The most important thing to know about Medical Emergencies in infants/children

By: Carmel Blue Infant CPR teacher, Fire Fighter Paramedic teacher Stephen Giacalone
A few days ago there was an emergency situation at Carmel Blue.  The emergency was made that much worse because it involved a baby.  Seems this baby was fighting a low grade fever and when the fever rose dramatically she had a Febrile Seizure.  Due to quick action (and proper preparedness) by those present we are happy to say the baby is fine.
As a result, Sharone asked me to prepare a little something about how to best approach or handle an emergency when that emergency involves a child or your child.
First of all – prepare yourself. Take an Infant CPR and Emergency response class regularly. Have a plan of action what you would do in case of an emergency.
In my experience as an Emergency Medical Technician (EMT), as a Paramedic, and as a Firefighter, I have seen many many things. Some good and some not so much. The five most common emergencies I have seen involving children have been:
1. Trauma
2. Seizures
3. Respiratory emergencies
4. Allergic reactions
5. SIDS (sudden infant death syndrome)
This list is by no means a statistical list!  It is merely what I have encountered most frequently. I do not want to get into the specifics of each of those items on the list.  That is a class in itself.
The message I would like to convey is this; as soon as you recognize that there is a problem, act on it! 
The biggest issue that contributes to poor outcomes in children is a delay in recognizing that there is a problem and then getting help.  That help can be in the form of a family member, friend, bystander, and just as important, contacting 911.
I completely understand that when it is your child it is nerve-wracking and scary.  Honestly, even I get extra wound-up when a call comes in for a sick or injured child, and I have been doing this job for almost 24 years!  The important thing to remember is try to stay calm and focus on the task at hand, and that task is helping your child. As parents, you are in-tune with your child or children more so and better than anyone!  Trust your parent intuition.  Recognizing that there may be or that there is a problem is crucial. Reach out for help immediatley and contact 911.  If it turns out to be nothing, then great!  But, if not, then you will have done the best thing possible for your child.
I hope this little article helps.  I am also pretty sure that this little article will elicit some questions.
That’s perfectly fine.  I am more than happy to try to answer them in the future.
Join me at Carmel Blue and learn to spot the warning signals and what you can do in response at our
Infant CPR and Emergency response classes offered monthly.

The Zika Virus: What you should know about it before, during and after pregnancy

As with any newly “discovered” malady the information about the Zika virus and it’s effects on pregnant women and their baby is still being researched and can change.  For now the most comprehensive information I found when researching is this article from the New York Times from Feb 12th.  See the article below:


Short Answers to Hard
Questions About Zika Virus

The World Health Organization has declared the Zika virus an international public health emergency, prompted by growing concern that it could cause birth defects. As many as four million people could be infected by the end of the year. Officials at the Centers for Disease Control and Prevention have urged pregnant women against travel to about two dozen countries, mostly in the Caribbean and Latin America, where the outbreak is growing.

The infection appears to be linked to the development of unusually small heads and brain damage in newborns. Some pregnant women who have been to these regions should be tested for the infection, the agency said. Here are some answers and advice about the outbreak.

  1. United









    Areas with current or past evidence of Zika




    1.What is the Zika virus?
    A tropical infection new to the Western Hemisphere.

    The Zika virus is a mosquito-transmitted infection related to dengue, yellow fever and West Nile virus. Although it was discovered in the Zika forest in Uganda in 1947 and is common in Africa and Asia, it did not begin spreading widely in the Western Hemisphere until last May, when an outbreak occurred in Brazil.

    Until now, almost no one on this side of the world had been infected. Few people here have immune defenses against the virus, so it is spreading rapidly. Millions of people in tropical regions of the Americas may now have been infected.

    Yet for most, the infection causes no symptoms and leads to no lasting harm. Scientific concern is focused on women who become infected while pregnant and those who develop a temporary form of paralysis after exposure to the Zika virus.

  2. 2 Infected blood

    travels to the midgut.

    1 Mosquito feeds on

    virus-infected blood.

    3 Virus enters the

    circulatory system …

    How mosquitoes

    spread Zika

    Aedes aegypti




    4 … and travels to

    the salivary glands.

    5 Mosquito bites again, injecting virus-

    infected saliva into victim before feeding.



