since we had just boosted him when the bivalent came out we didn’t rush and now we are going to hold off unless there is a surge or new information comes in. Maybe next fall, but we will know more by then.

• My daughter was only in the age group approved this summer and she got her 2 Moderna vaccines. She also has had COVID. I will give her the bivalent booster at some point so she’ll have a third dose too, but not sure when.

What do I tell my patients?

• If you want to boost, sure! Again it won’t hurt.

• I definitely do recommend the primary series if you haven’t yet 3 doses. 

• Please, please, please get your flu shot, perhaps more important to me than a COVID shot. It’s not too late and kids with flu have been miserable this season.

I hope you find this helpful! Drop any questions in the comments.

Another reminder my book is up for preorder! if you want to support my work and enjoy my content please preorder Advanced Parenting today.

I am really hoping that my book has something helpful for everyone. We all deal with our children’s stuff and even if our children aren’t currently mid-challenge other parents in our communities are in the thick of it and we can better support them if we see all that happens behind the currents. 

It’s terrifying to put a book worth of content out into the universe and a heavy lift to do it on top of a full time job founding a preventive care institute… but this message made my week and is exactly why I keep on keeping on.

Yes it’s a parenting book, but “the why” is that we have to better support parents who are so alone in the hardest part of their parenting journey. If you’re looking for a speaker for an upcoming event or to support parents at your company / school / community organization also reach out, I’ll do my best to help.

But, we know that air quality is an issue that disproportionately affects women and children and has an impact on life expectancy, pregnancies and on the development of chronic diseases like asthma, dementia, and cardiovascular disease. Being thoughtful and proactive about good air quality makes sense.

However we keep this discussion in context, the deterioration in indoor air quality from cooking is likely brief and children may not actually be the population most impacted (chefs, parents who cook). But just as we think about sunscreen for protecting your skin during your daily commute to decrease propensity for wrinkles and skin cancer, a small dose of something like UV radiation or poor air quality daily can add up, and adds up more the more years you have left to live.

My interest in air quality is long standing, and I worked at the Mt. Sinai Children’s Environmental Health Center as a college intern many moons ago. During the pandemic I did a deep dive into ventilation and hep-a filtration. It’s really a bottomless pit of information and technical research. And it’s something I don’t talk about a lot with my patients because we don’t have that much control over the air we breath, and thinking about the harms of something we can’t control is very stressful. But I want to talk about it today because I think there is actionable guidance to consider.

The story

When we moved this year and I was starting a practice with a focus on preventive medicine, innovations and technology, I bought an air quality monitor. We are living on a lower floor, and the apartment above us is under construction and I said let’s see. I figured the air my family breathes in our bedrooms mattered most because we spend hours there a day. After monitoring I learned all the bedrooms have excellent air quality (all green/ AQI 50). I also plugged it into the rooms that face the busy street and also noted no problems from street air. And then I unplugged it and let it get dusty.

Last week when I saw the article, I plugged it in my kitchen. I am very lucky to have a nice big kitchen especially by NYC standards. Our appliances are at least 12 years old but in good working order. Now I have learned every time I cook my air quality deteriorates from an AQI of <20 / green to an air quality over 150 / red and about 1/4 of the meals the AQI goes over 200. Note what happened with dinner last night (quesadillas for the kids on the stove).

When you review the scale this indicates that everyone - not just children or sensitive individuals will be negatively impacted. This is true for the stove but also true our oven alone pops the air quality by about 50 points.

When we place the hood on to improve ventilation the AQI drops by 20-50 points and to the yellow range. After we finish cooking it comes down quickly in minutes. We haven’t experimented with opening a window (rainy day) or running a fan (don’t own one), but presumably these would have a similar impact.

We aren’t in a place where we want to consider shopping for an induction stove and a kitchen renovation, so we are going to purchase an air filter to either run continuously or run while cooking in our kitchen.

So, the question all of you have is how this affects you and your family. I do think it’s very important news. While we await more information I recommend:

• Improving the ventilation of your kitchen by running the hood or opening a window.

• If you were thinking about renovating your kitchen anyway in the next few years to switch to induction yes considering it, but also being aware that kitchen is combustion and likely generates some particulate matter or air pollution so remembering that matters.

• You could buy an air quality monitor and do your own science experiments. But you can also safely assume that your kitchen is similar to mine as the device is expensive. I’ll link it but please know I have no financial affiliation with this company.

The equity issues around air quality worry me. And I’ll re-emphasize that this is a first world “let’s optimize our health” issue. Let me know any questions in the comments.

I wrote a book! Too often I have seen as a mother, as a child, as a pediatrician and as a friend that parents are left adrift when their child faces a diagnosis or a disability. They leave the doctor or the school conference and say “What do I do now”. Or they fall into dealing with it and a year later feel how hard it is and think “What am I doing wrong”.

