Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Friends And Bacon

At dinner tonight we had breakfast for dinner (genius meal when you’re stumped by an unending need to create something “new”). At the end of the meal we were all discussing our love for bacon. Without a beat this came from the 6 year-old in our midst:

“Mama, could I live a long time and still have a piece of bacon everyday?”

I thought about it. Yes, it seems, yes. Yes, every day with bacon!

“Yes, I said, “I think you can have bacon but only if you exercise everyday and if you have really great friends. The kind of friends that make you feel alive.”

I launched into some sort of summary of the art of moderation with bacon, pouring out facts about fats, cholesterol, and diverse food choices – the essential need to balance bacon with things that grow in the ground. As I waxed on with a macronutrient-level discussion the 6 year-old in front of me just kept moving with his idea. Turned out he wanted concrete responses for his life with bacon. He pushed into the friendship part.

Screenshot 2015-01-22 20.20.23A long life with bacon goes something like this: of course you need to eat a lot of other goodnesses with your bacon. We can borrow wisdom from the Mediterranean diet and reduce the red meat we eat, put fish on the table twice a week, eat lots of seeds and nuts and ensure fruits and veggies show up on every plate we serve. Debates will wage on about the magic foods we eat, today it was the complexities to the value of an orange over OJ so we always have to put food advice in the context of life. I told my 6 year-old tonight he’d have to exercise every day and get outside, twirl around without a ceiling, take a lot of steps, and be connected with nature.

But perhaps most essential to living a long life (with bacon), I repeated, is solid choices with whom he chooses to live his precious life. If you’re going to eat bacon every day you have to make great friends and forge partnerships with those who make the world feel possible. In my mind you need soul-fetching friends — the ones who literally make you feel like you can fly. We have to spend time with those who let us unpeel ourselves without judgment and urge us to take risks, help us take our time, and lend support to shelter whatever we consider dear. Read full post »

Influenza Hitting Hard: OTC Medications For Symptoms

Image courtesy: http://www.cdc.gov/flu/weekly/#S5

Image courtesy: CDC

Influenza is hitting hard this year thanks to a drifted influenza strain (H3N2) causing a more serious illness and one that is not included in our annual vaccine. Because of the hard hit, public health officials are reminding us to get high-risk patients into see physicians early if they have symptoms of “the flu” or influenza infections. Reason being, those at high-risk for complications may benefit from a prescription anti-viral medicine that can lessen the burden of illness and decrease risk for complications. Over-the-counter medicines you buy don’t fight influenza.

What Is “The Flu” And What Is Influenza

In general, in healthcare we use the term “the flu” when discussing an infection with influenza, a virus that causes widespread body aches, high fever, cough/cold symptoms, headache or even leg aches. Some children vomit with influenza infections as well (incidentally many patients with lab-confirmed influenza that I’ve seen this winter have also been vomiting) although in general influenza infections are upper and lower respiratory infections, and not the “stomach flu.” We worry about influenza as it’s in the list of top ten causes of death in the US and because it can cause severe symptoms, even in children. Infants and young children are at particular risk for serious infections as their bodies and their immune systems haven’t fought off influenza before.

High risk patients: 

  • Children 2 years & younger (their immune system not as robust and not as much “memory” to fight off severe influenza infections).
  • Adults age 65 year & older (their immune system is aging and not as robust fighting off severe influenza infections).
  • People with underlying health problems (including asthma) or other lung problems, other chronic health conditions (like diabetes, heart disease).
  • Pregnant moms or newly postpartum moms.
  • Those people immunosuppressed.

The Numbers So Far

According to the CDC, widespread influenza activity is being reported in 46 states. The most common strain is that drifted virus H3N2, accounting for over 90% of the more than 5,000 reported influenza-positive tests recorded last week (ending January 10). It’s still too soon to tell whether we’ve reached the peak of flu season, however there are early signs that the virus is lessening in parts of the country. So far, this year the influenza vaccine is estimated to be about 23% effective, clearly not as effective as usual but still providing some protection.

What Over-The-Counter Medicines Can Help With Influenza?

It’s important to remember that over-the-counter (OTC) medications cannot cure “the flu” nor shorten your suffering with symptoms. They’re designed simply to help you get through the illness and should be taken within the proper guidelines. In general children under 4 should not be given OTC cough and cold medicines. 