    2.How does a mosquito transmit Zika?
    The virus moves from its gut to its salivary glands.

    Only female mosquitoes bite people: they need blood in order to lay eggs. They pick up the virus in the blood. It travels from their gut through their circulatory system to their salivary glands and is injected into its next human victim. Mosquito saliva contains proteins that keeps blood from clotting. When a mosquito bites it first injects saliva so that its prey’s blood does not clog its straw-like proboscis.
















    Probable range

    of the yellow

    fever mosquito,

    Aedes aegypti





    3.What areas is Zika likely to reach?

    Zika is spread by mosquitoes of the Aedes genus, which can breed in a pool of water as small as a bottle cap and usually bite during the day. The aggressive yellow fever mosquito, Aedes aegypti, has spread most Zika cases, but that mosquito is common in the United States only in Florida, along the Gulf Coast, and in Hawaii – although it has been found as far north as Washington, D.C., in hot weather.

    The Asian tiger mosquito, Aedes albopictus, is also known to transmit the virus, but it is not clear how efficiently. That mosquito ranges as far north as New York and Chicago in summer.

  4. 4.Can the Zika virus be sexually transmitted?
    Yes, but experts suspect that it rarely happens.

    Experts believe that the vast majority of all Zika infections are transmitted by mosquitoes, not sex. As of Feb. 2, there have only been three reports suggesting sexual transmission.

    • In 2008, a scientist studying malaria in Africa returned to Colorado and apparently infected his wife before developing symptoms himself. Both had fever, rash and headaches. A year later, tests on their blood, which had been frozen, revealed that both had had Zika.
    • In 2013, live virus was found in the semen of a 44-year-old Tahitian man; whether he infected anyone is unknown.
    • In early February, health officials in Texas announced that a traveler who had returned to Dallas from Venezuela apparently had infected a sexual partner.

    In the first two cases, the men had genital pain and blood in their semen, suggesting that their testes or prostates had been infected. Details regarding the third case were not released.

    Based on these reports, the C.D.C. issued tentative new guidelines suggesting that pregnant women avoid contact with semen from men who have recently returned from areas with Zika transmission. Men returning from these regions should consider using condoms, the agency said.

    Officials did not provide guidance on how long to do so. British health authorities have suggested using condoms for at least 28 days.

    There are still many unknowns, including:

    • Can a woman pass the virus to a man through sex? Can it be passed through anal, oral or any other form of sex?
    • Does a man have to have blood in his semen to be infectious? Is he infectious before the blood appears?
    • If there is no blood, does he have to have had Zika symptoms like fever and rash to transmit the virus? How long does a man remain infectious?
  5. 5.How might Zika cause brain damage in infants?
    Experts aren’t certain how it happens, or even whether the virus is to blame.

    The possibility that the Zika virus causes microcephaly – unusually small heads and often damaged brains – emerged only in October, when doctors in northern Brazil noticed a surge in babies with the condition.

    It may be that other factors, such as simultaneous infection with other viruses, are contributing to the rise; investigators may even find that Zika virus is not the main cause, although right now circumstantial evidence suggests that it is.

    It is not known how common microcephaly has become in Brazil’s outbreak. About three million babies are born in Brazil each year. Normally, about 150 cases of microcephaly are reported, and Brazil says it is investigating nearly 4,000 cases. Yet reported cases usually increase when people are alerted to a potential health crisis.













    Microcephaly cases in Brazil

    By state, as of Jan. 30

    Rio de Janeiro







    Possible cases

    under investigation



    6.What is microcephaly?

    Babies with microcephaly have unusually small heads. In roughly 15 percent of cases, a small head is just a small head, and there is no effect on the infant, according to Dr. Constantine Stratakis, a pediatric geneticist and a scientific director at the National Institute of Child Health and Human Development.

    But in the remainder of cases, the infant’s brain may not have developed properly during pregnancy or may have stopped growing in the first years of life. These children may experience a range of problems, like developmental delays, intellectual deficits or hearing loss.

    The consequences can vary widely from child to child. Pinpointing an underlying cause helps clinicians to advise parents about their newborn’s prognosis.

    Genetic abnormalities are a common cause. Microcephaly can also be triggered by infections of the fetus, including German measles (also known as rubella), toxoplasmosis (a disease caused by a parasite found in undercooked contaminated meat and cat feces) and cytomegalovirus.

