Remedies for Nausea and Vomiting

Nausea and Vomiting: What’s Wrong?

Your child’s nausea has turned to vomiting, and you want to help him fast. Luckily, bouts of vomiting in kids aren’t usually harmful, and they pass quickly. Common causes are stomach viruses and sometimes food poisoning. Check in with your doctor if your child is less than 12 weeks old, acts sick, or if you are worried.

Signs of Dehydration

One of the best things you can do is watch for dehydration. Kids get dehydrated more quickly than adults. Watch your child for: acting tired or cranky, dry mouth, fewer tears when crying, cool skin, sunken-looking eyes, not urinating as often as normal, and when he does go, not peeing very much or urine that is darker yellow.

Treating Dehydration

To prevent and relieve dehydration, try to get your child to drink in very small amounts. Even if vomiting continues, she’s still absorbing some of what you give her. Try ice chips, sips of water, sports drinks, or oral rehydration solutions like CeraLyte, Enfalyte, or Pedialyte. After she vomits, start with a small amount: a few tablespoons every few minutes. Over time, give her more as she is able to hold it down. Make sure she urinates regularly.

What About Flat Soda?

For many years, parents used flat lemon/lime soda and ginger ale to help kids replace fluids, and many doctors still recommend those. But research has begun to show that oral rehydration solutions are better for kids. These drinks offer the right amounts of sugar and salt. An alternative can be a sports drink mixed with an equal amount of water.

Liquid Diet

When it’s been several hours since your child last vomited, you can begin a clear liquid diet beyond just water, electrolyte drinks, or oral rehydration solutions. Stick with liquids you can see through. They are easier to digest, yet they offer nutrients to give your child energy. Think clear broth, cranberry juice, apple juice. Popsicles and Jell-O can work well, too.

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Masks and Summer Heat: Expert Tips

Dr. Teresa Murray Amato rode the subway into Manhattan from Queens the other day and found that summertime and face masks aren’t an easy fit.

“It was a warm day. I definitely felt it was a little hot,” said Amato, director of emergency medicine at Long Island Jewish Forest Hills in Queens, N.Y.

Despite her discomfort, Amato resisted the urge to remove her mask — and she recommends that you do the same.

COVID-19 continues to spread even in the humid heat of summer, so it’s important to keep wearing masks and maintaining social distancing to prevent transmission, said Dr. Waleed Javaid, director of infection prevention and control at Mount Sinai Downtown in New York City.

At least 10 states — Alabama, Arkansas, California, Florida, Nevada, North Carolina, Oklahoma, South Carolina, Tennessee and Texas — reached record levels of hospitalized COVID-19 patients on Sunday, the Washington Post has reported.

This was the risk of reopening, but public health officials have said it’s worth it if people wear masks.

Evidence has shown that masks can reduce transmission of the new coronavirus, if everyone wears one, Amato said.

Summer heat may make your mask feel stifling, but you should keep wearing it if you’re near other people or in enclosed spaces, she said.

“Even though we know it’s going to be a little uncomfortable, I really think the benefits outweigh the discomfort of being a little warm while wearing your mask,” Amato said.

Keeping both your mouth and nose covered is important. Folks struggling with their mask in the heat might try switching to a lightweight one that’s more breathable.

At this point, surgical masks are in good enough supply that people who are uncomfortable with a cloth face covering might consider buying a box, Amato said. Even grocery stores are carrying them now.

“A light surgical mask probably does the trick with the least amount of discomfort,” she said.

Sweat is another problem. If your mask becomes damp with sweat, its ability to screen out coronavirus is diminished, Amato and Javaid said.

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Cancer Drug Might Help Curb Severe COVID-19

Could a cancer drug spare hospital patients from the ravages of severe COVID-19?

Yale doctors think it can after giving the medication, known as tocilizumab, to severely ill patients back in March.

How does tocilizumab work? It has a long history of dampening the life-threatening immune system reactions cancer patients often experience while undergoing treatment. Since the same kind of dangerous response develops in many COVID-19 cases, the researchers thought the drug might make a difference for the sickest patients.

