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Does Youngest Require Stitches?

Even after dealing with the illnesses and injuries of three kids over fifteen years, I’m never certain if a cut of any kind requires only a simple bandaid/gauze pad or actual stitches.  And Youngest today cemented his family title of Stitch King with an injury that initially scared the hell out of me:  an inch long laceration under the left eye.  And it begged the question of whether or not he needed stitches or just some antibiotic cream and a gauze pad over the eye.

Why Stitches?

Stitches, also called sutures, are simply used to assure that the edges of open wounds are held together long enough to permit the skin to heal itself.  The principle is the same as stitching fabric together, except that in time, skin can heal over an open wound.  With the edges held together closely enough, the wound is also provided further protection again an infection and scarring is minimized.

In this instance, Youngest was in the side yard tossing a piece of PVC pipe in the air like a baton when an end landed on his face.  Because the pipe had been cut, the striking edge of the pipe was rough and caused a laceration of about one inch below the left eye.  Most specifically, the crease where the cheek meets the pouch of skin beneath the eye.  He came around to where I was cutting bushes with his hand covering the eye and my stomach turned when I saw the wound.

Stitch or Not?

Physicians use several criteria for deciding whether to use stitches or not.

  • The amount of blood emanating from the wound isn’t necessarily an indicator of stitches.  In this instance, Youngest had very little blood loss, especially since many wounds around the face and head can bleed heavily.
  • Are the skin edges of the wound so far apart that they can’t be easily pinched together?  Youngest’s wound looked like a typical laceration in that there was an obvious cut but the wound wasn’t gaping.
  • Can you see the deeper layers of flesh – called subcutaneous – beneath the top layer of the skin itself?  When I dabbed the wound with a clean, wet washcloth, I saw that the top edges of skin were peeled slightly back so that I could see deeper layers of tissue despite the narrowness of the wound.
  • Is the location of the wound such that scarring might be an issue?  A physician might be more likely to suture a wound in the face or other visible area to minimize scarring.  Youngest can’t avoid the coming shiner and sutures, but we can minimize the scarring over the long-term.
  • Is the wound located where there’s a lot of body movement?   A similar gash on the knee would certainly require stitches simply because the constant stress of skin movement at the injury site would delay healing because of persistent stress on the wound edges. 

In Youngest’s case, the visibility of the subcutaneous tissue and our desire to minimize facial scarring led the ED physician to use six stitches to close the wound. 

Sources:

http://firstaid.about.com/od/softtissueinjuries/a/06_stitches.htm

www.emedicinehealth.com/removing_stitches/article_em.htm

 

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PracticalDad Solution:  Re-evaluating Christmas

I believe that children want – more than anything – to spend time with their parents.  And since Dad is typically involved with play, they want time with you.  Stuff is nice, but they’d rather have your undivided attention.

When each of my children was born, I made a promise to that infant that I wouldn’t buy her or him a lot of stuff.  Requests for things would largely be met with No.  However, I would give unstintingly of my time, since that is what is what I – as a cancer survivor – find most precious.  I have managed to live up to that promise for years but I now find that the press of life with three children and schedules leaves little time for what we took for granted in earlier years.  Requests by Youngest for gametime, wrestling or reading a book are increasingly met by refusal because of other commitments.  And last night I considered what I’d read with the older kids, and played with them, that I haven’t done with Youngest.

So I’m considering something different for a Christmas gift this year.

Instead of figuring out all of the presents that a kid should get, I would make my time my primary gift to each.  Each would receive a printed coupon book with each coupon claiming time for a different activity – movie nights, reading hours, wrestling matches and the like.  It won’t be as cheap as you might expect since some of the activities will require tickets or evening "dates" for dinner out.  Yes, there will still be wrapped presents under the tree but each will reclaim time from me that has become lost in the shuffle of daily life.

 

 

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Discipline:  Is Clemency a Good Idea?

My three major concerns in enforcing discipline are immediate response, enforceability, and consistency.  But another question that occurs is whether clemency is ever advisable.  Does giving a reprieve create more issues?