    Microcephaly may also result if a pregnant woman consumes alcohol, is severely malnourished or has diabetes. If the defect occurs in a child’s first years, it may be a result of a brain injury during labor.

    There is no treatment for an unusually small head.

    “There is no way to fix the problem, just therapies to deal with the downstream consequences,” said Dr. Hannah M. Tully, a neurologist at Seattle Children’s Hospital who specializes in brain malformations.

  7. United States


    Dominican Republic

    Puerto Rico


    St. Martin



    U.S. Virgin Islands









    El Salvador


    Costa Rica



    French Guiana











    pregnant women

    should avoid



    Note: American Samoa, Cape Verde and Tonga should also be avoided.

    7.What countries should pregnant women avoid?
    About two dozen destinations mostly in the Caribbean, Central America and South America.

    The Pan American Health Organization believes that the virus will spread locally in every country in the Americas except Canada and Chile. Here is the C.D.C.’s current list of countries and territories in which Zika virus is circulating. The latest updates are here.

  8. 8.How do I know if I’ve been infected? Is there a test?
    It’s often a silent infection, and is hard to diagnose.

    Until recently, Zika was not considered a major threat because its symptoms are relatively mild. Only one of five people infected with the virus develop symptoms, which can include fever, rash, joint pain and red eyes. Those infected usually do not have to be hospitalized.

    There is no widely available test for Zika infection. Because it is closely related to dengue and yellow fever, it may cross-react with antibody tests for those viruses. To detect Zika, a blood or tissue sample from the first week in the infection must be sent to an advanced laboratory so the virus can be detected through sophisticated molecular testing.

  9. Photo

    The C.D.C. testing algorithm for pregnant women who have visited countries in which the Zika virus is spreading. CreditCenters for Disease Control and Prevention
    9.I’m pregnant and I recently visited a country with Zika virus. What do I do?
    Some women should get blood tests, and just about all should get ultrasound scans.

    On Jan. 19, the C.D.C. issued interim guidelines for women in that situation and for their doctors. The guidelines are complex — and may change.

    In general, they say that pregnant women who have visited any area with Zika transmission should consult a doctor. Those who have had symptoms of infection like fever, rash, joint pain and bloodshot eyes during their trip or within two weeks of returning should have a blood test for the virus.

    That recommendation is controversial, because even women with no symptoms may have been infected — 80 percent of those who get the virus do not feel ill — and there is no evidence that babies are hurt only when the mother has been visibly ill. But at the time the guidelines were issued, the C.D.C. and state health departments simply did not have the laboratory capacity to test every pregnant woman who visited Latin America and the Caribbean in the last nine months, as well as every pregnant woman in Puerto Rico. On Feb. 5, the agency added a recommendation that pregnant woman who do not show any Zika symptoms should also receive testing two to 12 weeks after returning from a Zika-affected country.

    Even for women who get blood tests, the news is not entirely reassuring. Tests for the virus itself only work in the first week or so after infection. Tests for antibodies can be done later, but they may yield false positives if the woman has had dengue, yellow fever or even a yellow fever vaccine.

    Under the C.D.C’s testing algorithm, pregnant women who have been to affected regions – whether they have symptoms or not, and whether they have negative or positive blood tests – should eventually have an ultrasound scan to see if their fetuses are developing microcephaly or calcification of the skull.

    Unfortunately, an ultrasound usually cannot detect microcephaly before the end of the second trimester.

    Some women also should have amniocentesis to test the fluid around the fetus for Zika virus. But amniocentesis involves piercing the amniotic sac with a long needle through the abdomen; it is slightly risky for the fetus and is not recommended before 15 weeks gestation.

    Several companies are working on rapid tests for Zika infection. The C.D.C. also usually distributes test kits and training materials to state health departments during outbreaks, which should increase testing capacity.

  10. 10.I’m of childbearing age, but not pregnant and not planning to get pregnant. Should I go to an affected country?
    Only if you use birth control consistently.

    Half of pregnancies are unintended. If you want to visit a country where Zika transmission has been reported, Dr. Laura E. Riley, a specialist who works with high-risk pregnancies and infectious disease at Massachusetts General Hospital, advises strict use of birth control to ensure you don’t get pregnant.