The result — while preliminary — appears to be a dramatically lower death rate among patients placed on mechanical ventilators.

How much lower? Among the first 239 COVID-19 patients treated at Yale New Haven Hospital, in Connecticut, during the early weeks of the pandemic, 153 were treated with tocilizumab, including all 48 patients who had been placed on ventilators. “Instead of survival rates of 10% to 50% reported elsewhere, it was 75% in [ventilated] patients treated with tocilizumab,” said study author Dr. Christina Price, Yale’s chief of clinical allergy and clinical immunology.

In addition, among those seriously ill patients who ultimately survived COVID-19, tocilizumab appears to have significantly shortened overall ventilation time. While hospitals around the country were having to keep patients hooked up for between 12 to 14 days, ventilations at Yale typically lasted only about five days.

How tocilizumab works against COVID-19

What accounts for its apparent success against COVID-19?

It all originates in the threat posed by a deadly immune system phenomenon known as “cytokine release syndrome” (CRS), an out-of-control inflammatory response that the virus triggers in some patients.

CRS is “when the body’s response to fighting the virus goes so unchecked it ends up being harmful, damaging the liver, the kidney, the lungs. You need an immune response. You can’t totally shut it down completely. But you can’t let it get out of control, which is what can happen to cancer patients undergoing treatment. And to COVID patients,” Price said.

The problem? “There were no [U.S. Food and Drug Administration]-approved medications for COVID in March,” she stressed.

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What Does Asymptomatic COVID-19 Look Like Under the Surface?

Asymptomatic individuals carrying SARS-CoV-2 shed the virus longer than those with COVID-19 symptoms, with other lab findings suggesting the symptomatic patients mounted more robust immune responses, a small study in China found.

Median duration of viral shedding among 37 asymptomatic patients was 19 days (interquartile range 15-26; range 6-45) versus 14 days among 37 matched symptomatic patients (IQR 9-22; log-rank P=0.028), reported Jing-Fu Qiu, PhD, of Chongqing Medical University, and colleagues, though viral shedding does not necessarily mean the patients were infectious.
Virus-specific IgG antibody titers and cytokine levels were also significantly lower among asymptomatic patients in the acute phase of infection, when viral RNA can be found in respiratory specimens, the authors wrote in Nature Medicine — both of which indicated that immune responses weren’t as strong in the asymptomatic group.

Asymptomatic transmission of COVID-19 is one of its biggest mysteries, with the World Health Organization recently reminding the public of the distinction between asymptomatic patients, who never develop symptoms, and presymptomatic patients, who go on to develop symptoms later in the course of disease.

Qiu and colleagues characterized asymptomatic carriers as the “silent spreaders” of COVID-19.

“However, our understanding of the clinical features and immune responses of asymptomatic individuals with SARS-CoV-2 infection is limited,” the researchers added.

For the study, they examined data from 178 patients with PCR-confirmed SARS-CoV-2 infection in the Wanzhou District in China, including 37 without symptoms. Median age in the latter was 41, and 22 were women. These individuals were matched by age, sex, and comorbidity with 37 symptomatic patients for antibody detection and cytokine measurement. Qiu and colleagues also included a group of 37 individuals who tested negative via RT-PCR for cytokine comparisons.

Lab values and imaging were not entirely normal for the asymptomatic group. Eleven had increased C-reactive protein levels and six had elevated levels of alanine aminotransferase. Chest CT found “focal ground-glass opacities” in 11 and “stripe shadows and/or diffuse consolidation” in another 10 of the group; in two-thirds of these 21 patients, the abnormalities were in only one lung. The remaining 16 showed entirely normal imaging.

Around 80% of both symptomatic and asymptomatic patients tested positive for IgG antibodies about 3-4 weeks after exposure. The difference was greater when examining IgM antibodies, with positive findings in 78.4% of symptomatic patients and 62.2% of asymptomatic patients.

In the early convalescent phase, defined as 8 weeks after hospital discharge, symptomatic patients had higher IgG levels, though both groups experienced over 90% decreases in IgG levels. A larger proportion of asymptomatic patients had decreases in neutralizing serum antibody levels versus symptomatic patients (81.1% vs 62.2%, respectively).