Another child – a friend of my own kid – returned home after dark after having a mechanical problem with his bike.  He erred in assuming that his elder sibling would pass his whereabouts to the parents, who were briefly away.  The father’s response was to ground him as a reminder that it’s his responsibility to inform them of his plan and then obtain permission.  I’ve done the same thing when one or more of my own have failed to inform or show up late.

But Murphy’s Law can crop up when the grounding occurs within a short time of an event that is particularly important to the child.  In this instance, my son had invited this boy and others to a Halloween Scary Movie night.  What might Dad do?  Should he grant clemency?

What are some of the considerations on whether to provide clemency?

  • What did the child do to deserve discipline?  Is it recurring?  This occurrence was a failure to think and not being "bad", and is a rarity for the child.  Dad’s discipline wasn’t meant to be punitive as much as to force the child to understand that there are consequences for (in)actions; and not keeping Dad apprised of his whereabouts is meaningful.
  • How is the child handling the discipline?  If the kid whines and creates an issue about the discipline, do you want to grant clemency?  Or will doing so encourage future whining and general nastiness?  Kids have to learn that they will encounter unpleasant situations in life and that whining can make it worse.  As one father said, his pastor referred to it as learning to "suffer well".  I agree, although we refer to it as "sucking it up".
  • Does the child ask for the reprieve and if so, how does he handle it?  Kids have to learn how to speak without whining and if he can manage to actually carry on a conversation, then there’s possible merit in rewarding that effort.  Frustration and emotion are difficult to control and the effort should at least be noted, even if you deny the request.
  • What’s the nature of the upcoming occasion?  Does it involve other kids or people with whom he should associate?  You don’t have to say I don’t approve of this guy, but allowing him to attend after finding out who else is involved sends a powerful message.  Is it a one-time occasion that won’t come again?  My father gave me a reprieve to attend my junior year homecoming dance.  And then it was back into the doghouse.
  • Know your child.  Will he use this as a reminder or excuse to demand further clemencies?  Not everyone will use this occasion as a tool for future demands and some kids will respect the deal.  You might want to consider if it’s going to haunt you in the future.

Kids and situations can be so variable that there isn’t always going to be a right decision.  But asking these questions can help with the thought process as you consider the situation.

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Seasonal Duties:  Autumn

Like most families, I’m the partner responsible for the typical Autumn duties, such as covering the air conditioning unit and winterizing the house.  But I’m also responsible for other duties that most fathers typically don’t cover.  You could call these "winterizing the kids" since they pertain to clothing and other issues and they’re as common in our household as checking the smoke detector batteries when the clocks change.

Winterizing the Kids

  • Pull all of the winter coats and assure that each child has a winter coat – with hood if possible.  I wait on this until October since coats tend to be more expensive and my concern is that a sudden Autumn growth spurt will render a coat unwearable if it’s bought too early.
  • Pull the winter boots and assure that each child has a pair that fits.  Because most stores only buy a set amount of boots, you don’t want to wait too long into the season; waiting too long might mean a harder time trying to find a decent pair later on.  If you do buy boots for one or more of the kids, be sure to make it a bit larger than the actual shoe size, by perhaps half of a size.
  • Pull the hat and glove bin to assure that they have what they need and whether too-small items can go to Goodwill.  I’ll also wash the items for the season.
  • Think about the Christmas pictures, if you have them taken.  Most studios are starting to fill the appointment books and you should be prepared.  Making the appointment also means that you have to arrange for haircuts in advance of the photos and assure that the kids have appropriate clothing to wear.  In our case, I’ll be making the hair appointments for a week in advance of the photos and will ascertain whether I need to get clothing.
  • Pay attention to the summer clothing since some stores will have clearance sales on remaining summer clothing.  Consider whether you can get a good deal on summer clothing in the next size up and store it for the winter.
  • If you haven’t done so, pursue the flu vaccinations for the kids so that their bodies have had an opportunity to build immunity when the seasonal flu arrives in December and January.

And after all of that is finished, sit down with a hot cider and enjoy the change of seasons.