    Women who become unexpectedly pregnant while traveling or shortly afterward will face blood tests, monthly ultrasounds and a great deal of anxiety.

    “Why would you ever sign yourself up for that?” said Dr. Riley. “There’s enough in life to worry about. I wouldn’t add that to my list.”

  11. 11.I’m pregnant now, but wasn’t when I visited one of the affected countries. What’s the risk?
    Very low, experts say.

    With rare exceptions, the virus does not appear to linger in the body, and people who recover from the infection are immune.

    “Our understanding, thus far, is that the risk is very, very low if you were in that place prior to conception,” said Dr. Laura E. Riley of Massachusetts General Hospital.

    “I wouldn’t be worried about if you conceived after you got back to the U.S.”

  12. 12.I’ve just returned from a place where Zika virus is spreading but experienced no symptoms. How long until I can be sure I can’t pass on an asymptomatic infection?
    At least a month.

    There are two types of transmission to consider. Once home, you might be bitten by a mosquito that could carry the virus to someone else. Or, in rare cases, you might pass the virus to a partner through sex.

    For mosquitoes, you should worry for perhaps 20 days, max.

    Health agencies hold to a variety of estimates for the Zika virus’s incubation period in the body, but all are between two and 12 days after the mosquito bite. Most people start feeling sick – if they get symptoms at all – between the third and seventh day.

    People who get sick usually recover within seven days, meaning that the immune system is clearing or has cleared the virus from the blood. So if you were infected on your last day in the tropics and experienced no symptoms, for about 20 days, in theory, you might pass the virus to a mosquito back home.

    Sexual transmission has too many unknowns attached to it to say anything definitive. But if the Zika virus has to invade a man’s testes in order to be passed through semen, it may linger there for weeks or even months. The testes are somewhat shielded from the immune system, so it can be harder for the body to get rid of an infection there.

    British health authorities have urged men returning from areas in which the virus is circulating to use condoms for 28 days to be reasonably sure that they cannot infect a partner.

    The C.D.C. has said that pregnant women whose male partners have spent time in these areas should abstain from sex or use condoms during intercourse for the duration of their pregnancy. Guidelines may change once more is known.

  13. Photo

    Gleyse Kelly da Silva holding her daughter, Maria Giovanna, who was born with microcephaly in Recife, Brazil. The birth defect has been linked to the Zika virus. CreditFelipe Dana/Associated Press
    13.Does it matter when in her pregnancy a woman is infected with Zika virus?
    Earlier in pregnancy seems to be more dangerous.

    The most dangerous time is thought to be during the first trimester – when some women do not realize they are pregnant. Experts do not know how the virus enters the placenta and damages the growing brain of the fetus.

    Closely related viruses, including yellow fever, dengue and West Nile, do not normally do so. Viruses from other families, including rubella (German measles) and cytomegalovirus, sometimes do.

  14. 14.Should infants be tested?
    Other birth defects may be linked to the virus.

    Federal health officials say that newborns should be tested for infection with the Zika virus if their mothers have visited or lived in any country experiencing an outbreak and if the mothers’ own tests are positive or inconclusive.

    The reason, officials said in interviews, is that infection with the virus could be linked to defects in vision and hearing, among other abnormalities, even if the child does not suffer microcephaly. The other defects may require further assessments and testing.

    The new guidance applies only to infants of mothers who reported symptoms of Zika virus infection — a rash, joint painred eyes or fever — while living abroad in an affected country or within two weeks of travel to such a destination.

A new Prenatal Fitness Program:CB & the Bay Club. For non members too!

A NEW PRENATAL program: Yoga and Aqua sport at the Bay Club SF

SF Bay Club and Carmel Blue Pregnancy and Parenting Center created this special PRENATAL program that combines the benefits of Aqua fitness and Yoga in two separate sessions a week. It’s the perfect exercise regimen during your pregnancy. Meet other expectant moms and enjoy low impact physical activity while preparing your body, heart and mind for pregnancy, labor and for parenting.

Not a member?  No problem.  You can join the program and enjoy The SF Bay Club’s low chlorine, heated pool, fully equipped yoga studio and spacious locker rooms.  Located near Downtown they provide shuttle services and parking.

