Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

A mom, a pediatrician, and her insights about keeping your kids healthy.

Empathy And Compassion For Transgender and Gender Non-conforming Children and Teens

gender-bathroomI saw this bathroom sign in my sons’ school a week ago. Talk about inclusion. I’m not only pleased that my boys are being exposed to open inclusion, I’m delighted they are getting the message that they can be whoever they are at home and at school. NO question in my mind the data proves if a child, teen or adult has questions about their gender their life is at risk for being harder. This is manifest in the high rates of anxiety and depression, bullying and ridicule, and feelings of isolation in those who are gender non-conforming and transgender. This is only estimated to be about 1% of the population (numbers are imprecise as many people hide this challenge) but how we all support those who question their gender matters for us all, the 99% of us who don’t have this challenge.

We must have compassion and empathy for children and teens who are transgender and gender non-conforming. We must accept children and teens and their families, and we can connect children and families who struggle with resources (below).

Children Are Born With Gender, Parenting Has Little To Do With It

  • Research shows that gender is established at birth. That means children are often born knowing if they are a boy or a girl irregardless of their sex (the chromosomes/genes that determine their body’s appearance and sexual characteristics). Sometimes children know this early, sometimes later in life.
  • Research shows that there is no evidence that parenting is responsible for a child having a different gender than their sex. Meaning — parents don’t have control, with their actions, over their child’s gender. They can’t change a child’s gender.
  • Research shows that children are less likely to end their life when they have challenges with their gender identity if they are accepted by their families. This means children who grow up in homes who accept them are less likely to suffer. Maybe a no-duh, but it’s something all parents should know.

This is complicated stuff, of course, and isn’t the same for all children and teens. Some children question their gender early in life (as early as preschool years) and will traverse childhood knowing they are transgender while other teens may find out at the onset of puberty that something isn’t quite right. Some children or teens just don’t identify with one gender or another (gender non-conforming). When they question this, we want to make sure they get what they need.

The most important message is that we must be open to what children express, connect children, teens and families with resources they need, and be aware of the risks for suffering in children who question their gender. Thankfully, there are lots of people to help and resources. Seattle Children’s Hospital now offers a specific clinic to support transgender and gender non-conforming children and teens (age 8-21 years). Experts and staff provide support for puberty blocking (stopping onset of pubertal development) or hormone therapy (hormones to have body characteristics match gender). They can also support conversations and planning for those who want to transition.

Statistics & Risks For Transgender Children And Teens

  • Transgender population is hard to define, probably less than 1% of adolescents
  • All gender non-conforming are at increased risk for bullying, anxiety, depression & suicide
  • 71% of transgender people said they hid their gender or gender transition to try to avoid discrimination

2014 Williams Institute Study On Transgender Issues:

  • 41% of transgender people attempt suicide
  • 57% report family choosing to not speak to them
  • Nearly 55% report being bullied and harassed
  • Nearly 70% experienced homelessness

What Communities & Parents Can Do & Teach:

  • If your teen has identified as a different gender since early childhood, it’s unlikely he or she will change their mind. Parenting won’t change this. Work on changing expectations, not your child.
  • When your child discloses his or her identity to you, respond in an affirming, supportive way.
  • Accept and love your child as they are. They will need your support and validation to develop into healthy teens and adults.
  • Stand up for your child when he or she is mistreated.
  • Be on the look out for signs of anxiety, insecurity, depression, and low self-esteem.
  • Connect your child with LGBTQ organizations, resources, communities and events. It is important for them to know they are not alone.

Online Resources For Children, Teens And Families

This list is from resources I found myself and from advocates for trans health. Any feedback on links included here is welcome — please comment!