 

 

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Rites of Passage:  Paranormal Activity

Kids grow faster than you realize and before you know it, they’ve gone from watching the Hannah Montana show to asking to see R rated movies.  And while I normally toe the line on ratings – no, you can’t see that since it’s rated R and you’re thirteen – tonight was the occasion that I crossed that threshold with Eldest.

Eldest is closer to seventeen than thirteen and was asking to go see Paranormal Activity.  She honestly didn’t expect to go but I surprised her by purchasing two adult tickets on Fandango to assure that we had seats for that showing; a good thing since the show was sold out.  I started to write that there were multiple reasons for taking her, but the simple reality is that we both like horror movies and I wanted to enjoy her company for the evening. 

Besides that however, is the understanding that some things are first time events – the first glass of wine with dinner at home and the first driving lesson, for example – and it’s a bit more special if you can share those moments.  In my world, taking a child to their first R rated movie is a threshold.  But before doing that however, I did the research so that our evening together wouldn’t be uncomfortable.  My criteria was that there would be no sexual scenes and no drug glorification, a la Cheech and Chong.  The research is worth the effort if you can have a memorable evening together, tailored to your common interests.

And besides, it was a great Halloween flick that she’ll talk about for years.

So consider those first-time moments to share with the kids, but only after doing the research first.

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Kids and the Common Sense Test

As kids age and grow, you want to help them move from naive innocence to a more measured awareness of the world around them.  And especially about the people that inhabit it.  Which is why I persistently try to develop their common sense by asking:  Now think, does that pass the common sense test?  Does that make sense?

What exactly is common sense?  My definition has been that it’s the ability to think through situations and examine problems in a manner that is both rational and realistic.    Bear in mind that my own youth was spent talking office politics at the dinnertable with a father who a co-worker later described as having "the ability to slit a guy’s throat two weeks before he even knew that it was slit."  So I’m aware that I am a skeptic and need to protect my kids from veering into full-blown cynicism.  Yet they also need to learn how to consider what they see, hear and consequently do.

When do the common sense questions apply?  Surprisingly, more often than you might think.

  • In reviewing the answers to math problems.  Okay, you have that answer.  But does it make sense that the answer to that addition problem is less than one of the two addends?
  • In considering the answers to history and social studies questions.  If you heard a recording of one of FDR’s Fireside Chats in class, does it make sense that he delivered the Gettysburg Address?
  • As occurred in my house this morning, if using gasoline engines less helps the environment, does it make sense that riding a dirtbike falls into the same transportation alternative as walking?
  • So Kelly was bragging of her family’s money and that she owns a pair of $725 shoes.  Think about what your shoes cost, does it make sense that a parent does it make sense that a parent would spend that much money on shoes for an adolescent girl who’s still growing?  
  • Your classmate George has Swine Flu (H1N1)?  Who told you this?  Before you panic, was George tested to be positive or could this be the typical seasonal flu?  Does it make sense that a classmate would know this firsthand?

The upshot of this is that you have to pay attention to the kids’ comments and conversations.  As much as I would love to walk into the mancave, the reality is that a large part of parenting and fatherhood means that I have to listen to what the kids are saying, reading, listening to, watching and doing.  And I then have to apply my own common sense test to determine whether I need to address it further.  The next question is how much time I have to spend on the issue and whether to handle it in the moment or set aside time later.

I then have to work to assure that I am consistent in how I ask the question.  Kids learn much through repetition and hearing the question in the same format will help cement it into their thinking.

It’s a time-consuming process and often frustrating.  But without the time spent in pushing the common sense questions, they’ll be at a disadvantage in critical thinking at a time when it’s more desperately needed than ever.

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Handling the Flea Infestation

Keeping up with regular flea treatments is a necessity for animals and my dropping the notes from the family calendar has led to a flea infestation that has taken over my life.  Because it’s been years since we’ve had issues with vermin of any kind, I’ve had to remind myself that treating any kind of infestation requires disciplined persistence.