Aqua Fitness: The moment you enter the water your body says “ahh” and your playful energy kicks in gear.  Let the water’s buoyancy ease your prenatal discomforts while the power of the water’s resistance helps promote cardio, strength, endurance, balance and flexibility.   Also great for circulation, mood, health and wellness.

Prenatal Yoga: Carmel Blue prenatal yoga is a wonderful way to prepare your body, mind and soul for childbearing.  We will emphasize working with your changing body and changing needs, promoting awareness, breathing and strength as a path for enjoying your pregnancy and preparing for childbirth.

No Yoga experience necessary.  We provide yoga mats and props.

Appropriate from week 6 till birth.  

Prenatal Aqua on Wednesdays 8:15 – 9:00 AM

Prenatal Yoga on Fridays 8:15 – 9:30 AM

Sign up for the monthly prenatal series that includes 4 aqua fitness classes and 4 yoga classes.   


Members $ 150.00 for 8 classes

Non-members $ 210 for 8 classes


SF Bay Club 150 Greenwich Street (between Sansome and Battery)

To register or for more information please contact Tricia Probert at

Five Super Foods to Support Postpartum Moms

Gestation and childbirth are no easy task, even at the cellular level. Your body needs specific foods to replenish nutrient stores, help you feel more energized, and to support the healing process. If you are breastfeeding, eating a nourishing diet not only helps you feel better, it can improve the quality of your breast milk. Besides filling your pantry and fridge with nourishing foods, it’s important to make time to eat. Ask your partner or a friend to take your baby for a walk while you sit down and enjoy a meal for twenty to thirty minutes. That simple act can feed you in many ways; it supports better digestion; the body can absorb nutrients more efficiently in a more relaxed state; mindful eating leads to more satisfaction, so you’re more likely to eat the amount that you need.


Here’s a list of five foods you can buy or easily make, some yummy serving suggestions, and how they benefit you and your baby.

  1. Cultured dairy

Organic whole milk yogurt and kefir help replenish calcium stores. Their supply of healthy fat and protein also stabilizes blood sugar levels, resulting in more energy and better moods. While some women are not able to digest milk, cultured dairy contains less lactose than regular milk and has beneficial probiotics. These healthy bacteria strengthen the immune system and help with nutrient absorption. Calcium, in particular, is used in utero for growing bones. Even if you’ve taken calcium supplements before and throughout your pregnancy, food remains the best source of absorbable calcium.

Serving Suggestions: To reduce processed sugar intake, look for plain organic whole milk yogurt and kefir. Use bananas and berries as natural sweeteners or a spoonful of preserves, local honey, or maple syrup. Add crumbled walnuts or slivered almonds for an even greater nutrient boost.


  1. Mollusks (oysters, mussels, and particularly, clams) 

These two-shelled morsels contain more iron than liver or red meat. If you’re not a meat or mollusk eater, spinach and molasses are good sources of plant-derived or heme-iron, but they still provide less iron than animal foods, which contain more absorbable heme- iron. During childbirth, women commonly lose blood, which can result in an iron deficiency. Without enough iron, a postpartum mom can feel sluggish and depleted, and even become anemic. Since most postpartum moms are also sleep deprived, it becomes more important to support energy levels with adequate iron intake. After having my children, I could feel my energy levels improve postpartum when I ate liver and other iron-rich foods; I even craved them.

Serving Suggestions: Squeeze lemon on your oysters or add clams to tomato sauce as vitamin C improves the body’s ability to absorb iron.


  1. Dark Leafy Greens

Looking for a great source of calcium that’s not in a pill or glass? Fresh greens such as rainbow chard, beet greens, dino (lacinato) kale, escarole and arugula are some of my favorites. For convenience, look for the pre-washed varieties. These foods provide a wide spectrum of valuable minerals, fiber, and phytonutrients. They’re also good at stabilizing blood sugar levels.

Serving Suggestions: Steam greens gently in a covered pot or skillet with a little water or broth; remove center rib of kale or chard and chop thinly to use in salads with a 30-Second Homemade Vinaigrette (see recipe below); add to wraps; or mix greens in warm grain salads with quinoa, millet, or farro.