  • National Center For Transgender Equality consider watching this video on Facebook where children, teens and families share stories about being transgender. Parents talk about fear, challenges with acceptance and discuss their safety. “The easiest way to support transgender people is to follow their lead” and “this is who I am” really do stand out.
  • Healthy Children article on transgender and gender non-conforming from American Academy of Pediatrics
  • Seattle Children’s Gender Clinic This has information on services and ways to see experts
  • Centers for Disease Control LGBTQ Resources overview information
  • The Trevor Project works to reduce severe depression and suicide in those questioning or struggling with their gender identity. They have a helpline (1-866-488-7386) and a chatline that you can connect with live.
  • My Trans Health – trans-friendly healthcare providers in Chicago, Dallas, Miami, NYC, San Francisco and Seattle
  • RAD Remedy (Referral Aggregator Database) described to me as a site, “dedicated to connecting trans, gender non-conforming, intersex, and queer folks to accurate, safe, respectful, and comprehensive care. Patients can review and rate providers on competencies and services provided.”
  • Seattle Children’s Gender Diversity Support Groups
  • Gender Diversity Family Support Groups
  • Social media: The trans community has an established presence on Instagram under certain hashtags, but has recently started cropping up more and more on Twitter with the hashtags #TransTakeover #ThisIsTrans #MomentsInTransition and #IamTransButAlso.

When Is It ADHD In A Child?

I talked with Erin Schoenfelder, PhD,a specialist in ADHD and Director of Behavioral Treatment at the PEARL Clinic (Program to Enhance Attention, Regulation & Learning) here at Seattle Children’s Hospital, about ways to recognize ADHD in children and teens. The previous post we shared included the acknowledgment that it may be harder to parent a child with ADHD and provided reasons for it along with 5 tips to help parents and families. In the podcast above, Dr. Schoenfelder helps parents, teachers, and pediatricians understand what ADHD is and identifies ways to support, diagnose, and evaluate children with whom parents and teacher hold concern. First and foremost make sure you understand how a child sleeps before doing any further work-ups! Sleep challenges can be a big mimicker of ADHD as deprivation causes inattention and distractibility.

What is ADHD?

  • Developmentally atypical symptoms of inattention and/or hyperactivity/impulsivity.
  • Developmental disorder that persists over time and years and is consistent across settings (i.e. children have challenges at school, at home, during sports activities, at a synagogue or church).

Signs, Symptoms, Red Flags

  • Problems in multiple settings completing work, getting along with others, following directions, and succeeding
  • Teacher noticing the child is standing out from others
  • Child an outlier in a group – soccer practice, birthday parties, home
  • Risky behavior, getting injured due to impulsivity
  • Falling behind in learning due to off-task behavior

Read full post »

3 Reasons And 5 Tips For Parenting A Child With ADHD

Turns out that in clinical practice I’ve learned that it’s okay to acknowledge that some children are simply harder to parent than others. From what I can tell it’s really true. Often those parents struggling with children with behavioral challenges blame themselves more than is necessary. Sometimes rationale for why it’s harder helps.

There are all sorts of reasons for increased challenge. Chronic or challenging underlying illness, mental health struggles, and/or behavior challenges are a few of the reasons that some parents have a much harder job. I talked with Erin Schoenfelder, Ph.D. a specialist in ADHD and Director of Behavioral Treatment at the PEARL Clinic (Program to Enhance Attention, Regulation & Learning) here at Seattle Children’s Hospital about how parents often NEED a different parenting strategy if their child has ADHD. She outlines it beautifully in the podcast. These 3 reasons and these 5 strategies Dr. Schoenfelder shares can help families support children with the unique challenges that come along with ADHD.

Why do children with ADHD need different parenting strategies?

Normal good parenting strategies (sticker charts, send to room, natural consequences) don’t seem to work for kids with ADHD. Parents need additional strategies. When children with ADHD fail to thrive in typical structures for reinforcement, it doesn’t mean parents are failing. Parenting a child with ADHD can at times be harder than parenting a child without attention challenges.

1. Children may lack internal “self regulation”

  • Kids not regulating their own engines to stay on track. So children with ADHD may be very susceptible to external environments, including distractions, inconsistencies.
  • Therefore, behavior is inconsistent. Kids aren’t able to do what they know how to do.

2. Limited window on time for discipline

  • “Now” versus “Not Now.” Make sure you provide immediate feedback for children with ADHD. If you wait, it may lose relevance or even be lost in the memory bank.
  • Children with ADHD may have a tendency to have their window get “flooded” easily, and they cannot shift forward to predict what will happen next, or backwards to recall what has/hasn’t worked in the past.
  • Children don’t connect behavior and consequence the same way as children without ADHD.