That being said, there are four types of medications that can make getting through the flu a little more bearable. Read full post »

Sleeping With A Smartphone

460297347Turns out small screens in the bedroom may be worse for sleep than a TV. Little screens enter the room without much effort, stealing away in a pocket or backpack without notice; smartphones also grab our attention in novel ways. The light emanating from small screens is really close to our face (potentially interfering with that lovely melatonin spike before bed in ways a TV across the room cannot) and small screens are often interactive, requiring us respond or type back, provoking alertness. The first study evaluating effects of smartphones and tablets on sleep in US children is out. While the news isn’t surprising it isn’t good either.

We may be raising a really tired generation of children.

I’ve been chatting for years about trying to keep TVs out of childrens’ bedrooms. Simply put, television adds little to a child’s life when viewed right before bed. In fact ,Seattle Children’s experts Dr Michelle Garrison and Dr Dimitri Christakis have shown consuming television just before bed can cause children to have more trouble falling asleep, more nightmares, and more awakenings during the night [here’s more info–> why no TV before bed is better]. Recently though, we learned what we all likely suspected: interactive, small screens may be even worse for a child’s sleep than the TV. Tablets, TVs, iPads, and smartphones are for most adults and kids a normal part of everyday life, even during infancy and toddlerhood. 2013 Common Sense Media data finds 45% of 5 to 8 year-olds have a TV in their bedroom and 72% of children from birth to 8 report using mobile devices during the day.

A study out this past week in Pediatrics shows small screens in the bedroom have a troubling effect on children’s sleep. Read full post »

Forgive Yourself In Advance

Our children will never be the sole judge of our job as parents of course. We are likely our own closest and most fastidious critic. And really it’s just us (and our partners) that can truthfully reflect and evaluate how it goes as we raise our children — what our hopes were when we started on the journey of raising another and where we find ourselves. And so, however radiant the peaks and successes seem, the anxiety of our choices in this high-stakes job will likely dominate. The angst with how this all goes as our children mature ties our feet together at times, and can feel a little like stuffing big rocks into our pocket as we jump off the dock into the lakes of our lives. We’re hard on ourselves. Sometimes this is good and motivating, centering or stabilizing, and at times it can even be useful when sorting priorities. But sometimes, it’s simply unkind. Some of the best advice I was given after my boys were born was this: Read full post »

Pre-Vacation Tanning?

This girl in a tanning bed should provoke the same response in you that a photo of a 5 year-old smoking a cigarette would.

This girl in a tanning bed should provoke the same response in you that a photo of a 5 year-old smoking a cigarette would.

More than a million people go indoor tanning every day and research says the average city has more tanning salons than they do Starbucks or McDonalds (I’m wondering about Seattle though since coffee shops truly dot every block). I’m also guessing the tanning industry is somewhat seasonal; if we did the research on which week people go tanning, we’d find a bump during winter break, yes?

The pre-vacation tan is often used as a handy excuse for hitting the indoor tanning salon this time of year. There’s no such thing as a “safe” tan since tanning is a reflection of damage to the skin cells — a tan is the body’s response to damaged DNA in the skin cells. However, vacationers (lucky you!) often feel that getting a tan before they go to the equator will protect them. Instinct here is wrong.

Data finds that those who indoor tan before their trip are careless while on the trip, thinking they are protected, and in the end have more sun exposure and ultimately more sunburn than those who don’t.

People may visit a tanning salon to prepare the skin for a sunny vacation, the “prevacation tan”, thinking that a “base tan” will protect against subsequent skin damage during the vacation. This leads to extra radiation before the vacation and also afterward, because people may use fewer sun-protection precautions during the vacation because of a mistaken belief that the tan will protect them. The “prevacation tan” results in minimal protection (an estimated SPF of 3) and provides virtually no protection against sun induced DNA damage. ~ Pediatrics, April 2013

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Winter Skin And Itches That Rash

OTC-Dry-Skin-Infographic_FinalLiving in the northwest it’s easy to forget the sun exists during the winter. Most days are dim, usually drizzly and almost always cloud-covered. It’s easy to remember to take care of your skin when your arms and legs are playing in the warm rays of the sun but when you’re bundled under scarves and rainwear, our self-care falters. We care for our children’s skin often better than our own. Winter brings a slew of skin harms with it. Giving your skin the TLC it needs during these dark months will keep it healthy (and looking great) once it’s time again for spring exposure.

