As I mentioned before, dang gui (angelica sinensis, 当归) soup is my go-to Chinese herbal tonic for whenever I have any issues that I suspect may be remotely related to blood, circulation, or hormones. Men can benefit from this tonic in the same way, too. Whenever I drink it, I feel revitalized and relaxed at the same time, helping my sleep and energy. I swear by it, and so do 2,200+ years of traditional Chinese medicine.
Although the dang gui herb comes in extract, capsule, or powder, I have only had the tea form. Having tried taking other Chinese herbs in capsule form, I think that the brewed method is far superior in feeling immediate benefit.
There are two basic recipes either sweet with dates or savory with chicken drumsticks, that you can use to prepare the soup/tea. Personally, I LOVE the bitter and sweet flavor of the sweet tea. I asked my mom to write me the recipe as she always prepares it for me and I haven’t ever done it myself. Now I’ve written down the surprisingly simple recipe here for myself (and you!) and have no excuse not to be able to prepare it for myself.
About 5 slices of dang gui (當歸)
About 8 red dates aka jujubes (红 枣 or 大枣) or more if you like it sweeter
Substitute the red dates with 2 chicken drumsticks if you prefer savory
The number of dang gui slices and red dates are really more about the taste/effect that you prefer. The more dates you add, the sweeter the tea will be. Likewise, the more dang gui you add, the stronger the tea.
I get the dang gui from a local Chinese herbal store and recently have been able to find organic jujubes online at luckyvitamin.com.
Rinse both ingredients, then put them into a pot of water (about 6 rice bowls of water – that’s how my mom measures things, haha).
Cook on medium high heat for about 20-30 minutes.
Then turn to medium low heat until the soup is ready (stop brewing when the liquid is equivalent to about 2 rice bowls of soup/tea).
If you prepared the savory version, you can salt to taste.
It’s probably obvious why I’ve been researching how to make fresh food last as long as possible (not including freezing, pickling, cooking, etc.). In an effort to go grocery shopping just once every two weeks, I’ve discovered my Achilles heel in my desire for fresh produce. Below are the methods I’ve found so far for some fresh food that I recently bought.
How to store cucumbers as long as possible
I found conflicting opinions. Epicurious says to clean, dry, and wrap them in a dry paper towel, tucked inside a plastic bag. However, kitchn.com begs to differ. Its writer says to keep them on your counter at room temperature, away from ethylene-gas-producing foods like banana, melons, tomatoes (which cause other foods to ripen/spoil faster).
Well, I’ve already tried the Epicurious method and it has never gotten me past a few days, so next time, I’m going to try the counter top method.
How to store leafy greens / salads as long as possible
We find our broccoli to go bad within a couple of days, so I can tell you for sure how NOT to store it: Don’t leave it in a plastic bag in your vegetable crisper. We get terrible results from this. Listonic and Wikihow offered two different options to try: 1) Wrap it loosely in a damp paper towel and it may last 4-5 days. 2) Store the broccoli like a bouquet in a bowl/jar of water, stem side down and it could last 5-7 days.
How to store zucchinis as long as possible
Storing zucchinis didn’t seem to be as interesting for the internet as tomatoes. The general consensus seems to be to avoid putting zucchinis in the fridge if possible because the cold ages the zucchini. If you do put it in the fridge, then put it in a plastic bag (partially open or perforated to slow down the oxidation process).
During this time of “shelter in place,” I’m tempted to give myself a bigger break than usual when it comes to parenting. Then I remember two things: one, we don’t know how long we’re going to be dealing with this, if this is, in fact, the “new normal,” and two, if I relax my parenting now, I might be giving myself more work for later to fix habits I’ve undone in a couple of weeks (screen time, anyone?).
The best thing about her book is that it’s practical and usefully laid out. For each “thing” that mentally strong parents shouldn’t do, she lists examples of ways we actually do what we shouldn’t do – without even realizing it. You will almost always find yourself in some of her examples. She shares a detailed story highlighting that “thing” parents shouldn’t do and then provides a variety of tips and guidance for what you should do instead. First, if you just want to read her list, see below. But the list doesn’t mean much without the context she provides in each of the chapters. She really brings each of these “Don’t Do’s” to life with lots of example situations and personal experience.
13 Things Mentally Strong Parents Don’t Do, according to Amy Morin:
They don’t condone a victim mentality
They don’t parent out of guilt
They don’t make their child the center of the universe
They don’t allow fear to dictate their choices
They don’t give their child power over them
They don’t expect perfection
They don’t let their child avoid responsibility
They don’t shield their child from pain
They don’t feel responsible for their child’s emotions
They don’t prevent their child from making mistakes
They don’t confuse discipline with punishment
They don’t take shortcuts to avoid discomfort
They don’t lose sight of their values
I’m dissecting my own behavior around this list as a form of parenting self-analysis. Starting with the #1 Thing that I should try not to do too often. . .
#1 They Don’t Condone a Victim Mentality
My kids will moan and complain that it’s their worst day ever. That it’s everyone else’s fault but their own that they weren’t focused during a basketball game. That their math book is stupid and that’s why they’re frustrated. Or they’ll let their sibling push their buttons until they explode while their sibling sits smugly and happily in the other room.
Morin calls a victim mentality a learned behavior that can be learned from parents unfortunately. Some things that I’ve been guilty of as a parent:
Making excuses for my kids’ failures or shortcomings (yes, I’ve blamed their terrible tempers on their father and their negativity on genes from my pessimistic mom)
Thinking that my children are helpless sometimes
Instead of giving time to these thoughts, I should be helping my child focus on what he can control in his life. For example, being trapped more or less in our home now, I’m trying to empower them with how not to be fearful of coronavirus. I’m telling them that we have to train ourselves to wash hands automatically, not touch our faces, and to be mindful of space and contact with others at all times. If the kids get into fights with each other, I can ask them to think of what they can do to make themselves feel better and not expect me to solve it or punish the other child.
I’ve had lots of opportunity to work on my parenting these last few days, and without getting too ahead of myself, I want to say that I’ve noticed more independent behavior. I’ll be sure to have another post on “#2 They don’t parent out of guilt” which I already know will give me some cringe-worthy self-reflection. . .
We have stopped oral immunotherapy updosing, after having reached a dose of 1 whole nut for each child (see why in the section below, “New information since we started OIT”). So now we are entering maintenance phase at a daily peanut for one child and a daily cashew for the other. Our allergist said that after about 3 months on the 1 nut dose, they would be protected from accidental ingestion of up to 2-3 times their dose – which would be about 2-3 nuts.
It took us 7 months, updosing on a schedule target of every 2 weeks, to go from roughly 2.5mg of nut flour to 1 of an actual, decent-sized nut. We had a few updoses with 2.5 to 3 weeks in between due to illness, scheduling availability, and travel.
We’re only 30 minutes away from our food allergist. Each appointment was 1.5 hours long. I got used to measuring out the nut flours everyday. All in all, in retrospect (now that it’s over!), the time invested didn’t seem so bad.
Reactions during updosing
Overall, we had a pretty smooth experience with updosing. We did not have any anaphylactic reactions. We followed most of the guidelines:
We usually dosed in the evenings around 7 to 7:30pm. Our kids go to bed around 9pm. We did occasionally dose late around 8pm.
We skipped dosing on particularly hectic/exciting days like Halloween.
We did shower after the dose a few times, but we kept it particularly short and not too hot and did not have reactions.
We dosed with Zyrtec on updose days and for 2-3 days after based on initial recommendations of our allergist.
Both my kids had occasional tummy aches, but I could never be certain if it was related to dosing. I suspect that some were and some weren’t.
Twice, one child had the feeling of something in the throat. Both resolved with Zyrtec.
My peanut-allergic child had coughing reactions on 5-6 occasions within the two hour window of dosing that were resolved with Zyrtec.
Our allergist basically recommended that we stop at 1 nut. This is a change in thinking since the time we began OIT last year. Originally, our provider thought that OIT would continue up to about 3-4 nuts. Here are the recent learnings that resulted in the change of their decision:
Clinically, our provider saw that patients in maintenance were having more reactions at 3-4 nuts versus patients who were doing very well on just 1 nut, while conferring a strong level of protection of up to 3 nuts. (Incidentally, for what it’s worth, I learned that a maintenance dose of 8-10 nuts is around the level of what is considered “free eating.”)
This supported my own anxiety-inducing findings on Facebook OIT groups where it seemed that many parents shared that their kids were having reactions, even anaphylactic ones on maintenance doses of 3-4 nuts or more.
Palforzia, the “drug” containing pre-measured doses of peanut flour will also only go up to 300mg (1 peanut), so this falls in line with what is now considered “safe” and FDA-approved.
I also came across this 2018 Palforzia aka AR101 study that showed only 67.2% of patients who had been on a maintenance dose of 300mg peanut flour were able to pass an exit challenge of 600mg without dose-limiting symptoms. This made me less comfortable about the 2-3 nut protection level mentioned by our allergist. If you’re data-inclined, here’s the appendix for even more details (including the OIT dose schedule, patient characteristics, etc.) on the study.
All in all, our provider suggested that we stop at one nut for now and reassess in 3 months whether we would like to continue, given the recent findings and after we see how our kids fare on their 1 nut maintenance. Our provider also said that we would need to be completely reaction-free for the next 3 months to even consider updosing to reach 3-4 nuts (which is about 3-4 more updose appointments).
Our peanut-allergic child with suspected underlying asthma conditions would not be recommended to continue past 1 nut due to the risk associated with the conditions, unless we resumed asthma control medications. We’ll have to think hard about that one because the behavioral changes were very unsettling.