3. Children with ADHD may have different processing of rewards

  • Dopamine is processed differently in the brain of children with ADHD. Therefore when they get the chemical kick of reward, they may experience it differently.
  • Everyday things feel less rewarding and interesting than they are for other kids.
  • Other things (screens) may feel SUPER rewarding…

Read full post »

How To Dose OTC Medicines In Babies

kyotcs_feverinfographic_weightageAbout 4 million sweet babies are born in the U.S. every year. And since September & October are two of the most popular months in the year for the birth of babies I’m taking a moment to share a couple of reminders for new families and those of you who support them.

1. Nursing Moms & Over The Counter (OTC) Medications: Every new parent feels a sense of overwhelm and exhaustion after welcoming a new baby. It can be especially exhausting when moms are breastfeeding and carry the new concerns about what they’re eating, how they’re both supporting themselves and their baby’s milk and when moms and dads have concerns about passing OTC medications (or Rx ones) through mom’s milk. Here are a few guidelines and reminders:

  • Don’t take aspirin if you’re breastfeeding.
  • It’s always best to avoid extra strength formulas of any medication, as they stay in the blood stream longer.
  • Always ask your doctor if you are worried or have questions about a medicine or supplement you’re taking if you’re breastfeeding. Always makes sense to ask.
  • Read the Drug Facts label as this will sometimes help you understand risks.
  • I like LactMed as a resource/search tool to help find information on medications. LactMed is updated monthly and is a database of over 1,000 drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects on the nursing infant. All data are derived from the scientific literature and fully referenced.

2. When Your New Baby Gets A Cold Or Fever: Your baby’s first bout with a cold or fever can leave you feeling scared (and exhausted) as you watch your baby deal with the inconvenience of mucus and snot, coughs and/or sneezes. Infants are more susceptible to infections because they don’t have fully developed immune systems hence why we all work hard to avoid exposures for them early in life. But upper respiratory infections (“colds”) do happen even with the best of protections.

Oral cough and cold medicines (including cough suppressants, cough expectorants and multi-symptom cold medicines) are not safe for infants and young children under the age of 4 or 6 years of age.

However, if your baby has a fever and is OVER the age of 3 months, you can give them acetaminophen to help relieve symptoms. The label on OTC medicines for infants and children only includes dosing for children age 2 and older; so talk to your doctor for dosing for younger children.

Always dose medicine by your infant’s weight, not their age, so at every well child check-up as your baby grows, ask your pediatrician to provide the proper, current dose for OTC medicines.

You can also give your child ibuprofen for mild infections, fever, or teething. Dosing for children 6 months and older is on the label; talk to a doctor for dosing for younger children although it is not typically recommended. Here’s more on dosing acetaminophen and ibuprofen by weight in infants and toddlers.

There are also several non-medicine interventions for colds. If your infant or toddler is too young to be given OTC medications or you’d prefer not to use them, there are other options to help relieve symptoms and keep your baby sleeping and comfortable. Read full post »

Playing Multiple Sports Is Better For Most Children

New data out (that I happen to LOVE) seems to go against many parental instincts, including a few of my own. I think plenty of parents have been led to believe in the last few decades that specialization and mastery in a single sport early in life is GOOD for their children. Some of that instinct rises from our guts in the mis-appointed “10,000 hours rule.” The idea that once our children do something for 10,000 hours they will be an expert. The 10,000 hour rule (brought to masses in part via Malcolm Gladwell) suggests that with dedication and time (10,000 hours) a person will develop mastery over a sport or skill. A recent American Academy of Pediatrics clinical report states, “it has often been misquoted that to succeed, an athlete needs to have 10,000 hours of practice/competition over 10 years. The media have incorrectly extrapolated Ericsson and co-workers’ studies of chess players to a formula for sports success. Many examples exist of successful athletes who have <10,000 hours and others who have not succeeded despite having >10,000 hours of practice/competition.”

Children in sports have changed over the last 40 years.