These findings should serve as a caution against assuming prior infection confers immunity to future infection, Qiu and colleagues said.

“These data might indicate the risks of using COVID-19 ‘immunity passports’ and support the prolongation of public health interventions, including social distancing, hygiene, isolation of high-risk groups, and widespread testing,” the team wrote.

Plasma levels of cytokines were also similar between asymptomatic patients and healthy controls, though significantly higher levels of stem cell factor and leukemia inhibitory factor were found in the asymptomatic group, the researchers noted, calling this a “reduced inflammatory response characterized by low circulating concentrations of cytokines and chemokines.”

Qiu and co-authors cited the varying sensitivity and specificity of antibody tests (obtained from a company called Bioscience) as a limitation to their study, adding that the results may be confounded by existing antibodies to other coronaviruses, such as SARS or MERS, as well as common cold viruses.

Vaccine makers face biggest medical manufacturing challenge in history

Developing a COVID-19 vaccine in record time will be tough. Producing enough to end the pandemic will be the biggest medical manufacturing feat in history.
That work is underway.

From deploying experts amid global travel restrictions to managing extreme storage conditions, and even inventing new kinds of vials and syringes for billions of doses, the path is strewn with formidable hurdles, according to Reuters interviews with more than a dozen vaccine developers and their backers.

Any hitch in an untested supply chain – which could stretch from Pune in India to England’s Oxford and Baltimore in the United States – could torpedo or delay the complex process.

Col. Nelson Michael, director of the U.S. Army’s Center for Infectious Disease Research who is working on the government’s “Warp Speed” project to deliver a vaccine at scale by January, said companies usually have years to figure this stuff out.

“Now, they have weeks.”

Much of the world’s attention is focused on the scientific race to develop a vaccine. But behind the scenes, experts are facing a stark reality: we may simply not have enough capacity to make, package and distribute billions of doses all at once.

Companies and governments are racing to scale-up machinery to address a critical shortage in automated filling and finishing capacity – the final step in the manufacturing process of putting the vaccine into vials or syringes, sealing them and packaging them up for shipping.

“This is the biggest logistical challenge the world has ever faced,” said Toby Peters, an engineering and technology expert at Britain’s Birmingham university. “We could be looking at vaccinating 60% of the population.”

Several developers, including frontrunner Moderna, are experimenting with new ways to mitigate the extreme cold storage demands of their vaccines, which at present need to be kept at minus 80 degrees Celsius (-112 Fahrenheit).

SiO2 Materials Science is working on producing vials that won’t shatter at super-cold temperatures.

Travel restrictions, meanwhile, are posing more prosaic problems; Johnson & Johnson, which plans to start clinical trials this summer, has struggled to send its vaccine experts to oversee the launch of production sites, for example.

‘NEVER IN HISTORY’
By setting up massive clinical trials involving 10,000 to 30,000 volunteers per vaccine, scientists hope to get an answer on whether a vaccine works as early as this October. But even if they succeed, manufacturing in bulk, getting regulators to sign off and packaging billions of doses is a monumental challenge.

Seth Berkley, chief executive of the GAVI vaccines alliance, said in reality, the world is unlikely to go straight from having zero vaccines to having enough doses for everyone.

“It’s likely to be a tailored approach to start with,” he said in an interview. “We’re looking to have something like one to two billion doses of vaccine in the first year, spread out over the world population.”

J&J has partnered with the U.S. government on a $1 billion investment to speed development and production of its vaccine, even before it’s proven to work. It has contracted Emergent Biosolutions and Catalent to manufacture in bulk in the United States. Catalent will also do some fill-and-finish work.

“Never in history has so much vaccine been developed at the same time – so that capacity doesn’t exist,” said Paul Stoffels, J&J’s chief scientific officer, who sees filling capacity as the main limiting factor.

Emergent’s manufacturing plant in Bayview, Maryland, can accommodate four vaccines in parallel using different manufacturing platforms and equipment.