Our other cashew/pistachio-allergic child could be allowed to continue if there are zero reactions in the next 3 months. However, in that case, we would do a pistachio challenge of some sort. When we began OIT, we were told that desensitizing to cashew results in desensitizing to pistachio (due to the cross-reactivity) in about 80% of the cases. Our allergist now says that this is actually the case in 90%+ of the allergies, and after 3 months on the 1 cashew maintenance dose, they would recommend a challenge of eating 3 pistachios in the clinic to see if my child has desensitized to the pistachio as well (1 cashew = 2.5 pistachios).
Here are five things I’ve learned about when dealing with health insurance:
#1 Health insurance representatives and provider office personnel often give wrong, different, or incomplete information
How are you supposed to know what information is correct if you get different information depending on who you talk to? What’s worse is that, you then usually make financial or health decisions based on this incorrect information.
If you ask about coverage benefits, the health insurance representative may forget to tell you that your deductible applies. I have been told over the phone that services from an out-of-network provider are covered 100% (no deductible mentioned). Only to find out after the claim has been denied and 15 phone calls later, that our deductible needed to apply first. Perhaps someone could have told me when I asked the first time? Get a summary of the plan benefits sent to you. Better yet, make them send you the long detailed version and look up the answer to your question. Don’t rely on over the phone answers.
The provider’s office has also on occasion told me that they are out of network, even when I was able to find them in the online in-network provider directory and then confirmed it with a health insurance representative. In those cases, you can now get a confirmation number of the phone call along with a record of the call content. However, you have to ask for it.
# 2 Services performed by in-network providers may need coverage by different types of insurances or may not be covered
Well, I didn’t know this was possible, but after being billed for the refraction portion of a visit to the ophthalmologist office, I discovered that you may need to break down claims to submit different portions of it to medical insurance and vision insurance. However, you have to figure this out in ADVANCE so that YOU can tell the eye care provider’s office which doctor will be allowed to perform which service on you.
These days, many eye care offices house ophthalmologist, optometrists and eye care shops in the same location. We needed to check on the sudden onset of myopia (therefore the need for an ophthalmologist), but checking the eye problem also involved the need to check vision, a refraction service which could be performed by either the ophthalmologist or the optometrist, both of which performed services on my son at the same visit.
However, it turned out that we were only covered if we had the optometrist perform the refraction. So although the optometrist was seeing my son at the visit, the ophthalmologist happened to perform the refraction. Therefore, we had to pay for the refraction out of pocket. Make any sense? Somehow, you really need to do your research before you go to any doctor. I’m sure this happens in many doctors’ offices. However, I bet you the doctor’s office won’t be able or willing to help you much when you ask questions BEFORE a visit. Who’s screwed? You’re screwed.
# 3 Surprise billing
They’re finally doing something about this “surprise billing.” I have an Explanation of Benefits (EOB) that now actually states what to do if you receive a “surprise” bill – they’ll try to help you fight it. In fact, there was even a recent article in the Atlantic about this, stating, “A fifth of U.S. patients get surprise bills from surgery—even if their surgeon and hospital are in-network.”
Surprise billing occurs when you are receiving a medical service from an in-network provider and, unbeknownst to you, part of your service is performed by an out-of-network provider. You will receive a “surprise” bill for that portion of the service. This could be $150 or lots of $$$ depending on the service.
Two examples of situations where this might happen: 1) you’re getting lab work done at your in-network provider, but without notifying you, they send the lab to an out-of-network lab to perform some of the tests. This happened to me. 2) You’re getting surgery and the work has been pre-authorized by your insurance as in-network covered services. However, maybe the anesthesiologist or another doctor who does a little work on you (while you’re out cold) happens to be out-of-network. You get the bill for the out-of-network services.
#4 FSA or HSA – not both
Maybe a lot of you knew this already, but not me. You can only have an FSA or HSA – not both. (However, you can have a limited purpose FSA that’s for vision and dental expenses only and HSA together.) We signed up for an FSA at the beginning of the year. Mid-way through the year, we had a job change and had to change insurance plans. We looked at the HSA and discovered that was a good option for us. BUT guess what, since we already had an FSA for the calendar year, we were not allowed to enroll in the FSA plan. And we were not allowed to cancel the FSA, in order to enroll in the HSA. No double-dipping, but you gotta read to figure this out because no one will point this out to you.
#5 Administrative labyrinth
I’m not sure if NOT getting to enroll in the HSA was actually a blessing in disguise. HSAs (and to some degree FSAs) are for those who are extremely good at keeping receipts, completing paperwork, reading the fine print, following up when claims get denied, resubmitting receipts, making phone calls that last 30 minutes each (at least), and a plethora of time to do these things. The administrative labyrinth also applies any of the problems mentioned above. You know yourself. Are you going to have the time to follow up on all of this (because you will inevitably have to)? Otherwise, it’s $$ to Uncle Sam or cash you can never use.
Or if you don’t care about getting screwed – you can just save yourself time, and know you’re probably getting a bad deal with your insurance. But I say, keep calling them, keep irritating them, send your horror stories to the media, or we’re all going to have to deal with this miserable system forever.
Do you have more to add to my list? Send them over!
Changing jobs? Open enrollment? Recently, we were choosing between a variety of health insurance plans, including ones with HSA options. Before I thought to look online, I had already made my own comparison spreadsheet, but I guess that’s all well and good because it was a nice, eye-opening experience to think through the ridiculous rules of each of the health insurance plans myself. Even the plan representatives barely understand the rules.
Later on, I found a few different health plans spreadsheets online that I thought were helpful and collected the links below. There are also various calculators and comparison widgets on health websites, but they hide the logic and calculations they’re using to compare, so it’s not as useful. In the end, it’s a bit like picking stocks because of the assumptions and guesses you have to make about your future needs, but I still found it more useful than not thinking about it at all. Hope some of these are helpful to you too.
#1 Mr. Money Moustache and Reddit Health Comparison Spreadsheets
These two spreadsheets that I found on the forums of Mr. Money Moustache and Reddit are quite similar and straightforward to use. They compare a PPO plan to an HDHP w/HSA. They graph out the costs of the plans based on medical costs which is helpful to see around what cost point that the plans are most cost-effective. It comes down to what you think your costs are likely to be:
#3 Healthcare Plan Worksheet on spreadsheetsolving.com
I also liked this spreadsheet on spreadsheetsolving.com (interesting site and worth further review for those of us who like spreadsheets!). The poster did a nice job of talking through the logic behind the calculations:
Recently (9/27/21), I came across this post at thefinancebuff.com called “Do The Math: HMO/PPO vs High Deductible Plan With HSA.” The post helps you to think about how to choose a healthcare plan and includes an abbreviated worksheet to work through a simple comparison, especially if you’re not in the mood to slog it through with a detailed spreadsheet. The Finance Buff website itself is a great resource for personal finance, btw!
#5My Detailed Health Plan Comparison Spreadsheet(s)
To use any of the spreadsheet versions below, log in to your Google account while you are accessing the spreadsheet, then you will be able to select “make a copy” and modify it however you want in your Google Drive.
In each of the versions below, there’s a tab to estimate usage costs, and then another tab to see how the different deductible amounts for the plans actually played out based on the estimated costs. Don’t forget to adapt the spreadsheet logic to your own plans’ rules. Also, If you catch some obvious errors, I would love to be notified!
Health Insurance Plan Comparison V1 – February 2020
In the Reader-modified 2021 version, a reader customized my spreadsheet with more details and a more clear way of incorporating copays and coinsurance. I’m looking forward to trying out this modified version pretty soon as we have the option to change plans again this year!
I’d been sniffing the hair on my children’s heads – yes, moms do that. And found that they smell very different. I can’t even describe the smell though – one like vanilla soup and the other like citrus tea. That got me wondering what they might smell like as teenagers and then adults. Would my deliciously smelling kids become stinky people with various body odors? Would I need to arm them with deodorants? Was I going to need to do a 3 week research project on finding the best, non-toxic deodorants?
I’ve noticed that men and women and folks of different ethnicities also seem to have different body odors. I’m of Asian descent and have never used deodorant in my life and have probably rarely needed it (although I suppose I should get some second opinions about that). My husband of European descent can have more distinctive scent, but many of my male Asian friends have claimed that showering after the gym is utterly unnecessary from a body odor standpoint.
I got searching. Researching trivial things is a guilty pleasure of mine.
The answer first
Here’s the bottom line on whether you and/or your child will be stinky:
A mutated, non-functioning ABCC11 which results in lower secretion of MRP8 has been found in approximately 80-95% of East Asians (Chinese, Korean, Japanese, etc.)
In the rest of the world, this gene mutation exists in only 0-3% of people of European and African ancestry, and 30-50% of people from South Asia, the Pacific Islands, Central Asia, and indigenous Americans. Those with a mutated ABCC11 aren’t completely immune from body odor, just that they will probably have a lot less of it and maybe indetectably so.
This gene incidentally also determines the type of earwax you have. A non-functioning ABCC11 gene results in dry ear wax, whereas a normal expression of the ABCC11 gene results in wet ear wax. Therefore, the type of earwax you have (at any age) can help determine your levels of body odor.
What makes the actual body odor?
The main source of our body odor comes from our body’s sweat glands in combination with the bacteria on our skin. At birth we have eccrine sweat glands all over our body which excrete water and salt mostly, but at puberty we develop apocrine sweat glands in the armpit and groin regions. Apocrine sweat glands secrete proteins (including the odor causing MRP8 protein) and lipids and when they mix with the bacteria on your skin, body odor is created.