There is increased pressure to participate at a high level, to specialize in 1 sport early, and to play year-round, often on multiple teams. This increased emphasis on sports specialization has led to an increase in overuse injuries, overtraining, and burnout. ~Dr. Joel S. Brenner

And it’s just not true that grunt hours in a single sport will make champions of all of our children. Worse — focusing early and often on one single sport may lead to overuse injuries, burnout, isolation, and a less likely shot at succeeding at and loving sports for a lifetime.


I think in the time of the tech boom we can also be led astray by the “Zuckerberg effect”  — the idea that we can only really change the world by focusing on a single thing and becoming a global master in doing so.

Reality is, those children who specialize in a single sport early are at higher risk for overuse injuries, burnout, quitting sports altogether and even isolation and loneliness. Successful, even elite athletes, are more likely to develop when our children don’t specialize in a single sport until late puberty, around age 15 or 16 years.  Read full post »

Community and A Conference

21091855984_fc2bb18bd0_kI feel so much gratitude every day. I feel it for near cliche reasons (my sweet babies, good health, shelter, opportunity to make change, perspective that seeing the world has afforded me, and the freedom we have living here in a democratic society). Sometimes gratitude overwhelms me. And unsurprisingly that’s typically true on the most challenging days of life; I don’t see and feel and smell my gratitude on the easy days as well as I do on the days when life taxes and feels uncertain. I sense the gratitude housed in me most when I’m leaning on those around me, when I cry or when I’m worried or lack control in a situation. And the reason is this: my gratitude is greatest for the people in my life and seems to swell when I feel a sense of belonging. For being alive, for being a part of something greater than myself, and for the luxury of being suspended, taught, and caught just in time by the net of those who have me. Who trust in me and in themselves that we have the courage to live with intention, compassion, and empathy and that we can dent the universe. Supportive communities change everything…

My work here at Seattle Children’s in building digital tools, partnering in the design of curriculum created by patients, and nurturing parent-to-parent support with digital technology is influenced wildly by my net of community, my witness to suffering, and of course, my own experiences of when communication fails in the health space.

Like a lot of people, I feel I have the most incredible friends and I do feel I have the most supportive community of co-workers, patients, colleagues, advisors, and entrepreneurs who nurture in me an ongoing will to keep trying out new things in the health space. Most of the people in my community and on “my team” are as passionate and desperate to see change as I am…

We all have a team. Most of us have multiple, of course. Sometimes we define team with our families, a group at work solving a unifying problem, or by the outlines of communities from childhood or other stages in life. Social networks have woven some of these teams into daily networks we historically couldn’t have had. Thank goodness that with networks, texts, social channels, cellular phones, and other intuitive technology we typically never have to be far from those who surround us.

My good friend Susannah Fox is the one who long ago said, “Community is Your Superpower.” She began to proclaim this after fastidious work to understand and describe some of early research in peer-to-peer health care while doing research at Pew Research Center and now works in government to serve patients around this country at large. But her point and her wisdom extends to every corner of of our lives. The wild power that comes from insight and expertise from those who are like us. Not just emotionally but with information, resource, and tactics to solve life’s vexing problems, together.


I mention all this because tomorrow around 4am I’m leaving my family in the dark to head to the airport to attend the Medicine X conference in Palo Alto. I’m joining dear friends, expert patients, entrepreneurs, nurses, executives, physicians, and artists as we gather to examine the opportunity of emerging technology to enhance our lives, solve health problems, hone solutions, and inspire diligence to making health care better. At Medicine X the patient voice is louder than at any other medical conference I’ve attended around the world. But more than anything as I ready to attend, I think of my visit as a return to a web of people and ideas that pour fuel into the center of me to keep thinking of ways to make change faster. Read full post »

No More Antibacterial Soap At Home or School

It’s a clear no-go on those “antibacterial” soaps you see on people’s counters and sometimes in our schools. They are soon to vanish from stores. No good evidence the (typically liquid) soaps actually protect our family from bacterial infections better than washing with regular soap and water and there are some concerns the ingredients used to make the soap may pose risk. Because of this, the Food and Drug Administration (FDA) recently announced a ban on chemicals/pesticides used in antibacterial soaps due to safety concerns, including two of the most commonly used ingredients: triclosan and triclocarban. Some of these antibacterial soaps will still be used in hospitals.