Funded by the government in 2012, the plant includes single-use disposable bioreactor equipment featuring plastic bags rather than stainless steel fermentation equipment, which makes it easier to switch from one vaccine to another.

This month, the company received an additional $628 million to make those four suites available to support any candidate the government selects, CEO Bob Kramer told Reuters.

BLOW-FILL-SEAL-REPEAT

As well as working with J&J, New Jersey-based Catalent signed a deal with British drugmaker AstraZeneca last week to provide vial-filling and packaging services at its plant in Anagni, Italy. It aims to handle hundreds of millions of doses, starting as early as August 2020 and possibly running through until March 2022.

It has ordered high-speed vial-filling equipment to boost output at its Indiana plant, where it is also hiring an additional 300 workers.

Michael Riley, Catalent’s North American president for biologics, told Reuters his biggest challenge was trying to compress work that normally takes years into months.

Adding to the challenge is that glass vials are in short supply.

To save glass, companies plan to use larger vials of five to 20 doses – but this raises new problems, such as potential waste, if not all the doses are used before the vaccine spoils.

“The downside is that after a healthcare practitioner opens a vial, they need to then vaccinate 20 people in a short, 24-hour time,” said Prashant Yadav, a global healthcare supply-chain expert at the Center for Global Development in Washington.

As part of the same drive, the U.S. Department of Health and Human Services and the Department of Defense have awarded ApiJect Systems up to $138 million to upgrade its facilities to be able to make up to 100 million plastic pre-filled syringes by the end of this year, and as many as 600 million in 2021.

The company plans to use a technology called Blow-Fill-Seal, where syringes are blown out of plastic, filled with vaccine and sealed in seconds. This will need Food and Drug Administration approval, CEO Jay Walker told Reuters.

BREAKING COLD CHAIN
SiO2 Materials Science is, meanwhile, ramping up capacity of plastic vials with a glass lining, which are more stable at ultra-low temperatures.

“You can bring us down to minus 196 Celsius, which none of the vaccines need,” Chief Business Officer Lawrence Ganti said. “You can throw it against the wall and it doesn’t break. Our founder has done that. He’s thrown frozen vials at me.”

The company expects to boost production from the current 5-10 million vials a year to 120 million within three-and-a-half months, he told Reuters.

Once packaged, many vaccines need to be kept cold – and some leading contenders made from genetic material such as messenger RNA need to be kept very cold – presenting another challenge that may limit access.

“People who work with mRNA store it at minus 80 degrees centigrade, which is not something you’re gonna find in most pharmacies or doctor’s offices,” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and co-inventor of the rotavirus vaccine.

Peters of Birmingham university has been gathering data from poorer regions of Africa and Asia, and said breaks in the temperature-controlled supply chain – “cold chain” – are already frequent.

In some places, it is common to lose 25% or more of vaccines because of broken cold chains, he told Reuters.

“So if you’re looking to manufacture four billion, and you reckon you’re going to lose 25%, then you have to manufacture five billion,” he said. “It’s all the elements to move it from the point of manufacture to the point of aggregation, right down to the health centres and then out to the community.”

QUARANTINE QUAGMIRE
Companies developing mRNA vaccines, including Moderna and Translate Bio, which is partnering with Sanofi, are working to make candidates stable at higher temperatures.

Ron Renaud, CEO of Translate Bio, said he was confident this would happen “within a short amount of time”.

Colleen Hussey, a Moderna spokeswoman, said: “We are getting more confident that we could run our supply chain at -20C, which is an easier storage condition than deep freezing,” she said.

Moderna plans to add a small period of time in which the vaccine can be stored at normal fridge temperatures of 2 to 8 degrees Celsius in doctors’ offices or clinics.

“We will know more in the next 2-3 months,” she said.

The pandemic is also presenting obstacles of a less technical nature.

Catalent, which has some 30 plants globally, has had to write special permission slips in eight languages explaining that their workers are considered essential.

J&J is having trouble getting experienced personnel to far-flung labs to oversee the transfer of technology to contract manufacturers because they’re subject to 14-day quarantines.