What’s the connection to ear wax?
The ABCC11 gene that determines your body odor also determines your ear wax type. It’s expressed in humans as two alleles resulting in either sticky brown cerumen also known as “wet ear wax” or dry flaky cerumen aka “dry ear wax.”
The dominant allele, let’s call it “W,” produces wet ear wax and body odor. The recessive allele , say “D” (also referred to as the mutated version of the gene) results in dry ear wax and less of the odor causing protein. If you have two recessive alleles, DD, then you have dry ear wax. If you have wet ear wax then you either have WW or WD. For a refresher on genetic traits and to see how this will be passed down in your family, see here and here.
Check your ears and your child’s ears if you’re curious. For evolutionary reasons still unclear, dry ear wax is found predominately in East Asian populations (as mentioned above).
Things in your diet such as spicy, pungent foods in high quantities can come through your skin. Stress can increase the production of your apocrine sweat glands, and the breathability of your clothes can either trap in your sweat or allow it to evaporate. How often and when you shower (like post-workout) can also determine how much bacteria is on your skin and available to turn sweat into odor.
Bacteria and surroundings nothwithstanding, your scent may also change with age due to a couple major factors. Babies and pre-teens don’t have the apocrine sweat glands that produce the odor-causing proteins. For older people, scientists have discovered that people over the age of 40 emit an odor compound called 2-nonenal that occurs when chemicals breakdown in our bodies as we age. It appears to be linked to the muskier smell that people associate with older people.
So I checked the type of earwax in my kiddos and I’ve got one wet and one dry. Looks like I might have some future Google research on deodorants after all.
This is a niche post for those of us trying to explore the causes and cures for myopia. Since the causes of myopia are not fully understood, the treatments are still under discovery and experimentation. If you search online, you probably won’t find much evidence that the axial length of the human eye can be reduced – this is a key measurement that folks are using as an objective way to determine if axial length myopia can be reversed. However, I suspect that there exists some evidence – it just hasn’t reached Google’s top search results. I discovered that the axial length of my child’s eye was reduced over a 3 month period, leading me to think some researchers out there may have similar data on children.
So my current answer to “can the axial length of an eye be reduced?” Yes, based purely on numbers and measurements for a single child data point – more on this below, along with the caveats. All in all, it’s still encouraging information. (Update as of 11/17/22: In absence of a new post on axial length, I wanted to share that our optometrist once described a case of one teenage patient whose axial length dropped significantly for an unknown reason and the patient’s RX correspondingly dropped about 2 diopters! So YES, axial length absolutely can change, but IF and HOW it will happen is not understood.)
Here are the axial length measurements on my 8 yr old child who has an RX of OD: plano, OS: -1.25:
20-20-20 near work rule, outdoor time ~1.5-2 hrs/day, “active focus” 2-3x/wk for a few minutes at a time
OD: 24.37mm OS: 24.65mm
End of June 2019
20-20-20 near work rule, outdoor time ~2-3 hrs/day, “active focus” 2-3x/wk for a few minutes at a time
OD: 24.36mm OS: 24.66mm
End of August 2019
20-20-20 near work rule, outdoor time ~3-4 hrs/day, “active focus” 2-3x/wk for a few minutes at a time, plus lenses when reading
OD: 24.43mm OS: 24.75mm
Beginning of Dec 2019
20-20-20 near work rule, outdoor time ~1.5-2 hrs/day, “active focus” 1-2x/wk for a few minutes at a time, regular wear of multifocal soft contact lenses
OD: 24.38mm OS: 24.67mm
Things to note on the data
In a 3 month period, there was a .05mm reduction in the right eye and a .07mm reduction in the left eye. The practitioner wasn’t surprised by the positive change and said this was known to happen with the initial wearing of multifocal soft contact lenses, from which I inferred that more reduction isn’t to be expected.
.07mm is estimated to be the equivalent of 0.25 diopters, according to our optometrist.
.12mm is the average growth/year in the axial length of non-myopic children, according to our optometrist.
Although we incorporated many good vision habits, the reduction in axial length did not occur until my child was able to wear multifocal soft contact lenses.
Even though the right eye is not myopic, we decided to wear multifocals in both eyes to try and help prevent the right eye from becoming myopic. After one eye becomes myopic, it is common for the other eye to become myopic as well.
The increase in axial length came during the summer at a time when we were able to spend a lot of time outdoors in a lot of sunshine, we no longer had school (less near work time), and when we had added the use of plus lenses for reading.
I checked my child’s vision with an eye chart a few times a week, and it seemed to me like his eyes were getting better during the 3 months that there was an increase in the axial length.
Our attempts at “active focus” were so few per week that it’s not a significant factor for consideration.
My child gets almost zero screen time. He reads books a lot but will only occasionally read as much as 45 minute blocks which are then peppered with a 20-20-20 rule.
Thoughts on the effect of the multifocal soft contact lenses
Multifocal soft contact lenses and “active focus” – Since seeing that the contact lenses seemed to make the most difference in my child’s axial length, I’ve been thinking about how they work and how it might compare to the concept of active focus which I read about on endmyopia.org. According to endmyopia, active focus is the activity you need to do to stimulate your vision to improve – you look at something that’s just very slightly blurry and then focus on it to see if you can clear the blur. When you wear multifocals, your eyes also have to do something similar on a constant basis. Because there are patches of less clear vision, your eyes have to learn to adapt to pick out the parts that are clear to create the focused image that you finally see. I could be totally off-track, but just throwing it out there. Thoughts, anyone?
If you have any axial length measurements or similar experiences, please do share! Anyway, we’ll be measuring axial length again in another few months. Stay tuned.
This is a very helpful post in providing more numbers for understanding axial length, and understanding of possible ethnic differences, and growth differences in myopic and non-myopic children:
Just to be clear, this post is not about bashing doctors! We see many amazing, caring doctors. This post is about an over-reliance on what doctors in our healthcare system can do and taking charge of our own health. Maybe you already know different, but I grew up thinking that the doctor’s word was the final word. Unsure about anything? Go see a doctor. Nowadays, I still see a doctor, but I go online, research some more, and I take the doctor’s opinion into consideration as I decide what to do. Here’s why:
#1 They’re not always up to date on the latest research
Doctors are busy and many are in a practice where they are required to get through a certain number of patients each day. Maybe they don’t have time to keep up on the latest research on everything or have the time to communicate it to you.
For example, Benadryl, due to its lower safety profile, has no longer been the drug of choice for allergic diseases for at least a few years now. We’ve been seeing a variety of allergists and pediatricians regularly during that time, and none of them had informed us of this. We recently saw a new allergist, and were finally told of the preference to avoid Benadryl.
#3 They’re specialists and only looking at part of your problem
We really do need doctors who understand a lot about one particular area – there can be so much to know. The problem is that they can miss a whole lot of other stuff because our body works as a whole! Furthermore, because of the way medical records are set up, primary physician sometimes don’t get all of your medical information from specialists and vice versa.
If you don’t communicate the information yourself or don’t fully know it either, you’re out of luck. Unfortunately, all this means more work for you in uncovering what else might be going on in your body and connecting any dots. Nobody else is really going to look at the big picture or track it, except for you.
#4 The research they rely on is not always reliable
Doctors generally provide evidence-based treatment. That is the profession and how they’re taught. However, they can only rely on the research available to make recommendations for you. But the problem is that alot of that research is flawed too. A 2014 Atlantic article wrote that Dr. John Ioannadis, one of the world’s leading experts on medical research, estimates that 90% of the medical research that doctors rely on is flawed.
I was surprised by this, but then I will readily admit that I used to be one of those people who would just skim to the “Conclusions” part of any research article. I decided to pay attention to the methods and the details for how the studies were conducted and I realized that some of the conclusions were really not so convincing.
That sucks, doesn’t it? Again, more work and thinking on our part.
#5 They misdiagnose and can have widely different opinions
Recently, I had a cough that turned into some nasty cough and congestion. The family doctor told me I had a virus and if I didn’t get better, it must be bacterial and she would prescribe me antibiotics empirically. The allergist did a nose swab and said no bacteria. He gave me a skin rash test and told me that I had really bad allergies, prescribed me steroids, and recommended that I start on a program of allergy shots. In the end, I did nothing (more out of uncertainty than anything), but thankfully recovered two weeks later. But I could have had an unnecessary course of antibiotics or steroids.
Basically, the state of the US healthcare system (have you looked at your health insurance lately?), how it works, and how it impacts the medical care we receive really forces us to take charge of our own health and the decisions we make regarding our own care. Doctors provide recommendations, but now more than ever, it’s necessary and also possible (with a little Internet research) for us to ask more questions and evaluate the options better on our own.
The pediatric allergists who we’ve seen have said that all the allergy medications being used to treat children’s allergies are “very safe these days.” However, I like to double-check everything, including what the doctors say. Plus, to me, there’s a range of “safe” which I like to call risk reduction. Here’s what I found: there are in fact, nuances to the common allergy medications that are prescribed like Zyrtec and Benadryl, that are worth considering when deciding which to use and when. (If you want to try and reduce allergies without medications, see my posts on physically reducing allergens in your environment and also natural ways to minimize or treat your allergies.)