Writing Advanced Parenting has been a mission-driven labor of love to help these parents. Even if you don’t have a child with a diagnosis, your nieces and nephews, your neighbors, your coworkers do, and I hope the anecdotes in the book will shine a light on what is a nearly universal part of parenting - being a caregiver to a child through a struggle.

Please help me by pre-ordering the book and sharing it. This month bookstores will decide if they will stock it on shelves and how many to order, and they’ll decide based on pre-order numbers.

In my pandemic book, I had a chapter about newborns that I’ve been thinking about it recently as I have helped many friends through tough decisions about protecting hteir baby at home. It sounds easy to always keep sick people away from a newborn, but in real life it’s rarely straightforward. Decisions are often much more complicated.

• When mom or dad is sick the week of thanksgiving and the baby has already been exposed, are you really going fully quarantine apart?

• What about when the the older sibling is sick and keeping them separate feels impossible?

• Sometimes a friend or family member was recently sick - even if they are now better they still have a bit of a sniffle or cough. Should they come?

Tiny babies are obviously vulnerable. They depend on us for everything and they even have a soft spot on their head where you can feel their brain directly through their skin. As a pediatrician, I have seen ill babies cope remarkably well until they use up their limited reserve of energy and suddenly deteriorate. Because of the unpredictable nature of their response, we have precautions in place to take any illness seriously in babies under 2 months of age. Fever should be treated like an emergency and a doctor involved if your child is sick.

The magnitude of the risk from coronavirus seems similar to other viruses that circulate in our community every year. It may even be that the risk to babies from coronavirus is slightly lower than influenza and RSV (while the risk of coronavirus for adults is much higher than these circulating viruses). For newborns, the risk of complications and hospitalizations from influenza and RSV is significant and matters. Many parents prior to the pandemic may have underestimated the impact of these viruses, but now this concern is front and center on everyone’s mind. So I’d like to share a story where a baby got sick, and one where I took a calculated risk.

When my dear friend had her second baby, she wanted to travel by plane to spend time with her parents during maternity leave. Prior, her baby hadn’t been out much, as he was only six weeks. Likely en route he caught a virus, while at the grandparents’ house he developed fever and required hospitalization. He had blood draws and a spinal tap, a needle inserted into his spinal column that showed a common virus — enterovirus — had caused a viral meningitis - an infection that spread to his brain. He remained well, other than signs of a cold and fever, and was discharged after a couple of days. He’s now 11 and a smart, charming and athletic boy, but the illness caused a major stress. But this story is relatively common, we know that everyday viruses can cause more serious infections.

So you might think with after watching my friend go through this, I put my own children in a bubble, but no. When my son was born, Thanksgiving was 10 days later and 5 days after being discharged from the NICU. We had to decide whether to see family. I was worried that someone would get my little one sick. But my husband wanted to see his family and show off his new baby, and I was feeling ready to get out of the house. A few people were attending Thanksgiving who might not have been able to join the following year and it was important to my husband. So we decided to mitigate the risk as best we could.

For us, this meant asking everyone to have gotten the flu vaccine prior to Thanksgiving. While the baby was too young to be vaccinated, the flu vaccine decreased the likelihood of attendees exposing the baby to flu. (This was before the COVID vaccines were out but the concept is the same, the risk is decreased even if it’s not eliminated). We made sure that no one came sick or “sort of sick.” And we asked people to wash their hands on arrival and before holding the baby. When people were holding the baby, I would ask them to use a blanket over their clothing. This would protect their clothing from any baby spills and my baby from any fomites on their clothing. I’ve heard from many parents — particularly new parents — that navigating these conversations with friends and families can be difficult. I got a LOT of eye rolls. Your loved ones may disagree with the plan, but setting limits that you feel comfortable with is a normal part of parenting.

Keep in mind that individuals with influenza are typically contagious for 5-7 days and with RSV the average is 4 days though there is a wide range as shown in this chart.

Both viruses can be spread by respiratory means AND by contact (touching infectious particles). You can decrease baby’s exposure to respiratory droplets by using masks, air purifiers or keeping windows open. And as a pediatrician who often sees germs, I change clothes before I hug my kids at the end of the day. I also recommend wiping down phones and high touch surfaces to protect against infection.

Still at the end of the day, you make the best decisions you can with the information at hand. Despite best efforts sometimes babies will get sick. Have you had to make tough decisions this holiday? Or maybe you’ve been struggling with sick kids?

My book Advanced Parenting has loads of content about approaching difficult decisions and is available for presale! If you’re going on a shopping spree throw it in the cart!