“It is absolutely a factor,” said Stoffels. “If you have to send your people to the middle of India to get to filling capacity, that’s not easy at the moment.”

Vegetarian and Vegan Diets Explained

The simplest definition of vegetarianism is a diet free of meat, fish, and fowl flesh. But eating habits of vegetarians cover a wide spectrum. At one end are lacto-ovo vegetarians, who avoid animal flesh but eat eggs and milk products. At the other end are vegans, who forgo eating (and often wearing) all animal-based products, including honey. Raw foodists are vegans who eat mainly raw fruits, vegetables, legumes, sprouts, and nuts.

There are also pescatarians, who eat fish and seafood; and lacto-vegetarians, who eat dairy products but not eggs. Fruitarians follow a diet that includes fruits, nuts, seeds, and other plant food. Those who follow a macrobiotic diet eat mostly grains but can also eat fish. They don’t necessarily identify as vegetarians.

Flexitarians refer to vegetarians who occasionally eat meat and fish.

Reasons for Becoming a Vegetarian

Many adherents of vegetarianism and veganism – former Beatle Paul McCartney and actor Alec Baldwin are two celebrities who happily promote the cause — regard a flesh-free diet not only as more healthful, but as a more ethical way to live. They point to the cruel practices and the high environmental cost of raising animals for food as reasons for excluding meat from the diet.
Most Americans, however, continue to eat some form of meat or fish. Ten percent of people consider themselves to be vegetarians, according to a 2013 Gallup poll.

Vegetarianism and Health
Most doctors and nutritionists agree that a low-fat diet high in fruits, vegetables, and nuts can be a boon to health. There’s also research suggesting that reducing or eliminating red meat from the diet may cut your risk of heart disease.

Research also has shown that a vegan or vegetarian diet may lower your risk of getting type 2 diabetes. And a 2011 study found that vegetarians had lower triglycerides, glucose levels, blood pressure, and body mass index (BMI).

Does Being a Vegetarian Lower Cancer Risk?
It’s difficult to say whether being a vegetarian or a vegan lowers cancer risk. This is mainly because of the diversity within the vegetarian population.

Many studies of the cancer-vegetarian relationship conclude that diets rich in fiber, vitamins, minerals, isoflavones (found in soybeans, chickpeas, peanuts, and more), and carotenoids (found in carrots, sweet potatoes, broccoli, kale, spinach, tomatoes, red peppers, and more), seem to protect against disease, including cancer, when part of a health-conscious lifestyle.

An 11-year study in Germany examined colon cancer among 1,900 vegetarians. Researchers noted fewer deaths from cancers of the stomach, colon, and lung in study participants than in the general population — particularly among those who practiced some form of vegetarianism for at least 20 years. They suggested, however, that other factors, like body weight and amount of exercise, likely affected mortality rates in the vegetarians they studied.

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Kettlebells

How It Works
Burn up to 400 calories in 20 minutes: That’s what you’ll get from a kettlebell workout.

A kettlebell looks like a cast-iron cannonball with a handle on top. They come in various weights. You’ll use them as you do things like lunges, lifts, and shoulder presses.

The workout gets your heart pumping and uses up to 20 calories per minute: about as much as running a 6-minute mile.

Kettlebell workouts offer a lot of flexibility. You can include a few of the moves in your own workout or do a dedicated kettlebell workout a few times a week.

Buy a DVD or sign up for a kettlebell class at the gym to learn how to do the moves safely. It won’t take long to understand why celebrities like Jennifer Aniston, Jessica Biel, and Katherine Heigl are huge fans of kettlebell workouts.

Intensity Level: Very High
You’ll work up a sweat doing a series of fast paced cardio and strength-training moves like kettlebell swings, lunges, shoulder presses, and push-ups.

Areas It Targets
Core: Yes. Most kettlebell workouts include squats, lunges, crunches, and other moves that work your abs and other core muscles.

Arms: Yes. The kettlebell is used as a weight for arm exercises like single-arm rows and shoulder presses.

Legs: Yes. Lunges and squats are among the most popular moves in a kettlebell workout.

Glutes: Yes. Your tush will be toned by using the kettlebell for added weight during lunges and squats.