Best anti-histamine for kids: Zyrtec
For regular environmental allergies, Zyrtec seems to be the anti-histamine of choice. It’s the second fastest-acting (20 minutes – 1 hour) and lasts 24 hours. Benadryl apparently works the fastest, but its main ingredient has been linked to increasing risk of dementia. Many allergists no longer recommend Benadryl for kids at all. The Stanford clinical trials on OIT for peanut allergies used to require children to dose daily with Benadryl. When the studies came out about its link to dementia risk, they switched over to Zyrtec immediately.
Claritin takes longer to work (3 hours). Allegra, another popular choice, is shorter-acting and apparently less effective.
Anecdotally, on a Facebook group for children with allergies, some parents noted increased aggressive behavior and acting out during their child’s regular use of Zyrtec. They felt that symptoms resolved with the use of Allegra. I searched this briefly and found that allergy meds are sometimes linked to negative effect on behavior, although no one particular anti-histamine is blamed. It appears to depend on the child.
Our own pediatric allergist also recommended Zyrtec during our food allergy treatment, but did not have any particular reason for not recommending the others. If you’re looking for the quickest relief possible (and for one-off use) such as reaction to a food allergen, etc. then Benadryl might be your top choice. Also, according to our pediatric allergists, if you need the medication to get into your system faster, then choose liquid over tablet form. However, if your child needs the medication daily, then Zyrtec sounds like a safer choice.
Best nasal spray for kids: Flonase Children’s Sensimist
Two of our pediatric allergists recommended Children’s Flonase Sensimist (different formulation from the adult version). One pediatric allergist called it “super safe.” It appears to have the least amount of systemic absorption – which is what you want since you are mainly trying to treat nasal symptoms and want the drug to work locally. We were also warned to be sure and spray away from the nasal septum as spraying directly can damage the septum and cause nosebleeds.
Even with Flonase, it seems that the less you need to use it, the better. Studies have found that inhaled corticosteroids, like Flonase, can stunt a child’s growth.
One pediatric allergist’s ranking of allergy meds for children
Having children with severe food allergies can be very difficult on the parent as well as the child. However, other than plain avoidance, there are now actually a number of different options for families to consider.
If you have a child under 5, you have a particularly good chance of using some of these options (particularly OIT), to cure (not just desensitize!) your child’s food allergies. Researchers have found that the younger kids have much more lasting benefits of immunotherapy – meaning they could actually be cured(!) rather than just desensitized. My kids were unfortunately past that age when I learned that information – talk about some serious “wish I knew before!!!” Below is a list of treatment options that you can now consider.
#1 Oral immunotherapy (OIT)
Oral immunotherapy involves giving your allergic child increasingly larger amounts (over a long period like a year, etc) so that they gradually become desensitized to the allergen. OIT for peanuts and other nuts is the most studied, but it is available for other food allergens as well. This is known to have about 80% efficacy rate, but there are challenges with it. Patients regularly have mild reactions and sometimes anaphylactic reactions. It has the lowest safety profile of all the treatments so far, but is the most effective. We are trying this one! Read my OIT post to get the key details to help you decide if it’s right for your family.
These are liquid drops that appear to have a higher safety profile (less side effects), but generally less efficacy than OIT. It’s also much easier than eating doses of your allergen each day. It involves putting small drops of liquified allergen underneath the tongue and holding it for a couple minutes – this also has to be done for 1+ years. Like OIT, it’s unclear how long the benefits of the therapy can last without regular dosing. Some OIT practitioners offer SLIT, but not many yet. SLIT is also available for environmental allergens. The most recent research out on SLIT found the efficacy rate to be about the same as OIT. If the research continues to be promising, this option may emerge as the option that most allergists will be comfortable with due to its safety profile.
This is a patch that you place on the skin that releases small amounts of peanut protein that mixes with your sweat to get into your skin. So far, the research says it’s not as effective as OIT or SLIT, but does offer some modest protection.
This one is less well known than the ones mentioned above. I have not had a chance to read much about this method, but appears to be a homeopathic approach to strengthen the immune and digestive system first (through probiotics) and then gradual ingestion of the allergen (that part sounds like OIT). I found some news coverage and well-known chef Ming Tsai has a son who was cured of his allergies with this method and spoke about at on this episode of Dr. Oz.
#6 Peanut allergy vaccines and antibodies
These are fairly new and I haven’t gotten around to reading enough about them, but they sound promising and I wouldn’t rule out trying them even after having completed OIT. They seem only available in clinical trials for the near-term.
Stanford just released news that an antibody treatment that they piloted was successful in allowing peanut-allergic patients to ingest about one peanut’s worth of peanut protein about two weeks after having received just one injection of the antibody. Compare that to the ~6 month process of OIT for one nut’s worth!
My child sprained an ankle and immediately, every well-meaning person around us kept at us with ice, and more ice. The day after the injury, our sporty, super-fit friends quizzed me, double-checking that we were continuing to ice the ankle. All this emphasis on ice gave me pause, because in traditional Chinese medicine (whose philosophy I have followed growing up), ice is never used for an injury. These opposing views sent me running to Google.
It turns out that recent research suggests icing an injury may not be the best way to heal an injury. In fact, a new March 2021 study found that ice may be more than just unhelpful, but may actually slow healing!
The bullet points below summarize the basic arguments against using ice:
For years, ice has been widely practiced as the standard treatment for sprains and sore muscles. However, recent research has determined that both ice and too much rest may actually delay healing. In fact, Dr. Gabe Mirkin, the doctor who coined the term RICE, Rest, Ice, Compression, and Elevate in 1978, wrote an article in 2015 stating that he now believed this method actually delayed, rather than helped healing.
A review of 22 research papers found little evidence that ice and compression helped healing over the use of compression alone, so there is actually scant scientific proof that ice helps
Controlled blood flow and inflammation is needed for the body part to heal and ice (as well as anti-inflammatories like ibuprofen, and other pain reducers) work against them, by shutting or slowing down blood flow to the area and turning off your body’s natural immune response of inflammation
If ice is used at all, it should just be used briefly and is only for the benefit of pain relief. You should use ice in those instances, but be aware that it may slow your recovery.
Instead of ice and rest, do movements (gently as needed) but as soon as possible. According to renowned physical therapists, Dr. Jim and Phil Wharton, “inactivity shuts the muscle down. Blood flow is restricted and tissue atrophy follows. In contrast, activity improves blood flow, which brings oxygen and removes metabolic waste.”
Icing may slow healing. It may be disrupting the body’s natural cell process in a way that actually delays muscle recovery according to a March 2021 study done on mice. Apparently, there are enough similarities between animal and human muscle to suggest that the body’s muscles may know how to heal itself better without the ice.
Ice vs. no ice is still widely debated and you will find professional, medical voices on both sides. However, if you do a search, you will find most articles by orthopedists, physical therapists, physicians alike advising you to use ice. It seems the idea of ice not always being helpful or necessary is either not well-known or perhaps not acceptable to most people in this field where the idea of using ice for injuries has been ingrained for some time. I found that our own orthopedist at a well-known sports medicine clinic prescribes ice.
This turned out to be a much more controversial topic that I expected it to be. It definitely reinforced my propensity to question conventional medical wisdom (5 Reasons Not to Rely on Doctors). Arguably, I found the evidence to back my personal bias towards traditional Chinese medicine (of not using ice). I saw arguments ranging from ice is harmful, to neutral, to helpful. I think at the very least, I saw that ice is not necessarily helpful nor necessary, (and I won’t have to feel like I wronged my child by not giving ice).
In another post, I wrote about how I decided to lean towards minimalist footwear for my kids and for myself. Well, I didn’t realize that finding children’s minimalist, athletic footwear (and there are definitely degrees of minimalism here) would be so difficult! In fact, most popular brands had very thick soles and were heavy. Others were too rigid and narrow, particularly in the toebox, and even others also had positive inclines, so much that I was effectively putting my child in a slight heel. None of those made any sense to me and yet those were the majority that I found.
Below is what I eventually found (some of which I ended up buying, others which I considered). Zappos and Amazon are my go to sites for buying shoes due to their easy buy and return policy. Buying shoes isn’t like buying t-shirts – easy return policies are so key!
Tsukihoshi Mako – These are my personal favorite. They’re flexible, some sole, zero drop heel, very washable. Lots of color options (compared to some others) and athletic-looking enough that my kids didn’t feel too different from their Adidas, Under Armor-clad peers. Velcro closure for fast in and out! Plus, this model has been around for many seasons. Around $55 & up.
Tsukihoshi Kaz – These are another favorite, but don’t come in some of the larger “Little Kid” sizes. Same pros and cons as the Tsukihoshi Mako. Around $50 & up.
Merrell Kids Trail Glove – I just noticed these recently (2021) on Zappos and will have my boys try them out. They’re very lightweight and have a barefoot feel. The sole is minimal with very light cushion, but it’s still sturdy with with a lot of traction on the bottom. The toe box is pretty wide, but doesn’t seem quite as wide as I’ve seen on Vivo, Xero, or Altra models. Advertised as being good for cross-training, available in sizes for toddlers through big kids. Listed at $50.
Altra Kids’ Athletic Shoes – Altra’s running shoes for kids have a large toebox for toe splay. Last I checked, there were two models, Kokiri and Lone Peak – my kids found both models to be comfortable. They are flexible and lightweight. They are zero drop, and though the soles look thick, they are actually much less cushioned than your typical running shoe. We love these shoes, but we did find that the traction on both models wore down pretty quickly. $60-$70.
Prio – I’ve been eyeing this model for my kids to try maybe in the future. They’re not available on Zappos or Amazon, so ordering is a little more “work.” Also on the pricier side, $70. Check their website for more info and pics.