Fleas – the Basics

Fleas have a lifespan of about 90 days and the typical female flea can lay upwards of twenty eggs each day.  However, most fleas aren’t on the animals; they’ll be found in the household surroundings such as carpets, bedding and furniture.  What’s stunning to see is the jumping ability of the adult flea.  During a vacuum session last week, I noted that one leaped ahead of the vacuum and it appeared to reach a height of a foot about the floor.  This would be akin to watching LeBron James leap over Madison Square Garden.

Removing Fleas – Getting Serious

Understand that it will require assiduous effort to get rid of the problem.  There are several steps that I’ve taken to remedy things.

  • Take the animals to the veterinarian.  Ours were each given a single tablet of a flea killer called Capstar, which will have a rapid effect on the fleas as it spreads through the animal’s system and poisons the fleas.  This kills off the fleas that can lay eggs and the medication lasts long enough that any newly hatched fleas will be killed as they bite the animal.
  • Frequent changes of bedclothing.
  • Removal of any and all stuffed animals.  In this instance, I’ve bagged them for a month so that any hatching fleas will starve.
  • Daily vacuuming of the carpets and rugs.  That includes moving furniture since cats and small dogs can move almost everywhere and the flea can wind up almost anywhere in the carpet.
  • After vacuuming, removing the vacuum from the house so that the fleas don’t crawl out of the bag and back into the carpets.  Seriously.  It was recommended by our vet that we toss every vacuum bag, but the cost is prohibitive so we keep the vacuum in the garage unless we are using it.
  • Spraying the house with Siphotrol, available at the vets and reapplied in two weeks.  Note that the animals have to be placed in separate areas and the house vacated for several hours due to the odor.
  • Renewing the schedule for the flea medication on each animal so that the issue doesn’t happen again.

 And with the kids always watching, when they’re old enough, they’ll learn that the responsibility for an animal extends beyond feeding them and playing with them.

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Scheduling the Family Meal

When you’re responsible for the family cooking, you begin to understand that there are changes in the family lifecycle.  Timing and menus aren’t the same when you have an infant as when you have teenagers.

Yesterday was one of those changes that took me by surprise.

The media periodically run articles about the need for families to dine together, and I wholeheartedly agree that it matters.  But there are still weeks when coordinating family meals with competing schedules is difficult and I’m happy to get four family meals together out of seven.  As we moved from yesterday morning’s Fall baseball to afternoon housework and errands, I mentally planned out the evening meal with the understanding that Eldest would attend the Homecoming Dance.  Let’s see:  that amount of leftover chili takes an hour on the stove to heat up in that particular size pot and I have to also cut up apples for the microwave.  Another fifteen minutes in there for the tea to brew and it would be good to eat about one to two hours ahead of departure for the dance at 6:50.  That means dinner no later than 5:45.

As 5:45 rolled around and I called children and the spouse to the table, Eldest yelled back that she couldn’t come because of having to curl her hair; I’d have to wait about fifteen or twenty minutes longer.  It might not seem like much, but it is frustrating to watch hot food on the table start to cool in that period.

So I now have to factor the personal preparation needs of teens into the dining mix.  When the kids are younger, they aren’t concerned with their appearance and there are moments when you want to at least wear something even moderately appropriate for the table.  But I have forgotten that teens on the cusp on a major seasonal social event will extend their times significantly.  So the upshot will be that when I plan the evening meal on the day of an event, I’ll have to speak with the child in advance to learn what she’ll be doing and then factor that information into the planning.

Because I really do want to preserve the family meals as much as possible.  And if that takes some additional effort, then so be it.

 

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The 55% Paycut

It was frightening enough to have to provide the primary care for the infant, but doing so on a 55% paycut made it almost terrifying.

Prior to the arrival of Eldest, we were the prototypical DINKs – Double Income No Kids – living the urban lifestyle.  We frequently dined out with Thai cuisine being the preferred.  Movies and trips were standard and it meant little to routinely shop at the Barnes and Nobel Superstore.  And because my mate was in a federal government fellowship, her earnings were lower than mine as a corporate staffer.