Consumers may think antibacterial washes are more effective at preventing the spread of germs, but we have no scientific evidence that they are any better than plain soap and water.” ~ Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation & Research

Some history: Back in 2013 the FDA asked companies that produce antibacterial soaps to prove that their products were more effective than basic soap and water. Turns out, they couldn’t (or didn’t) provide data to show that these products were safe for long-term use nor that they are more effective. We know anytime we add antibiotics into our environment. water, food or agriculture, they kill bacteria off so that bugs that are less treatable with medicines have an easier time surviving. The end result are so-called, “superbugs” or bacteria in our environment and thankfully, rarely in our bodies, that are difficult or impossible to treat. That’s a LOSE-LOSE for humans (and animals). Hence the new ban on these soaps. Companies now must comply with removing the chemicals within 1 year’s time, or take the products off the market. There are 3 chemicals used in some soaps still allowed (not included in the 19 ingredients listed in the FDA ban) that rarely may still be found.

Why We Don’t Want To Use “Antibiotic” Soap

Some bacteria are good (the ones that live in our guts and the ones that live on our skin, for example) and contribute to our microbiome. We want to preserve those as these bacteria protect us, help us break down food, and even support vitamin production. There is also some data that every course of antibiotics we ever take changes this microbiome and may have lasting and long-term effects including susceptibility to chronic disease.

So as part of our wellness relies on these “good” bacteria, part of human wellness also relies on effective antibiotics against the bad ones (for serious infections, surgery, when an immune system is compromised). Clearly, we only want to use antibiotics when necessary; if we overuse them we create environments where resistant bacteria thrive. Once that happens, we won’t be able to cure infections they cause. Read full post »

For The Sake Of Privacy: Just Some Of The 20 Questions

img_9254This year, for the first time, I did the annual 20 questions (see below) with the boys at the start of school and realized that I couldn’t share all of the responses here. Just too personal, just too vulnerable, just too real. Sharing all of the answers they entrusted with me would somehow expose them. At some point, every “mommy blogger” censors and protects her children and I, of course, have been doing that since day one. But with these, even somewhat impersonal questions, I felt the exposure and raw responses more than ever. No way that I want to exhume vulnerability that the boys don’t need the world to hold…

Some moms cross over into the abyss of online oversharing with their children’s lives (I hope I won’t but life is clearly a work in progress). This mom wrote recently about over-sharing as a blogger and how it was her own father who stepped in to “Lion Grandpa” (I’m using that as a verb) for his grandson saying “enough is enough” when the mom discussed signs of his first pubertal change online. She pivoted and retreated from her raw content online and has decided to stop writing about rearing her children. Each year I write less and less about the boys and as time has unfolded I’ve taken to asking them before sharing.

There are about 200 bajillion blog posts about the challenges of “sharenting” online and blogging about children and/or the industry of moms who leverage their parenting experience in their work. No question that when it comes to sharing publicly, everybody has their own unique fingerprint of what lines exist and what lines we won’t cross. The decade (+) of blogging has clearly connected us; stories that detail intimate narratives about life and love and passion and failure and intent really do sew us together while being alive. This may be especially true in the isolation and rigors, doubts and overwhelm, and abundant joy that comes while raising children.

So to these 20 questions — the blog post has historically, around here, been a hoot for the boys. They do LOVE to be interviewed. We’ve used the interview as a benchmark into the annual unfurling of time. We have enjoyed the pool of reflection it’s given as the boys navigate concrete responses and loyalties of colors and airplanes to the progression in dreaming about the future. No question it’s fun to think about the 2012 responses and how they compare to today’s — I mean, these little boys really are growing up. Here’s the 2013 (includes 2012 responses) & the 2015 posts.

These boys are still just as sweet and innocent when they respond to the questions (developed when they were in preschool) but their reflections seem to swell now past the margins of the question and into the souls of who they are working to become. Lucky, lucky, lucky, lucky me. May you, too, have a series of questions you ask each year that you write down. Next year I’m editing them and adjusting for age and we’ll see just what renders into shareable — who knows! Until then, enjoy the silliness…

Most Of The 20 Questions At The Start Of School

Read full post »

Reducing Back To School Stress In 12 Minutes

I find the back-to-school time period to be a little bit stressful (hellowwww, understatement) and perhaps even anxiety inducing. Even good transitions rack up stress. As we brace for the holiday weekend and expect the onslaught of school in earnest while September unfolds, I suggest we can decrease the stress with a bit of info. Here’s my 12-minute podcast to support you as you send your kids back to school and set them up for an awesome start. We’re all hoping for a healthy, safe fall. Take a listen…it won’t take long and you may find yourself a little more relaxed and ready for the chaos. Immunizations, sleep, anxiety and tips for transitions!