Nike Free RN (pictured below, left) and Nike Flex (pictured below, right)for kids – some of the versions of the Flex and Free RN are pretty lightweight and very flexible. They tend to have thick, wide soles. Maybe that’s for stability? At any rate, I couldn’t discern much of any incline despite the thick sole on some of these models. Look carefully for what’s important to you though because there’s variation even within the models and from season to season. My kids found them super comfortable in general and said they felt like slippers. $40 – $70, depending on the model – plus these go on sale frequently when the newer versions come out.
PLAE – I don’t have a particular model in mind and we don’t own any of this brand, but almost all their shoes seemed to be zero-drop. We’ve definitely tried some of their models on a couple of times, too, but I find them a bit stiff and heavy though for a minimalist shoe. They look like a good fit for wider feet and toebox and the bottoms feel robust, for those wanting a sturdier sole. $50 & up.
Martial arts and wrestling shoes – Most shoes used in these sports tend to be zero-drop. Their flexibility varies. Asics makes a wrestling/martial arts shoe, so it is a high cut shoe, but aside from the ankle support, the rest of the shoe is very flexible, zero drop, with varying degrees of width. Puma, Adidas, Asics also have martial arts shoes that are zero drop, somewhat flexible, but sometimes a bit narrow in the toebox, and the leather (faux?) can make the shoe a little stiffer to begin with.
Indoor soccer shoes (not the grass cleats!) – Indoor soccer shoes are typically zero drop, so we got that requirement out of the way quickly. They also have the “cool” factor, so my kids are always excited to see these. After that, you have to sift through the brands and models for the ones that suit your child’s feet. Nike has the most models that felt flexible and lightweight. Alot of them look good, but have rigid soles and for whatever reason, soccer shoes tend to run narrow though, and are all lace-ups. Around $35 & up.
In my quest to quell my child’s myopia, I discovered the myopia reversal community online. It seems there are many adults who are trying to improve their vision naturally. Yet while the medical eyecare community has not reached the point where they will even consider that myopia reversal is possible, myopia control for children is a growing sub-specialty and reaching mainstream eyecare practices in the US. In Asian countries where myopia is unusually high, myopia control is already a common practice. Considering that myopia control didn’t exist when I was growing up, (and yet here it is), I’m wary of dismissing the possibility of myopia reversal too quickly.
Researching and comparing these two “fields” was helpful for me in deciding how to manage my child’s myopia and also in convincing me that it was worth trying to reverse some of my own myopia. Below are some of the similar ideas that I found between the two areas .
Single vision lenses (SVL) will likely progress your myopia – This is not yet a commonly known fact, especially among adults. On the plus side, as I mentioned earlier, myopia control is definitely a growing sub-specialty and I think it’s only a matter of time before it will become common practice:
Myopia control view: Optometrists who provide myopia control options to children know that the traditional single vision glass lenses or contact lenses will mostly likely cause your prescription to get worse and worse. (Yes, that’s the lenses that you and I grew up wearing.) The current thought is that myopia stabilizes in adulthood, but the eye is particularly susceptible to growth in childhood and teenage years since those are “growing” years for the body. SVL are known to cause peripheral light to focus behind the retina, which is thought to stimulate the axial growth of the eye and therefore increase myopia.
Myopia reversal view: In the philosophy of two popular myopia reversal methods, Jake Steiner’s endmyopia.org and Todd Becker’s gettingstronger.com, it is also believed that the cycle of progressively stronger RXes are due to wearing SVL that perfectly correct or overcorrect your vision. If your myopia is worsening as an adult, it seems that perfectly corrected or overcorrected SVL could also be a contributing factor. They call it “lens-induced” myopia
Reducing near work strain is important in treating myopia – Giving your eyes a break from reading a book or the computer screen is common wisdom (that many of us probably have trouble following). However, myopia treatment takes this a step further.
Myopia control view – Multifocal or bifocal glasses and multifocals contacts give the child different corrections for distance viewing and near viewing. The theory here is that the near viewing through an add power reduces the strain of close work. Although studies haven’t found much clinical benefit from bifocal glasses as from the multifocal contacts, researchers think it may be due to children not being able to use the bifocal lenses correctly (looking thru the right part for the particular activity at hand).
Myopia reversal view – Similarly, many myopia reversal methods also include wearing either a reduced RX or plus lenses for near work to reduce strain.
Outdoor time affects myopia – Spending time outdoors is believed to play a central role in vision.
Myopia control view – Research in myopia control is full of studies on the possible link between myopia and time spent outdoors. It is believed that spending more time outdoors (3 hours/day) can help prevent myopia in children (although studies find that it’s not helpful once myopia has begun). Although there are many theories (i.e., the eye needs vitamin D, outdoor time replaces screen/reading time, being outdoors skews the eyes towards using distance vision, etc.), it’s also not clear why the outdoor time may prevent the eye from growing too much.
Myopia reversal view – Jake Steiner’s endmyopia.org frequently posts about the importance of incorporating outdoor time into part of the rehabilitation. While myopia control researchers still don’t feel that they have found the reason that outdoor time is beneficial, Mr. Steiner believes that outdoor time spent actively trying to see things more clearly is the reason that outdoor time can improve vision.
The effects of both treatments are variable in individuals – both research and anecdotal evidence show that neither myopia control nor reversal methods are guaranteed to work. Researchers don’t know why myopia control works for some children but not so much in others. I haven’t found any formal myopia reversal studies on adults – perhaps I just haven’t logged enough hours in the search. Nevertheless, the treatments do seem to work for many adults anecdotally and definitely for many children.
This Medium post by an Australian optometrist describes how the traditional approach of glasses for children is becoming outdated and that myopia is becoming recognized as a condition that can be treated:
This post is a summary of the key information (but a long list, nevertheless) that I found helpful in making our decision and knowing what to expect once we started OIT. I gathered it through reading online resources, quizzing OIT providers, and lurking on Facebook private practice OIT groups.
OIT for food involves ingesting increasingly larger amounts (often referred to as “doses”) of the allergen until you reach your target amount of desensitization. You decide what you want your target to be.
Some people just want to be “bite-proof” which is being able to accidentally ingest the equivalent of say, a few nuts, and not have a reaction. Others want to be able to eat a lot of the allergen.
Desensitization is not a cure – OIT desensitizes your body to the allergen so that you don’t react, but you are still allergic and you may still have reactions (more likely to be minor, but reactions nonetheless) to the allergen.
There is about an 80 something percent success rate in clinical trials. OIT providers say that success rate is more like 90+ percent because of private practice’s ability to tailor the treatment to the patient. In clinical studies, participants may have to drop out if they can’t keep up with the trial’s dosing schedule, etc.
Doing OIT is often referred to as a program of X number of months, after which you graduate and go into the “maintenance phase.”
The length of the program is determined by the patient’s goal, how well the patient tolerates the doses and the gradual increase, your own scheduling availability for increasing your dose (aka “updosing”) at the OIT office, and your OIT doctor’s protocol.
The maintenance phase, at this point in time of medical knowledge, is basically the rest of your life! Once you stop increasing your doses at the OIT provider’s office, you go into maintenance phase. If you ended your program at a dose level of say, 3 peanuts, then you are supposed to eat the equivalent of 3 peanuts a day for the rest of your life. After being in maintenance phase for a couple years (time varies by patient), you may be able to reduce your dosing to twice a week (like Mondays and Thursdays) or every other week, etc, but it all depends on the patient.
If you don’t finish OIT or quit during maintenance, you may lose whatever desensitization that you have gained, but in theory, you don’t become more allergic because you tried OIT.
OIT in practice looks roughly like this:
First dose appointment – Your initial dose day may involve taking very, very small amounts of the dose up to a pre-determined total dose or until there is a reaction, known as an eliciting dose. This depends on your provider’s protocol. The amount that you stop at is the amount that you will be ingesting daily at home until your next appointment.
Dosing at home – you take the dose amount of the allergen daily at home, with applesauce (applesauce may be best if you experience problems with other foods) or any foods you like (to either hide the taste, or ensure you get the entire dose). Prior to the dose, you should have a meal or a high carb snack. Apparently, this helps to minimize reactions.
Updose appointment – you return to the doctor’s office after a minimum of 1-2 weeks on your dose (or more depending on scheduling and how the dosing goes). You do this until you reach your target dose and enter the maintenance phase.
Vacations/sick/exceptions – you’re not supposed to dose or fully dose when you are sick (more likely to have reaction due to increased inflammation levels in the body or higher body temperature due to fever), traveling (elevation, far from hospital, time changes), or doing things that may make it difficult to follow the rest period. After these exceptions, you contact your doctor to get instructions for slowly building back up to the dose you were on.
The protocol and guidelines you follow will vary depending on the OIT provider you choose as well as on the patient’s needs and progress. There is no standard protocol and if you consult a few OIT providers, you will find that each doctor’s protocol varies slightly. These are some of the differences that I found:
Dosing schedule – number of doses per day seems to range from 1 to 2 doses per day. Increasing the dose can also vary from one increase per week to every two or three weeks. Some providers say you should only dose in the mornings as there seems to be an increased likelihood of having a reaction to an evening dose (rising cortisol levels, etc.). The schedule may also be modified due to the patient’s progress.
Rest period: in addition to the 2 hour rest period, some providers say you should not exercise for 1 hour before your dose. Some providers have reduced the required rest period from 2 hours to 1 hour.
OIT is available for most of the top allergens (milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybean), but depends on your provider.
Multi-allergen vs. one allergen OIT: You can do OIT for multiple allergens at once. Some providers recommend it, others don’t. I preferred not doing multi-allergen OIT because I didn’t like not knowing which allergen the body was reacting to.