  1. Natural Sugars 

It’s 3pm and you need a boost. Instead of reaching for foods with processed sugar or a sweet caffeinated concoction at your local café, keep a variety of fresh seasonal fruit on hand. If you’re looking for gluten-free alternatives, try roasting Japanese sweet potatoes and delicata squash; I find these sweeter and more delicious than other varieties. Fresh fruit and starchy vegetables contain important nutrients and fiber that slow down digestion, reducing a blood sugar spike. Without the spike and crash, energy levels remain more stable and less erratic.

Serving Suggestions: Bring along a piece of fruit when you leave home for a healthy snack on-the-go. Eat your fruit with some nuts. The combination of fruit and nuts will further reduce a spike in blood sugar levels and also satisfy hunger for a longer period of time.

Cooking Tip: Preheat oven or toaster oven (It cuts off automatically!) to 350 degrees, scrub potato, yam, or squash and place on a tray. Cook for 30-60 minutes depending on the size. The flesh should pierce easily with a fork when done. Serve with coconut oil, nutmeg or cinnamon, and sea salt. With squash, slice open and remove seeds first.


  1. Nuts and Seeds

Choose your favorites and keep on-hand in a container in your stroller, car, or purse. Hunger may strike unexpectedly if you are breastfeeding. Look for raw or roasted as roasting doesn’t decrease the nutrient content significantly.  Choose salted or unsalted; salt is essential for proper cellular function. Nuts contain good-quality fats, protein, and fiber, all of which assist in stabilizing blood sugar levels. They are easy to tote and to eat with one hand for a snack if you are holding your baby with the other.I recommend almonds for their superior calcium content, walnuts for their high omega-3 content and versatility (soaked and toasted walnuts are my go-to nut), pumpkin seeds for their high zinc levels, which helps with tissue repair, and sesame seeds for their high calcium content.

Serving Suggestions: Hummus contains tahini, a paste made with sesame seeds, so if you like hummus, eat it with sugar snap peas, carrots (scrubbed but not peeled as most of the nutrients are in the skin), and cherry tomatoes. These veggies are all easy to prepare and are full or phytonutrients. Personally, I prefer dipping carrot sticks in roasted salted almond butter for a yummy high-calcium snack.


        6. 30-Second Homemade Vinaigrette (Makes about ¾ cup)

2 Tbs aged vinegar such as (sherry (my favorite), red wine, or champagne vinegar)

½ cup extra virgin olive oil

Sea or mineral salt & fresh ground pepper, to taste

Shake together in a sealed jar until well blended. Shake again as needed.It does not need to be refrigerated. Both vinegar and olive oil are shelf-stable ingredients.


By Virginia Watkins

5 Self Care Tips for New Mamas


You’ve recently had a baby and experienced a shift in your lifestyle. Time you’ve once had all to yourself is now being shared, if not dedicated, to caring for your proudest little creation. In doing so, you may have forgotten how to take care of yourself the way you once did. Here are 5 things you can do to not only improve your self care, but make you feel a whole lot better.

1. Dress Your Best
Remember the first day of the school when you felt invincible as you rocked the perfect outfit through the halls? That’s the feeling you’re aiming for here. You look good, you’ll feel good. Toss the maternity clothes aside and take an extra bit of time to find that outfit that highlights all the right places.

2. Find A Good Support System
Whether it be hiring a mother’s helper, staying in touch with your parents, or joining a local mom’s group, you want to create an outlet that allows you to express your feelings and ask for help. Nothing beats the feeling of knowing you have people that back and support you.

3. Take a Shower
This seems like a no-brainer, but you’d be surprised how many new mothers forget to do this. Taking a shower isn’t necessarily at the top of your priority list anymore, but it makes all the difference in the way you feel. Find time to take one when baby is asleep or if they are awake, bring the baby swing or bouncer into the bathroom and talk/sing to baby as you shower.

4. Put Good Food Into Your Body
Eat real food, not processed or fast food. We hear this all the time, and yes, the box of cookies is starring you right in the eyes, but your body will thank you. You’ll have more energy, lose the baby weight, and feel healthier overall.

5. Take Time For Yourself
Whether it be going for a walk, visiting the beauty salon, or sitting alone for 5 minutes, it is important for your sanity that you find time where you are alone with yourself. Find a relative, friend, or sitter to watch baby and take the time to recharge your batteries and remember who you are.