Tips For Getting Sleep Schedules Ready For School:

  • Timing: Shift slowly and get started now. If bedtime has migrated to 10pm, for example, and you’re hoping to have your kids sleeping by 8pm for school, start now. Move bedtime forward about 30 minutes every 3 to 4 days.
  • Screens (this isn’t new, I know): Screens, using them and exposing ourselves to the light they emit, impairs our natural sleep hormone melatonin from rising and helping our brain drift off to sleep. Have all screens, tablets, phones, and laptops transition back to sleeping in the kitchen (not at the bedside). In minimum, turn off screens at least 1 hour before desired bedtime!
  • Sleep As Health: getting sufficient sleep contributes to improved attention, safer driving, less health risks, and a more steady mood. We’re nicer when we sleep! It also contributes to how we think on life and even how we remember events; when we don’t sleep we tend to remember things in more somber light. Getting enough sleep supports a healthier life and I would suggest an even happier one. Quick reminder: school-aged children need 9 to 11 hours of sleep and teens need 8 1/2 to 9 1/2 hours. Really!


Online Easy Access To Immunization Records

The digital health world recently took a step in the right direction when it comes to supporting access to your health care information. You can now be in charge of both your own and your family’s immunizations records in several states through a tool and online resource called MyIR (think “my immunization registry”). You can register yourself and your dependents and access to your official, consolidated immunization records on any device, any time. How great is that? No more calling your doctor’s office and asking them to fax your records over. Waiting for snail mail to deliver a copy is a thing of the past. For procrastinators with school paperwork, this is for YOU! With back to school rapidly approaching, now is the time to get your children up to date on their vaccines. And a great time for you to have unfettered access to the records.

New Immunization Record Access: MyIR

  • MyIR gives you access to your official, consolidated immunization records on any device, any time
  • Records get updated immediately after any new vaccine is given
  • Can be printed to give schools, athletic clubs and day cares
  • Available in: Alaska, Arizona, Louisiana, Washington & West Virginia

Here’s How To Get Your Immunization Record:

  • Visit: and register.
  • You can register yourself and any other family members
  • Verify: click Auto Match to have the site match your account with your state records
  • If Auto Match can’t find an exact match, click State Assisted Registration and follow steps (I had to do this and it was very efficient!).

myir auto matchmyir verify

2016 Vaccine Updates In Washington State

  • Last year, 85% of WA State kindergarteners had all required immunizations. Ideally we’ll get that up closer to 95%
  • Need 2 chicken pox shots documented this year. This year, schools are requiring documentation for all children in K-12 fro varicella vaccine. Parents need to make sure the school has the record to prove children have had both doses (given typically at 1 year and 4 year well child check-ups).
  • The flu vaccine is not required for school, but is safe and essential — flu vaccine is recommended for all children over 6 months of age.
  • Nasal flu vaccine not recommended this year — only option is the poke, but it’s the best bet at protecting your children from influenza!

HPV Vaccine Reminders

  • The HPV vaccine reduces the risk of cancer from HPV for boys and girls. It also reduces the likelihood of getting genital warts and lesions after teens or young women and men becomes sexually active.
  • All teens benefit: girls & boys receive 3 doses of the HPV vaccine starting at age 11. First dose at age 11 years, a second dose 2 months later, and a third dose at least 6 months after the first dose. If you wait a bit longer, the series doesn’t have to be restarted so get in to get the booster if you haven’t finished all three shots in the series!
  • No benefit in waiting!  The vaccine is proven more effective at younger ages (age 11 tends to give a more robust immune response than when giving the vaccine in later adolescence). There is no health benefit in waiting in immunize your teens — same pain with the poke but more time a teen could be exposed to HPV.