Zyrtec vs no Zyrtec: some providers require that Zyrtec or some anti-histamine is used prior to dosing. Others say it is optional. Some doctors require it for updosing and some doctors ask that you don’t use it on updose days. Pretty confusing. After some inquiry, I understood that the anti-histamine was mainly for the patient’s comfort and to avoid experiencing mild reactions. It wouldn’t prevent the chances of you having anaphylaxis if you took it nor would it make you physically any less desensitized to the allergen in the long run. One provider also explained that routine Zyrtec is highly recommended for the pre-teen ages 7-12 because they can generally be more anxious about OIT and having minor reactions can cause them to develop more anxiety over the allergen.
Other medications during OIT: Antacids, asthma medications are the most popular other drugs that you may find are needed during the course of OIT. Apparently, it’s important to keep asthma under control during OIT as uncontrolled asthma increases the likelihood of anaphylactic reactions. Even asthma that is exercise-induced or environmental allergy-induced may be very subtle (and never a problem for you or your child previously) is a red flag for OIT providers. If there are some warning symptoms such as needing albuterol or corticosteroids during colds or having persistent coughs, etc. during allergy season, OIT providers will likely put you on an asthma medication such as Qvar, Flovent, or Singulair. We had a bad reaction to Qvar and ended up treating through TCM with some success.
Xolair (an anti-IGE medication) is sometimes recommended for highly allergic, high risk individuals. One provider said that she would not normally start considering it unless the patient’s IGE levels were >100. If used, you would need to start it two months before you begin OIT. To take effect, Xolair would need to be given at 1 shot/month for 3 months. Xolair is currently only approved for chronic hives, so unless you have been diagnosed with chronic hives, you would likely need to pay out of pocket for the shot at ~$1300/shot. However, you would be able increase your dosing much more quickly than you would without Xolair. I’ve read a post that talked about providers who provide the drug for free in order to get through treatment faster – interesting post that hints of the provider drama behind OIT.
Note: the medications come with side effects. All of the medications listed above (anti-histamines, asthma medications, Xolair, etc.) seem well-tolerated by many, but all come with some troubling side effects related to emotions and behaviors that seem to affect a significant number of users. These are often reported on the Facebook OIT parents groups.
Anyone is a candidate for OIT and potentially treatable.
However, it’s believed that the younger you are when you are treated, the better chance you have of becoming not-allergic as opposed to just desensitized. This is because the young immune system is still developing and capable of resetting. Think the preschool set. One OIT practitioner told me that even 6 year olds appear much less likely to reach “no longer allergic” status.
At the same time, I’ve heard from some moms that their kids (who started OIT around 10-12 years old) are not allergic anymore and can eat as much as they like of the allergen.
Maintenance phase doesn’t mean that you are home free:
Some OIT graduates have reported reactions during maintenance if they don’t follow the rest period
People do experience reactions (even anaphylactic ones) after they have reached maintenance (EVEN if they have followed the rest period!) and even some with very low IGE numbers
Hormonal changes (during puberty or periods) can sometimes cause reactions
The only current way to know if you are no longer allergic is by having low enough IGE levels and negative skin prick test and passing a food challenge. This seems unreliable to me, however. In the same way that some people may develop allergies later in life, it seems to me that even if you no longer clinically present as allergic at one point in time, you could always redevelop the allergy. My conclusion is treated patients will always want to have the Epipen handy and you will always want to be careful of what you eat and how you feel.
Costs with and without insurance
With some insurances, your coverage can be up to 100%, minus co-pays. The providers typically bill your visits as specialist office visits and food challenge visits (like any other allergy provider would). If your insurance covers regular allergist visits, then they would probably cover OIT because they don’t register it as anything different.
If you don’t have insurance coverage, or your provider doesn’t take insurance, it seems like out of pocket costs could be $10K – $25K per allergen/year, depending on your goals and personal allergy situation. I got this cost range from a Facebook group for families doing OIT and one of the providers we visited.
There are often clinical trials available for certain allergens, but the cons seemed pretty significant. In some trials, you don’t know if you are the control group and in others, you have to keep up with the trial’s schedule of increasing doses or whatever other parameters they are testing for. Otherwise, you could be dropped from the trial if you cannot keep up with the dosing schedule, and so on. However, trials are free for the patient.
There is a new allergy “drug” called Palforzia, which has been FDA-approved and they may start to change (probably increase) the cost structure of OIT treatments. The drug is essentially pre-measured peanut flour in the form of a pill, so you don’t have to do it yourself and which I guess is supposed to help standardize the dosing protocol of OIT providers.
There are a range of things that could be reactions (other than anaphylaxis) and the problem is that you will often be unsure whether it’s a reaction or just something else that you might get in everyday life. Range of reactions:
OIT is introducing a new habit into your life and family lifestyle – like brushing your teeth and flossing, dosing is something you will have to remember to do everyday or on some schedule.
Thoughts after starting OIT
For us, OIT is turning an “unknown” into “slightly more known.” Choosing to do OIT is not a “no-brainer” and is a very personal decision. OIT takes more time and energy than simply nut avoidance, especially as it appears that patients continue to be at risk for reaction even after “successfully” completing immunotherapy. Unlike some who have extensive allergies, our nut allergies were not affecting our lives significantly and we wondered if we were bringing more risk, concerns, and health issues into our lives. On Facebook groups, you will see other families wondering the same thing.
However, I will say that on the first day of dosing, after I saw that my kids were actually able to ingest very small amounts of their allergens, I realized that I was getting some answers. I had never known how allergic they might be. I hadn’t known whether they could even touch a nut. We had always worried that if we kissed our kids after eating nuts that we might cause a reaction. We knew nothing about their reactions – it was just this big question mark. Now we’re beginning to know a little.
I read a lot of articles and studies about OIT and included some of them here.
Informative OIT starting points – helpful for understanding what it is about and what doing OIT entails (the top 10 myths section in particular has become much more detailed since I first came across it in early 2019, so if you haven’t reviewed that page in awhile, check it out again):
After a lot of searching the Internet and asking around for best practices, we settled on a few key resources for teaching Chinese to our children. The amount of resources and choices online can be really overwhelming and paralyzing if you don’t know where to start. There are a lot of good options and none will be perfect. I was definitely in the “paralyzed” category for awhile. Now that I’ve done the research, I realize that the key is to just pick a strategy and structure and get started.
Below are the main resources we use:
Resource #1: A curriculum/series of books
Pick a curriculum/series of books to provide you with the structure you need to teach. This should be your starting point and you can build out from here. We chose this book series by Dr. Ma Li Ping, based on a recommendation of a friend: https://www.heritagechinese.com/. We liked this series because it begins the first few levels without pinyin. It comes in both simplified and traditional versions. We felt that our children were distracted by the pinyin and wanted to introduce it later, so this series seemed like a good fit.
Resource #2: A reliable, online reference
We use Pleco as our online dictionary/app. It is a very comprehensive app. We often need to look up words for pronunciation and confirmation of stroke order, etc. It offers pronunciation in Mandarin and Cantonese and shows traditional and simplified characteristics. This app has a lot of nice features which we haven’t even gotten to use yet (like flashcards, self-tests, clipboard readers/translators).
Resource #3: A writing practice generator
I found this website called Chinese Worksheet Generator and it is such an awesome find! It’s free, no frills, straightforward to use, and works really well. The format that it prints in happens to suit our writing needs very well. You just type in the characters that you would like your kids to practice and it spits out a perfect looking sheet, complete with stroke order, pinyin, definitions, and meaning clues (if you want). You can delete the pinyin and definitions if you don’t want them to be printed.
Resource #4: Easy, fun exposure to Chinese language
Good videos in Chinese for kids learning Chinese are still a little hard to come by. By “good,” I mean that the story or content is interesting or entertaining for the kids *and* that the audio is slow and clear enough for learners to follow. Here are a few that we have used:
Netflix for Chinese Learning
Netflix has become so international, many of their children’s shows and movies are now available in various languages, both in audio and captions (though not always both). You’ll be surprised at how many of these shows are available in Chinese audio and traditional and simplified Chinese subtitles. Just three years ago, I would have to hunt YouTube and tiny library collections for these kinds of videos. The website, Mama Baby Mandarin, has a clear guide on to how to search Netflix for TV shows and movies in Chinese.
YouTube and Little Fox Stories for Chinese Learning
Little Fox Stories is an interactive children’s website for Chinese learners that also has strong video presence on YouTube. Their site has animated Chinese stories, songs, and games structured for different levels of learning. The stories come with vocabulary and interactive quizzes that are useful for learning. Their animated stories themselves are best viewed on YouTube. Not all the stories are equally good, but as intermediate-level learners, we have watched two stories so far that I highly recommend for their clear, slow narrative pronunciation, word choice, clear Chinese subtitles, and relative entertainment value:
Journey to the West series, a classic Chinese story that is retold in a kid friendly, very well produced language-learning video series. There are alot of versions of this video on Youtube, but not all have Chinese subtitles or are even in Chinese. This link is the one that has the subtitles.
Muzzy – Chinese version is a BBC-produced language learning program. As part of the program, they produce a story centered around a fluffy character named Muzzy. The language learning video about Muzzy is what my kids particularly enjoyed and which I found particularly useful as another entertaining story that was carefully narrated at a pace and language level suitable for beginning to intermediate child learners. We obtained the DVDs from the library, but they are now also available digitally on many of the library apps like hoopladigital.com.