Back: Yes. Using a kettlebell for a dead lift helps tone your back muscles.

Type
Flexibility: Yes. Working out with kettlebells will improve your flexibility.

Aerobic: Yes. This is a high-intensity workout that will get your heart rate pumping.

Strength: Yes. The kettlebell is an effective weight that will build muscle strength.

Sport: No. This is a fitness activity, not a sport.

Low-Impact: No. You can expect to be running, jumping, and doing other high-intensity moves.

What Else Should I Know?
Cost: The cost of a kettlebell ranges from $10 to $100 depending on the weight of the kettlebells (heavier ones are more expensive). You may want to buy DVDs or sign up for classes to learn the basics of a kettlebell workout.

Good for beginners? Yes, if you take a class or pick a DVD that’s for beginners and use a lighter kettlebell. There are also more advanced kettlebell workouts for those who are more fit.

Outdoors: You can do a kettlebell workout outside or indoors.

At home: You can use kettlebells at home.

Equipment required? Yes, a kettlebell. You can buy kettlebells in weights ranging from 5 pounds to 100 pounds at sporting goods stores and online retailers.

What Dr. Melinda Ratini Says:
Using kettlebells can be a great way to pump up your workout. You will be burning more calories in a shorter period of time.

Depending on the program, you may be getting both your strength training and your aerobic workout at the same time. Ask your doctor first.

Treat this workout with respect. If you choose a kettlebell that is too heavy or if you have poor form, you are likely to lose control of it. This can lead to a serious injury to your back, shoulders, or neck. Start out with an experienced trainer who can correct your technique before you hurt something.

Adding a kettlebell to your existing workout is great if you want to burn more calories in less time. It will quickly add muscle and stamina.

This type of high-intensity workout is not for you if you would rather do a more meditative approach to body sculpting, or if sweating isn’t your thing.

If you are trying to get into top form or keep in top shape, then swinging a kettlebell can help you reach your fitness goals.

Is It Good for Me If I Have a Health Condition?

With your doctor’s OK, you can include kettlebells in your fitness routine if you have diabetes. You will be building muscle while losing fat. Muscle burns energy more efficiently, so your blood sugar levels will go down. Depending on the workout, you may also get some cardio to help prevent heart disease.

This routine can also be a great way to help lower your blood pressure and your “bad” LDL cholesterol. Check with your doctor first, especially if you already have heart disease.

Using kettlebells in your workout puts some serious demands on your hips and back, as well as your knees, neck, and shoulders. It is a high-impact program. If you have arthritis or pain in your knees or back, then look for a less risky strength-training program.

If you have other physical limitations, ask an experienced instructor for advice on how to modify your workout.

If you are pregnant and have never used kettlebells, then this is not the time to start. If you worked out with kettlebells before becoming pregnant and are not having any problems with your pregnancy, then you will likely be able to continue using them — at least for a while. Check with your doctor first.

You will need to make some changes as time goes on. As your pregnancy hormones kick in, your joints will become looser. You can adjust by using lighter kettlebells and avoiding certain moves. Talk to your instructor and your doctor; they might suggest switching out your kettlebells during your last trimester.

Talking to Your Child About Bedwetting: Dos and Don’ts

As many as one out of five children wets the bed at night. Also called nocturnal enuresis, bedwetting is as common as it is misunderstood.

How you, as a parent, handle your child’s bedwetting can have a big effect on how successful your child is at staying dry. When you’re ready to talk with your child about bedwetting, here are a few simple tips that can help.