My decision to stay home only came about five weeks before my mate had to return from maternity leave.  It wasn’t simple and the knowledge that our combined salaries would be cut by 55% made it problematic.  How did we handle it and how would we do it differently now?

How We Did It

A baby means that you have new and unexpected costs for staples.  What costs can you anticipate?

  • Certainly diapers and remember that not all brands are created equal.  Do you need all of the special touches, such as diapers that let you know they’re wet by artwork that appears when it becomes wet?  These are items that drive up the cost.  In our case, we went with the Toys ‘R Us store brand.
  • Co-pays for doctor visits, assuming that you have such insurance.
  • Formula, if that’s what you use to feed your baby.  One neighbor referred to it as "liquid gold".
  • Rudimentary clothing, such as onesies.  You might find that the extended family will provide the special clothing or play clothing but the staples are likely to be on you.  You will also find that such items will typically not be found at second-hand stores although friends with other small children might be a source.
  • Other staples such as bottles, nipples, and other safety devices and equipment.  Larger items – strollers, carseats and the like – were either purchased prior to the baby’s arrival, when we had available cash, or were gifts from friends.  Don’t expect that you can purchase such items at thrift stores since liability concerns prevent them from carrying any baby furniture.  In this case, yard sales can serve as a source for reasonably priced equipment.
  • We set aside money for life insurance, a first for us.

We re-examined what the spending habits and made changes.

  • We were fortunate to rent at the time so we didn’t have the corollary homeownership costs or worries about a mortgage.
  • Cable was paid, but because we knew that we’d be spending more time at home.
  • We continued to occasionally eat out, but the demands of the baby and costs meant that I did much more cooking.  The Thai cuisine went away.
  • We continued to drive older vehicles, although we did carry a note on one of the two autos.  This was paid off early.
  • Insurance was re-bid to assure that our costs were the lowest we could get.
  • We paid extremely close attention to grocery sales and heavily utilized coupons, membercard savings and sales to cut the cost of some weekly groceries by 35 – 40%.

Despite these measures, we still found ourselves running a credit card balance.

When I reconsider those early days, there are certain additional things that I would consider.

  • Shopping at second-hand/consignment stores for everyday adult clothing.  I’ve found that the children’s rack at such stores is sparse as children’s clothing is either picked over before I get there or clothing is traded among close family friends.
  • Paying off the credit card in entirety, as we typically do today.

 

 

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What Exactly Is Quality Time?

How often have you heard a co-worker, neighbor or friend use the term quality time to describe time spent with their kids?  It’s a term that connotes play and recreation with the child with no sense of shared responsibility or work, and even I’ve used it as such in the past.  But there’s merit in re-examining what it means as the kids grow and responsibilities multiply.

As kids grow, they need to learn how to perform the daily tasks that keep their world running.  This includes fixing meals, cleaning their immediate areas and even handling outside chores.  Yet they truly do want to spend time with you; these moments provide significant opportunities to pass along the "tribal knowledge" that is often lost in the transition from one generation to another.  What can you expect from the opposite sex?  What’s it mean to be a good sport?  What are the hidden messages behind the events they witness in their daily lives?  Play with the kids is important as well as fun, but it doesn’t promote the environment of togetherness – frequently in close proximity and shared effort – that engenders serious conversation.  Understand that it isn’t something that is easily done with young children, even if they are willing to shift back and forth from play to time with you.  But as the kids age, they can participate in the work.  And that participation can lead to:

  • a sense of accomplishment;
  • a greater understanding of what’s involved in seemingly mundane tasks;
  • improvement in higher thought processes;
  • understanding of family and personal values that comes from one-on-one conversation;
  • unexpected fun.

The point is this.  Many fathers – myself included – will shunt the kids to their own activities as they find respite from daily life in the things that need to be done.  They then set aside specific periods of time specifically for family togetherness via entertainment and diversion.  But this habit is too limiting for the needs of your child, who won’t gain the true education that can come from their fathers.

The next time that you have a set of chores or a project, consider how to include your kids.  It can be a better time than you expect.