Once you become myopic, is it possible for your vision to improve? Ophthalmologists and optometrists say NO, and rather emphatically so. However, welcome Internet research, pseudoscience, and anecdotal evidence. Even the burgeoning science found in myopia control methods has many theories in common with the myopia reversal movement. After a lot of reading, it seems like it may be possible to reverse some myopia and that it’s worth giving it a try.
The basic method of reversing myopia looks like this:
Reduce your glasses or contact RX by a small amount at a time, 0.25 to 0.50 diopters (some people do more, but it seems like you may end up reducing so much that your eyes cannot focus enough to improve).
When wearing your reduced RX, routinely spend time focusing on slightly blurry things and trying to make them clear. When you can see 20/20 or 20/25 with the reduction, then reduce the RX some more. This could take weeks or months – each person’s eyes are different. Reduce each eye enough so that both eyes see about the same. Sometimes you will reduce more in one eye than the other.
Wear an even lower RX when doing near work (computer, reading, task work). Some methods say that this lower RX should just be enough so that you can see well enough to do your near work. This reduces the focusing and strain that your eyes go through in order to switch from distance focus to a near focus. It also reduces the strain of near work. This has some similarity to the concept of wearing plus lenses or multifocal lenses in myopia control for children. Another method suggests that this lower RX should be low enough so that print (whether on your computer screen or book) can have a slight blur so that you can work on trying to clear the blur.
Some amount of improvement, around 1.00 to 2.00 diopters, anecdotally seems very possible. In a variety of YouTube videos and online comments/blogs, many individuals seem to have been able to achieve at least this amount of improvement. I list them in Resources below.
My myopia reversal experience so far
I’ve been nearsighted since I was 8 years old, becoming highly myopic by high school. I figure I have nothing to lose by trying out the myopia reversal methods.
I started out with a glasses RX of -8.00 (R) and -6.25 (L), with -0.50 astigmatism in both eyes for most of my adult life. In June 2019, I began wearing glasses with a slightly reduced RX of -6.00 and -7.25, with -0.50 astigmatism in both eyes. I purchased glasses with this self-customized RX on http://www.zennioptical.com. (BTW, if you don’t have a complicated RX, I’ve discovered that getting glasses from your optometrist’s eye shop can be the biggest waste of your money ever! But that will have to be a topic of another post.) I determined my starting RX by purchasing a test lens kit and checking my vision with these free, online eye chart printables. I wanted to make sure that I would be seeing about the same out of each eye with my modified RX. I did get a lower RX for near work but I didn’t end up using it as I found it cumbersome to remember to switch glasses.
I found almost right away that I could see 20/25 with the reduced RX. This made me suspect that I had originally been over-corrected. I made the lifestyle changes as best I could, although getting adequate sleep or taking screen breaks during “crunch time” work was probably not always at ideal levels. I tried to look at slightly blurry words and seeing if they could become clear by focusing on them just a bit longer. This was usually street signs, etc. while I was out driving or waiting in lines or doctors’ offices.
At the end of September 2019, I saw the optometrist for a regular eye exam. He found that the astigmatism in my right eye had gone away. He also said that I could see 20/10 with my original RX. When I asked him to adjust my glasses RX to see just 20/20, he gave me this new glasses RX: -7.5 (R), no astigmatism correction; -5.75 (L), -.5 (CYL), 180 (AXIS).
My contacts RX was adjusted from R: -7.50, L: -6.50 to R: -7.00, L-6.00. When I checked the eyechart wearing this new contact RX, I actually couldn’t see any difference with my stronger, previous RX.
Prior to this recent myopia research, I’d never paid much attention to daily visual strength changes. By paying attention to what I can see on an eye chart, I’ve learned that eyesight can have minor changes daily and from hour to hour sometimes just based on what I’ve been doing. This leads me to realize that even the optometrist’s measurements can not be perfectly accurate so I am taking my recent optometrist prescription with a grain of salt.
However, it does seem that “the disappearance” of my astigmatism in the right eye is significant and the fact that I can see 20/20 with -0.50 diopters less in both eyes seems like a big improvement over my RX of just 4 months ago. I still suspect original over-correction may have had something to do with my new RX, so I will have to see how the next year goes.
There are two other sources that are “well known” (pop up high on search results) and also worth reading through for theory and techniques. They also have a lot more detail on their methods and the rationale behind them:
On reddit, there are some good arguments against trying to reverse your myopia or against whether it can work at all. The link below on blur adaptation seemed interesting, plausible to me. However, the fact that my son’s optometrist had actual data points of axial length reduction is also encouraging:
If you are in the US and want to buy contacts of your own modified RX, you may need to rely on the 8 hour prescription verification rule and hope that the optometrist office you list for verification does not respond before the 8 hour waiting period!
Do you want to share your language with your child? Have you wondered if you’ll be able to teach your kids your own language despite living in a foreign country? You absolutely can and there are benefits. Many studies have shown a cognitive benefit to bilingualism and it’s a great way to strengthen the bond with your child throughout their lives. The question is how will you be able to do it?
Despite living in the US and having English be our shared family language, we have been partially successful in teaching our children three different languages. They are now in elementary school and speak Chinese with me (yes, there is a little English mixed into the Chinese, as I am not a native speaker either), fully comprehend their Dad who speaks only a European language to them, and speak English everywhere else.
I consider this result to be “pretty good,” given that our need for and exposure to these non-English languages is minimal. We parents, speak English to each other as we don’t speak each other’s respective languages (at least not well enough). It’s not convenient for our children to attend a language immersion school, but we do try to have weekly home lessons in Chinese.
Many people ask us how we have managed to be able to teach our children so much fluency, especially when English is the dominant household language. Based on our experience, I feel that there are misconceptions about what it takes to create fluency and the amount of resources that you need to support it. Here are the 3 most important things that we did:
Be persistent and consistent – you cannot give up. This can be hard to do, but it is so important. Firstly, we had to be consistent in having each parent speak a single, different language to our children (also popularly known as one parent, one language, OPOL). We began this at birth. This may feel awkward at first, but in a week, it becomes a habit and you no longer have to think about it.
Delaying English was easy at first when they had not encountered the rest of the English-speaking world, but when they learned English at preschool, it became challenging. For many of our friends, this was the turning point. When your kids begin to speak English back to you, you cannot give up and speak English back.
At this point, I read many online sources that cautioned insisting too hard about the language and creating resentment in the child towards the language. I was fearful of that and I did receive pushback from my children, complaining about why they had to speak another language. I would back off, and then I would insist again the next hour, or the next day, etc. The way I viewed it, they would be linguistically the same whether they became resentful and didn’t want to speak the language as they got older, or if I just gave up and they never had the chance. I figured being pushy and insistent was worth it. And it worked. In both my children, we got over that “turning point.”
Since then, there is an ebb and flow in the mix of Chinese-English that I hear, if it seems like too much English is being used for words they also know in Chinese, I remind them of the Chinese vocabulary that they can also use. I consistently point out the advantages of their ability to speak another language fluently. As they are older now, they can appreciate the coolness of that.
Relax your expectations – this really helps with adhering to lesson number one and not giving up. I guess this also really depends on your goals and how flexible your goals are for your child’s language learning. If you are flexible, then you won’t be as likely to give up when you see that they are not speaking back to you in your chosen language. It’s not an “all or nothing” proposition. There can be a huge range of fluency and any amount can be beneficial:
Don’t be discouraged if their accent is not perfect or if they use the language incorrectly.
Don’t think that it’s useless if they can only speak the language but cannot read or write it.
Don’t believe that a school with language immersion is the only way to learn the language
Don’t expect that they’ll learn the language better if they go on language playdates (most likely they’ll only speak English!)
Don’t think that your mastery of the language is necessary for them to learn it, too. You can’t be a beginner, but you don’t need to have 100% fluency either.
Don’t feel like everything you say to them has to be in that language. If something is easier (say math concepts) in English, just do that instead of getting frustrated. It’s not all or nothing!
Don’t require that every word has to be in your language (let them mix in English if they need to)
For example, my kids rarely speak back to their dad in his native language. He didn’t want to push it during that “turning point,” that I mentioned above. But that hasn’t stopped him from continuing to speak in his language to them their entire lives to this point. Their vocabulary continues to grow even while they don’t vocalize it. On occasion, when asked to greet their European grandmother, we are surprised at the amount of language they are able to verbalize! If they want to learn to read/write another European language in school someday, they’ll be off to a great start. Think of the free gift that you are giving your kids without them even realizing it!
Talk a lot and repeat yourself. This is crucial, particularly if there aren’t others around in your home or community who speak the language you are trying to teach. This shouldn’t be a whole lot of extra effort either because you have to talk to them all the time anyway, right? Recognize yourself as the key, and possibly only resource. Your kids have to hear the language a lot.
Have conversations about anything and everything and use words that adults use, not kiddie language. Kids may not catch on at first, but they are in the window of language development where their potential is sky high, and they can pick up a lot more than you realize with your use of repetition. You have to give them the vocabulary to talk to you in the language you want them to use. In the earlier days, you may find yourself frequently repeating back in your language what they say to you in English, so that they can learn the words they need to express their thoughts to you.
Do you have lessons to share about bilingualism? I would love to hear them. My chief concern now is how to continue to keep the children’s language skills (even if they never learned more at this point) as they go through a monolingual education. Someday I hope to share tips about that as well!
A good resource about raising multilingual children:
It’s great to try and prevent myopia, but what if your child is already myopic? Or what if your child becomes myopic in spite of all your attempts to prevent it? Did you know that there are now ways that you can try to slow down your child’s myopia? Below I summarize the options that I researched and what we decided to try for myopia control.
