Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Cry-It-Out Improves Sleep And Reduces Mom Stress

Parents debating sleep training can rest (literally and figuratively) easy. New data out today in Pediatrics found that letting babies cry-it-out (CIO) or self-soothe does not increase signs of stress compared with babies who don’t. The study out of Australia tested two sleep training methods: “graduated extinction” (parents leave and return at increasing intervals of time, AKA one version of CIO) and “bedtime fading” where parents shifted bedtimes based on how long it took babies and young toddlers to fall asleep. The groups of babies and their moms were compared to those in a control group of babies and moms/dads who received only sleep education. The group in total was small, some 43 infants spanning 6 months to 16 months randomized into the three groups. I was fortunate to be able to discuss the study and what it means for parents on The TODAY Show this morning. In addition, I chatted about the study design, findings, and implications with Dr. Maida Chen, the Director of the Seattle Children’s Sleep Center. We were both excited as the study evaluated baby’s sleep, tracked their sleep with actigraphs (movement monitors), evaluated sleep by parental sleep diaries, measured morning and afternoon cortisol levels (a stress hormone) and tracked time to fall asleep, number of nighttime awakenings, total sleep time, mom’s stress, mom’s mood and long-term bonding. Even though the study may have some limitations (very small sample size and parents self-selected to the study with sleep concerns therefore it may be non-representative of parents at large who AREN’T worried about sleep) the randomization to the three groups and the measures studied boost the exciting results.

6 Take-Aways From The Baby Sleep Study

  1. No matter the sleep training method, moms reported feeling less stressed. Huge win! Moms showed significant reduction in stress in the two groups who used sleep training compared with the control group of moms.
  2. Babies allowed to CIO showed no more signs of stress (cortisol levels — a stress hormone– measured in the morning and afternoon) than babies who were sleep-trained via other two methods.
  3. The CIO method (graduated extinction) proved better in reducing the number of times the infants woke during the night, as well as the amount of time they spent awake during the night. Babies in the study who were allowed to CIO slept roughly 20 more minutes at night.
  4. The method known as “bedtime fading” means putting your infant to bed a little later each night (if infants took longer than 30 minutes to fall asleep) in the hopes that they will fall asleep quicker if more tired. Bedtime fading proved to help babies fall asleep quicker, but did not show as many benefits as CIO in regards to awakenings at night and total sleep time. Tip: can use different techniques to help with different challenges.
  5. No matter the sleep training method, there were no differences in behavioral issues and/or bonding with mom. In addition, no matter the sleep method or education control group, there were no differences in mom’s overall mood.
  6. All babies, over time, improved their sleep reflective developmental progress. In addition, babies were found to awaken at times (on actigraphs, the baby movement trackers) and not cry out for help. Researchers interpreted this as successful self-soothing.

The Bottom Line: Babies who are sleep trained tend to sleep better — those given a chance to self-soothe . There are a variety of methods in the sleep training toolkit, allow yourself some time to research the options and select one that matches your family’s style and values. You can even try combining different methods.

Mama Doc Tips For Considering Sleep Training And Cry-It-Out

  • The study out today finds that babies may be no more stressed if using techniques that rely on crying-it-out versus some more gentle bedtime shifts or in the control group. Letting your baby learn to self-soothe does decrease night awakenings and increases sleep. It also reduces a mom’s stress! WIN-WIN.
  • Consistency from night to night is key. Your consistency with the sleep routine is far more important than what method you choose to help get your baby to sleep. The ritual at bedtime (reading, bath, rocking, etc) is one of the most important daily activities you establish for your child from day 1 (or day 30). Choose a method that matches your philosophies.
  • Letting your baby learn to fall asleep all on her own at 1 to 2 months of age will serve you and your child again and again. Try this at naptime or bedtime. Put your babies to sleep on their backs in a bare crib while still awake but drowsy. They will learn how to drift off without you! Research shows that infants and children who are allowed to learn to self-soothe and get themselves to sleep will often be far better sleepers, even as adults.
  • If you’re concerned about your baby’s sleep challenges, talk directly with their doc. Research found that 1 in 10 children under age 3 has a sleep challenge, and often sleep trouble persists from infancy to toddlerhood.
  • Sleep needs to be a priority (for us all). Making sacrifices to have consistent bedtimes from early infancy that support routine bedtimes and sleep routines will always be worth it. For you and your child.
  • After your baby is 4 months of age consider letting them self-soothe and get themselves back to sleep after they awaken. Although babies will often wake up 5-10 times nightly, they won’t always need you to fall back asleep. Babies need practice learning how to get themselves to sleep on their own.
  • Swaddling can be a great way to soothe babies. It’s okay to swaddle infants and put them on their back to sleep in early infancy but it’s not recommended to START swaddling a baby older than 4 months. And it’s good to be out of swaddles once a baby shows signs they are able to roll around 3-5 months. (more info in this recent blog post on new data that swaddling babies on side or tummy increases SIDS rates)
  • 10 reasons babies wake up at night

All Dogs Bite

Baby and DogTo the owner of the two black poodles who bit my husband last Saturday early morning while running at Magnuson park, this is for you. But also for all of us as a reminder to something I know both from the medical data and from life experience too well: all dogs bite. Even when an owner assures you they don’t or won’t.