Bedwetting: Talking to Your Child
Educate. In a class of 30 children, as many as six kids may wet the bed. Letting your child know that other kids have the same problem can take the weight off his shoulders and help him feel he’s not alone.
Tell your child if you used to wet the bed. Was bedwetting a problem for you as a kid? If you or a close family member used to wet the bed at night, let your child know. This helps them understand that bedwetting may be hereditary and is not completely their fault.
Tell them they’re not to blame. Even if there’s no family history of bedwetting, make sure your child knows they’re not to blame for wetting the bed. Explain what can cause bedwetting, including how some children have small bladders or are such deep sleepers they don’t feel bladder contractions in the night.
Tell your child a doctor can help. Talk to your child about seeing a pediatrician or other health care professional to discuss bedwetting treatments. An examination by a doctor can also help rule out medical causes for wetting the bed, such as urological problems or a reaction to certain medications.
Talk to your child about treatment options. Make sure your child understands what’s available to help him overcome wetting the bed, including enuresis alarms, medication, and lifestyle changes. Generally, treatments such as medication are used for children older than 6. Explain, too, how each option works and what to expect from each treatment.
Talk about changing habits. Going to the bathroom before bed, avoiding caffeinated and salty foods, drinking a little less fluid close to bedtime — these and similar changes can help your child achieve dry nights, so talk to him about how he can help himself.
Be encouraging. When your child successfully follows the bedwetting treatment you’ve chosen — whether he’s had a dry night or not — give him praise and encouragement.
Stay low-key. After a child wets the bed, be sure to remain calm and positive.
Encourage your child to go on sleepovers. Your child doesn’t need to miss out. With the use of absorbent pants, medication, and the help of other parents, let your child know they can go on sleepovers or away to camp.
Ask if it’s OK to share. Many kids don’t mind it if other adults know about their bedwetting — especially if that adult can help, such as a parent at a sleepover, or a counselor at camp. But do check with your child first.
Talk to your child about taking part in cleaning up. Sharing the responsibility of changing and washing the wet sheets helps a child actively tackle the problem of bedwetting. Help them with the activity, and praise them for taking part.

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Do You Need to Wear Gloves at the Grocery Store?

Our experience with food has changed dramatically in a matter of a few weeks (along with everything else in life) because of COVID-19. We’re cooking at home more than ever before, and grocery shopping has become one of the few essential errands we leave the house for. Armed with our long shopping list and a face mask, we head out wondering if there’s anything else we can do to protect ourselves.

One question that keeps coming up is – Should you wear gloves at the grocery store?

The short answer is no. You do not need any kind of gloves at the grocery store.

Gloves will not protect you. If you touch a contaminated surface, the virus can transfer to your glove just like it could transfer to your fingers, so there’s no added protection from the gloves. If you touch your mouth or nose with the glove, you can pass the virus to yourself. And taking the gloves off after shopping is an especially vulnerable moment, as you can easily transfer any germs on the gloves to your hands and face if you’re not careful.

The reality is you’re much more likely to catch the coronavirus from the respiratory droplets of a person talking or sneezing near you rather than from an item you touch at the store – that’s why physical distancing is so important. To protect yourself at the grocery store, wear a cloth face mask and keep a minimum 6-foot distance from others. Plan your grocery trip so you can get in an out quickly during quiet times to minimize contact with others.

Gloves do not replace hand hygiene. Given that gloves don’t protect you from the virus, wearing gloves doesn’t save you time from hand washing. You still have to keep up with hand hygiene. That’s the most important way to remove the virus from your hands.

To protect yourself, you’ll want to use hand sanitizer as you enter and exit the grocery store and wipe down your shopping cart handle with a disinfectant. When you get home, wash your hands well with soap and water for 20 seconds. And clean any other items that might be dirty, like your phone and reusable grocery bags.

Gloves do not protect others. As you move about the grocery store, the gloves can get dirty from whatever you touch and transfer it along to others – just as your fingers would.

To protect others, touch as little as possible while you’re out. Don’t pick up produce and then put it back down.

Save the medical gloves. Medical gloves are meant for protection when you’re in high risk situations, like if you’re exposed to bodily fluids like blood, mucous, vomit and urine. The gloves protect patients, caregivers, and health care workers all day long from tasks at home like washing the laundry of a person sick with COVID-19, to tests and procedures at the hospital. For grocery shopping, the gloves don’t add benefit and aren’t necessary. Given medical gloves are in short supply, just as medical face masks are, please use gloves wisely.