When I was growing up, anyone who became nearsighted just got glasses and were told that there was nothing to be done to either improve or slow down their myopia. However, now, although it’s not widely practiced, many optometrists and ophthalmologists are offering their pediatric patients some options for myopia control.
These options don’t guarantee that your child’s vision will no longer deteriorate, but in very many cases, it slows down the progression by about 50% per year. Let’s say your child’s vision worsens by about -1.00 diopter per year and they are only 8-9 years old. They may be highly myopic by the time they reach college (when vision changes typically stabilizes). You might even be able to cut that in half! It’s a win even if they end up at -3.00 diopters instead of -6.00.
There are a lot of eye health risks (such as higher risks of retinal detachment, among others) that come with high myopia, in addition to the inconvenience of not being able to do anything without your glasses. That is significant considering that your child still has a lot of growing and potential deterioration of the vision.
First of all, regular glasses or contact lenses (basically single vision lenses) are not an option because they won’t do anything to slow down your progression.
In my research, I found the following options, first explained in my layman understanding and my opinion of the pros and cons of each. In the Resources section below, you can find great articles on all the more clinical and detailed explanations of each.
Atropine Eye Drops
Atropine eye drops are an eye medicine that you put in your child’s eye nightly. For myopia control, a very low dose is used. They relax your child’s eye-focusing muscle so that they don’t over focus.
Pros: 1-2 eye drops are fairly easy to learn to put in your child’s eyes nightly and children probably get used to this pretty quickly.
Cons: Although they seem to have a high rate of effectiveness (slowing progression at ~77%), the studies for long-term use of these eye drops aren’t available. Our own optometrist wouldn’t recommend these drops for longer than 5 years, citing lack of studies and side effects such as light sensitivity and blurred near vision.
Ortho K (corneal refractive therapy) are gas permeable contact lenses, which are small and firm compared to the multifocal soft lenses (next option). You put them on at night and during your sleep, it will shape your cornea according to your prescription. When you wake up, you remove them with a tiny plunger (not as scary as it sounds), and your vision is corrected. The correction is only temporary though, which is why you have to do it every night.
Researcher believe that ortho-k also slows myopic progression in a way that is similar to multifocals. They shape the cornea in a way that keeps the axial length of the eye from growing as much. (Myopia worsens when the eye continues to grow.) Effective rates are ~50%.
Pros: The lenses are small and probably easier to get on a young child. You don’t have to worry about anything happening to the lenses during the day. Corrected vision wouldn’t have any potentially blur spots as with the multifocals.
Cons: They can take a couple of weeks to take effect and get used to as the eye undergoes reshaping. You have to clean them everyday. This option felt invasive to me in the sense that the eye was undergoing a physical reshaping.
Multifocal Soft Lenses
Multifocal soft lenses (MFSL) are soft contact lenses with two or more powers that were originally made for nearsighted adults who started having presbyopia (needing reading glasses). These apparently help stem myopic progression by providing some amount of myopic blur which slows down the rate of retina growth.
I didn’t understand how a kid could see well through essentially a reading glasses prescription. An optometrist friend explained that when the eye looks through the lenses they will pick out the clearest parts of the image for a particular distance, so it doesn’t matter that the powers are different in some areas of their vision. The effective rates for this option are 30-50% in recent research.
Pros: These come in dailies, so you don’t have to worry about cleaning. They’re worn during the day and can be removed easily without any discomfort. They’re not as physically invasive as atropine drops or ortho-k which shapes your cornea.
Cons: They’re larger lenses (than the ortho k lenses) so can be more difficult to put in a child. Some children complain of some blurred distance vision (due to the add powers in the lens). Some studies found they decrease the speed of accommodation when worn.
Bifocal or Progressive Lens Glasses
Bifocal glasses / Progressive lens glasses are your regular glasses with the added reading glass portion on the bottom half or a progression of powers through the lens. They are also available in progressive format so that the power transitions without an obvious, unsightly line in the lens. You correct your child’s distance vision with the top half. The bottom half will be a reading glass prescription that helps their eyes to not focus so hard on the near work such as reading, computer, writing. The ranges I saw in effective rate of these glasses is around 10-30%.
Pros: No need to worry about contacts or eye drops
Cons: Glasses can be cumbersome for kids to wear and some children have difficulty with seeing comfortably with the different powers in the glasses. Low efficacy rate.
Coming soon – SightGlass Vision Diffusion Optic Technology (DOT) lenses are new special lenses designed specifically for myopia control and to be worn as eyeglasses. The idea behind the lenses is that they diffuse contrast for the child (in a way that mimics outdoor light setting) under the theory that high contrast environments such as reading, and other near-work cause the eye to grow longer and progress myopia. It sounds like the most promising eyeglass solution available yet. Studies have touted up to 74% reduction in myopic progression and up to 50% reduction in axial length growth. They’ve been approved for sale in Canada, but not yet in the US.
Pros: No need to worry about contacts or eye drops. Efficacy rate may be comparable to contact lens or atropine options
Cons: Glasses can be cumbersome for kids to wear, not yet available
Finally, some parents also choose to do both atropine drops in conjunction with one of the options above for maximum effect. If you just can’t get your child to put on contacts, for example, then glasses plus atropine drops may be your best bet.
Our Choice for Myopia Control
None of the options seemed perfect to me. Generally speaking, it seems that ortho-k has the most studies demonstrating its ability to slow progression. In the end, we chose multifocal soft lenses for our child because I felt it was the least invasive of the options that had high efficacy rates (ortho-k, atropine drops, MFSL). I haven’t ruled out the other options yet, but this is the one we are starting with. We also are incorporating as many healthy lifestyle and eye habits as possible. Since no one seems to know for sure, it doesn’t hurt to try everything that’s probably good for us anyway!
Considerations in choosing can include the health of your child’s eyes, their willingness to use contacts/drops, and their RX. Remember that the effective rates are just averages and your own results may be different.
A lot of studies and research continue to be done in these areas. Unfortunately, results are sometimes conflicting or inconclusive. Nevertheless, there are a lot of helpful articles on these topics that describe the different theories on what causes myopia and the different myopia control options that we have now to help you decide what to do for your child.
The BEST overview of the options from an optometrist’s perspective that I have ever read. This article also contains an interesting part on the predictor of myopia in children. He lists cutoff points of cyclopegic refraction that tell you the likelihood of your child developing myopia. It also includes a table showing the different types of health risks associated with myopia as it worsens:
Screen time is great! It immediately distracts my kids and gets them to stay still. They love the screen so much that they’ll watch videos in languages they don’t know just to have the right to the screen. For me, when I’m standing in line at the grocery, I can check my emails or run through my grocery list. I can leave work early and be with my kids more often since I have email and text access to stay caught up with the office. It’s so efficient, time is never wasted, and dealing with the kids could never be easier, but. . .
The unfortunate truth
The ugly truth is that I’ve seen my kids become monsters with terrible moods once I remove the screen. I’ve seen them so absorbed in the screen that they can’t see or hear anything that’s going around them. I’ve seen the red, glazed eyes after the screen is switched off.
As for myself, to be on a call with my kids around, I have to shush my kids repeatedly. Writing work emails and texts actually require a significant amount of concentration so that I have to step away from my kids or just plain ignore them since they don’t seem to understand when I tell them that I need to focus for a few moments on my phone. In those moments, I must seem obsessed with my phone and I have to completely disengage with my kids. Working while out with my kids or being “available for work” when I was with them is actually stressful and brings down the quality of my time with them.
I’m not alone
From my personal experience, I realized that the detriments of screen time outweighed its benefits in my household. Then I saw that I wasn’t alone. An article in The Atlantic pointed out that screen time was enabling “tuned out parents” and that the dangers of screen time ran both ways. The New York Times featured a piece on how even some people who work in the industry of producing smartphones and their apps are wary enough to place very strict rules around their kids’ exposure to screen time.
It starts with us! Parents on the phone while pushing their kids in the stroller. Reading phones while at sport practices or at the park and playground. We have to learn to put the screens aside as well.
At kids’ activities: I’m going to watch my child play, chat with another parent, play with my child, or do some exercises myself! I should be in the moment and pay attention when I can.
If I absolutely have to be on the phone, I’m going to explain to them why it’s so important that I need to be using my phone at that time.
During wait times with bored kids at the restaurant, grocery, or waiting room: I’m not going to use my phone as a first resort. Instead, I’ll play a game with the kids. Have a conversation. Find out about their days. Talk about something interesting. Teach them about something. What did parents do before the age of smartphones? This is an opportunity for kids to practice self-discipline and good behavior. Right, rolling your eyes? I know it’s hard work and I want to tear my hair out too sometimes, but I’ve seen parents do it well – bringing non-screen activities or chatting with kids happily.
As for the kids’ screen time, we’ve minimized this to almost none. Any screen time is supervised. Other parents will sometimes tell me that their kids spend all their time on the iPad or watching TV and that nothing else will satisfy them while at home since they began allowing screen time. As I mentioned earlier, I found watching Netflix videos, playing video games, and using other phones/tablets to be a slippery slope in my household. Kids were inevitably unhappy when the screen time ended. Their brains and eyes seem fried from the other world that they had been sucked into and their moods were just plain nasty. It happened every time.
So we removed anything that resembled routine screen time. It was hard at first but then they eventually found other things to do. And we had less tantrums and bad moods to deal with too! As they get into their teens, though, this probably becomes even trickier, but it is worth it to me.
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