Dry Skin And “The Itch That Rashes”

Our skin gets dry in the winter for a variety of reasons. Cold temperatures, lack of humidity and recirculated air (hello office heater!) can all contribute to dry, scaly spots. Winter is also a time when we see an increased risk for eczema flare-ups, a chronic, relapsing condition that brings incredibly dry, itchy patches of skin. The icing on the cake is that eczema primarily affects kids! A recent study suggests at least 10% of children in the US suffer from eczema, the “rash that itches.” A patch gets started, a child can’t help but itch it and the rash blooms. Between 2000 & 2010 pediatric cases of eczema came close to doubling and while this condition not only affects how skin looks and feels, it can have a direct impact on a child’s quality of life. Nearly half of kids with eczema report a severely negative impact on their quality of life, including sleep deprivation (from the itching), activity restriction and even depression. If your child suffers from eczema, talk to your pediatrician to create an action plan for combating these dry months and hopefully avoiding such severe tolls and trolls on everyday life.

Protecting Your Skin Year Round

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What To Know About Baby Teeth

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Things have changed over the past couple of years regarding how to care for baby teeth. Official recommendations for fluoridated toothpaste begin with the very first sighting of the very first tooth. This is news to many.

What we do early in our child’s life can have lasting consequences. Some quick reminders for new parents, grandparents and anyone out there lucky enough to be hanging out with an infant. Keep their mouth delicious!

5 Things Every Parent Needs To Know About Baby Teeth

  1. Use fluoridated toothpaste at tooth eruption. The minute those baby teeth come in consider it the start of the lifelong brushing habit for your baby. Brushing and rinsing the teeth after breastfeeding or formula, solid meals or snacks will always be recommended.  In minimum, build brushing into everyday, ideally morning and night, with a tiny amount of fluoridated child toothpaste (see image above). This may be most important after the last evening feeding.
  2. Tap water! Brush with tap water twice a day and provide tap water for your infants and children when serving water. After you brush teeth DON’T RINSE with water. Let the tiny amount of fluoride from the brushing sit on the teeth as long as possible to prevent decay.
  3. Use the right amount of toothpaste (image above). This provides protection from bacteria and acid but also avoids concern for too much toothpaste.
    1. < 3 years of age – rice sized smear of toothpaste on the brush.
    2. > 3 years (including adults) pea sized amount of toothpaste is all you need on your brush once you know how to spit.
    3. Don’t rinse after brushing.
  4. Timing: Most infants and toddlers, preschoolers and young children can brush their teeth and tongue in about 1 minute — goal really is to brush at the gumline on all sides of each tooth, paying special attention to back teeth, molars, and lower teeth where bacteria love to reside. For older children, teens and adults the rule of thumb is typically 2 minutes of brush time to brush teeth, tongue and rid mouth of dragon breath!
  5. Bacteria: Baby teeth enamel is thinner than adult (secondary) teeth so the mix of sugar and bacteria in the mouth must be deterred. We unfortunately transfer oral bacteria to babies when we share utensils, kiss them, clean their pacifiers with our mouths (don’t do it!), and drink from shared cups. If you have a history of lots of cavities the American Academy of Pediatrics’ new policy says, “Parents/caregivers, especially those with significant history of dental decay, should be cautioned to avoid sharing with their child items that have been in their own mouths.” I’m all for smooching babies so I say this: get to the dentist yourself to make sure your mouth is in tip-top shape to avoid some bad transfers…

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E-Cigarette Use Up, One Dead In New York

WAPC e cigaretteE-cigarette use is growing among teenagers. Vaping is on the rise among high-school students in particular, with rates increasing steadily each year. I still think of e-cigs as the gateway to the gateway drug. In my experience, teens remain confused. They hear about health benefits (harm reduction) in adults and they may think that confers safety. In addition, some teens have reported to me they have heard it will improve their sports and school performance.

Nope. No data to show e-cigs are good for anything in teens, in fact we know nicotine increases HR and BP which in the end could decrease sport skills. Just a teaspoon of liquid nicotine can be lethal to a young child and we know nicotine can have lasting adverse consequences on teen brain development. Becoming addicted to nicotine (the big worry with teen use) could have secondary health effects leading athletes to cigarettes which we know won’t improve their talent on the field.