6 Essentials for an Effective Face Mask

At some point, all of us will have to leave our homes and venture into public places. For now, it may be the grocery store or the doctor’s office, but later as social distancing measures slowly ease, we may actually be able to get a haircut or return to the office for work. The new normal will be different – seating will be spaced far apart, there will be plenty of clear barriers to protect workers, and you will likely be wearing a face mask.

In many places, you are already required to wear a cloth face covering, and it makes good sense. According to Dr. Anthony Fauci between 25% to 50% of people can be infectious and spread the virus without symptoms. It is easily transmitted by respiratory droplets simply by speaking or laughing, along with coughing or sneezing.

Of course, a cloth face mask is not foolproof protection from COVID-19, but it is much better than no mask. It is another important layer to physical distancing when used in combination with 6 foot spacing from others and hand hygiene. Unfortunately, there aren’t enough N95 or other medical masks in the U.S. for everyone. We need to save those masks for people on the frontline caring for those sick with COVID-19.

Not surprisingly, the cloth face mask market is increasing exponentially to meet demand, and the science behind what makes a good cloth face mask is inching along slowly. It is difficult to know what qualities to prioritize when searching for a face mask.

Here is what we know about what makes a good cloth face mask:

Sew or no-sew: Either sew or no-sew options are fine when used correctly. Do what’s reasonable for you. If you’re in a rush, go with a no-sew option. If you’re crafty, make your own mask at home. Or, order your masks locally or online. Choose mask designs recommended by reliable sources like the CDC. Another option is to check your local hospital’s website. Many are posting patterns with precise instructions to make masks they’ll accept as donations.

Fabric: The best cloth masks will use at least 2 layers of a tightly woven cotton fabric. Look for a high thread count. This acts as a filter blocking respiratory droplets while still allowing you to breathe comfortable.

Filter: Some will have a space to slip in a filter for an added layer of protection. The CDC recommends adding coffee filters to homemade masks. Online I’ve seen many filter options pop-up as people experiment with products in their home. These include cutouts from reusable fabric grocery bags made of polypropylene non-woven fibers, nylon fabric from pantyhose, paper towels, kitchen towels, bra pads, denim, and canvas to name a few.

We do not have much science to go on, so common sense is critical here. Is the filter worth adding when you consider safety and usability? The filter needs to be dense enough to block tiny, moist particles while also being breathable and comfortable. Are you inadvertently breathing something toxic? For example, some HEPA (high-efficiency particulate air) filters can have fiberglass, which would be very dangerous to inhale. Definitely do your own research to keep up with new information.

Fit: You need to be able to breathe comfortably with the mask on so that you do not have to slip it off while you’re in public to take a breath. The face mask must have a snug fit from nose to under the chin and back towards the ears. It’s useless if there are gaps that allow the air in. There are face masks available that come in different sizes. Also, you don’t want to have to fiddle with the mask, for example if it’s stiff, and potentially contaminate your fingers touching the outside layer of the mask. If you feel like you can’t breathe comfortably with your mask, don’t use it, and talk to your doctor about other face covering options.

Ease of use: Once you find a face mask you like, it’s only as good as how you use it. Make sure you can easily untie or remove the loops from your face and pull the mask away from your face without being contaminated by touching the front of the mask. Infinity scarves are not a good option for masks because they’re difficult to cleanly take on and off.

Plan your outings knowing you should not slip the mask on and off to eat or talk on the phone. If you’re exercising outdoors, you may not be able to tolerate a mask when you breathe hard. In that case, choose your exercise location carefully to make sure you can keep a physical distance from others and be safe.

Durability: You will need to wash the cloth mask after each use, so look for reviews online that comment on the masks wear and tear. If the mask loses shape, you will not be able to use it. If you are adding a filter, cleaning it will depend on what kind of filter you use. A coffee filter should be thrown away after each use. Also, the fabric should be pre-washed so that you don’t need to worry about shrinkage.

When you wear a cloth face mask, it shows you care about your own health and the health of others. It signals to others to be respectful of physical distancing measures and keep a 6-foot distance from you. A cloth face covering is also a subtle reminder that the professional masks are for those on the front line. With all the cool colors and patterns out now, you can even make it a style statement.