Rates of e-cig use rose from 4.7% in 2011 to 10% in 2012, now a recent Pediatrics study of 1900 high-schoolers in Hawaii shows 29% have tried e-cigarettes. Only 15% of the same group reported trying a cigarette. These e-cigs are getting around.

It’s not just use among teenagers that’s cause for concern. Young children living with or near nicotine may be at highest risk from e-cigs due to their curiosity and lagging judgment and ultimate exposure. The first child death related to exposure of liquid nicotine was reported last week. A child in NY has died from exposure to liquid nicotine after officials have been warning of the risks from sales lacking regulation. The risks are being felt everywhere as the rates of calls to poison control rose from 1 report in September of 2010 to 215 calls in February of 2014.  This NY death represents an enormous tragedy for this family but also for our ability to prioritize safety over sales. We can’t forget that the flavored nicotine used in e-cigs appeals to many senses in a toddler exploring their environment. Dr Alexander Garrard, Clinical Managing Director of the Washington Poison Center said, “The products smell very sweet, akin to a jolly rancher so they’re enticing to a number of different senses in kids. The packaging is very colorful as well.” All these things draw a child to experiment and possibly ingest.

Protecting children from this toxin, I would say, is a true failure of pediatric public health.

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Speaking Up At School

CS Mott graphicIs it partly our responsibility, as parents, to ensure our kids are in an immunized, safe environment? Maybe so.

Unsurprisingly, most parents want to make sure their children attend a school or daycare with children up-to-date on immunizations. This week is National Influenza Vaccination Week and provides a hearty reminder. Established by the CDC in 2005, it began as a way to raise vaccination rates during the month of December. Vaccinations historically tend to drop at the end of November (we get busy, we don’t go to the doctor), but this is only the beginning of flu season and it’s not too late to get yourself and your family protected. Influenza peaks in February and March so December is still a great time to get immunized for anything, including flu.

Although many daycare facilities are mandated to check immunization status at entry, not all keep up on the records as children age. New data finds many preschoolers are late to get their shot leaving about 1/4 of them in daycare/preschool not fully protected at any given time.

In a scenario where 1 in 4 children in their daycare center were not up-to-date with vaccinations, 74% of parents would consider removing their own children from that childcare center; another 11% would consider removal of their children only if an outbreak occurred.  ~National Poll on Children’s Health

Enter parent-to-parent healthcare… Read full post »

H3N2 And An Update on Flu

Lots of information floating around this past week about influenza. Of anything, remember this: it’s easiest to predict that influenza can be unpredictable and it’s also still true that a flu shot is the best way to protect your family from flu. I’ll explain why, along with a recap of what you should know about new data, here.

Flu season is just getting started in the United States (circulating infections in nearly all states) and this past week the CDC announced new information about a strain of Influenza A, H3N2. This is exactly what the CDC is supposed to do: keep us informed and help us prepare for an influenza season. This year the information standing out is risks surrounding the strain of H3N2 that has “drifted” and the reality that when H3N2 is the most common strain of flu going around it tends to cause more serious infections.
Did you know? Every year an estimated 20,000 children younger than 5 years old are hospitalized for flu complications. Like pneumonia. Everyone in your family who is 6 months and older should get a flu vaccine. This year, Next year, Every year. #getafluvax

When Influenza Virus “Drifts”

  • Vaccines for each year’s flu are formulated months in advance to allow time for vaccine manufacturing and distribution.
    • 100 centers around the world provide influenza surveillance and predict which strains will circulate to the US and North America. Decisions are made in February each year for the next year’s vaccine. Researchers look at trends to determine which viruses may be more prevalent.
    • The vaccine protects against three (trivalent vaccine) or four flu viruses (quadrivalent vaccine), based on the world’s predictions. Typically each flu vaccine has at least two strains of Influenza A and one or two strains of Influenza B. Of anything that is consistent it’s that flu seasons are unpredictable.
  • H3N2 is one strain of Influenza A in this year’s vaccine. The “drifted” vaccine is just another form of H3N2 that has different characteristics.
    • Flu viruses often “drift,” this happens every few years. The drifted H3N2 virus is one specific type selected for the 2015 southern hemisphere influenza vaccine (point being: this isn’t an unknown virus, it was just unknown how much it would spread in the US).

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