For many, having a dog isn’t just having a pet, they are clearly part of our families. We invest, we believe, we protect, and we stand behind them. I’ve written about the love my family has for our sweet dog Luna who passed away a year ago this month. Many of us love our dogs for many reasons, and they even have been shown to boost humans’ health in psychosocial but also fundamental ways. A study published in JAMA Pediatrics back in 2015 found that exposure to dogs during a baby’s first year was linked to a 13% lower risk of asthma in school age children. Having a dog also helps teach children responsibility and can boost their self-esteem. But we do have to remember, dogs are animals and they act like it when provoked, frightened or activated. All dogs will bite given the right circumstance. Coincidental to a dog bite in my family, this week is National Dog Bite Prevention Week and I’m sharing some tips from the American Academy of Pediatrics (AAP) for keeping your family and children safe from dog bites.

Each year, more than 4.5 million people in the U.S. are bitten by dogs, and of the 800,000 Americans who receive medical attention for dog bites, at least half are children. Almost 1 in 5 people bitten by dogs require medical attention. Children are, by far, the most common victims of dog bites and are far more likely to be severely injured. Most dog bites affecting young children occur during everyday activities and while interacting with familiar dogs. Remember, as most dog bites involve familiar animals, prevention starts in your home.

Some species of dogs are more likely to bite unprovoked or when startled (Pit Bulls, Rotweillers, German Shepards, Huskies, etc). But this post really is intended to remind us that even when a sweet lamb-like doggy of ANY breed gets frightened or provoked by an unsuspecting human, toddler or child, they may bite without even THINKING of it. Some of this is just animal instinct.

7 Ways To Help Prevent Dog Bites:

Read full post »

Moms, Benefit of Part-time Work, And Breastfeeding

pumpingA new study out confirms something that almost every working mom and dad already suspected — it can be a challenge to maintain breastfeeding goals when you return to work after only a few months with your newborn, especially when asked to return to working full time. The study out this week found that moms who worked about 1/2 time (19 hours or less) were able to continue breastfeeding similarly to those women who didn’t work.

Logical: the more hours a new mom works, the tougher it is for her to continue breast feeding. The amount of time we work may be more influential than the timing of our return to work. In this study, conducted in Australia, women who worked 19 or less hours in a week were much more likely to maintain breast feeding until their baby turned 6 months old, compared to moms who had returned to full-time employment. Additionally, women who work 19 hours or less only faced a 10% chance that they quit breast feeding altogether by the time their baby turned 6 months old. Your level of work place seniority will also affect your ability to continue breast feeding at 6 months, meaning those in managerial-type roles will have more success. Other factors that made it easier? Unsurprising it’s being older, higher education, better physical and mental health and being self-employed.

If we want moms to be successful with the recommended breastfeeding guidelines through infancy we should think on how we prime them for success. And how we support them.

It’s inconvenient but potentially important to acknowledge that it’s simply harder for moms to go back to the workforce, especially those who breastfeed, than it is for dads to newborns. In the first few months of life, the time it takes to nurse a baby is equivalent to a 8-9 hour work day for most women. Most babies will drain a breast in about 12-15 minutes if they are eager and actively feeding but babies often stay on the breast for up to 20 minutes or even 30 minutes at a time. Therefore, if you sit down, feed your baby on the right, feed you baby on the left, burp the baby and then change the inevitable diaper:  poof, one hour.  And, most newborns feed up to 8-10 times daily. 1+1+1+1+1+1+1+1+1. Math is easy when you do it this way.  Breastfeeding alone is a full time job for the first few months. The time spent with a baby nursing diminishes as the months unfold but it can still be a significant number of hours spent every day.

The take home for me here is that we may be more successful, culturally, supporting moms to return to work during the 1st 6 months after a baby is born if we give them options for part-time work. Especially if breastfeeding past 6 months is a goal. Read full post »

Swaddling On Side And Tummy May Increase Risk Of SIDS

SwaddleBoth of my babies loved to be swaddled. It helped them calm down and I always experienced them happier and easier to console while snuggled & bundled. My experience isn’t unusual. Research in the past has found that swaddling rates are increasing and it can help newborns with sleep awakenings while also creating a slight reduction in crying in babies under 2 months, and may help babies have more quiet sleep. So the new study out today in Pediatrics evaluating the relationship between swaddling and Sudden Infant Death Syndrome (SIDS) therefore caught my attention. The study pooled research and data from 4 previously published studies to look at risk for babies who are swaddled. Although the data and findings in this new study don’t prove relationships, it does evaluate risks for babies who are swaddled versus risks for babies who were not.

Pediatrics Study Finds Swaddling On Side And Stomach Increases SIDS Risk 

  • Meta-analysis of 4 studies looking at relationship of swaddling with SIDS risk that spans data from babies in 2 decades and 3 diverse areas of the world: United Kingdom, Australia, and United States (Chicago).
  • Conclusion: Current pediatric advice to avoid tummy and side positions for sleep especially applies to infants who are swaddled.
  • Swaddling risk increased with age in infants. Infants who were swaddled over the age of 6 months had a double increased risk of SIDS.
  • Swaddling risk varied with position of sleeping. The risk was highest for babies swaddled and put on their tummy while also higher for babies put on their side and then those swaddled and put on their back compared with babies not swaddled.

Read full post »

Frozen Food Recall Because of Possible Listeria

frozen vegetablesBig recall, worth a glance from a frozen food company out of my home state of Washington. The Food & Drug Administration (FDA) issued a recall of 42 brands that sell frozen fruits and vegetables. It’s a BIG list of products that could be in your freezer if you shop at places like Costco, Trader Joe’s or Walmart. This is especially true if you’re pregnant, are immunocompromised or have young children. The possible contamination in these frozen foods is a bacteria called Listeria that can cause more significant illness in those groups. The recall includes over 350 products, both organic and non-organic, which are sold between these 42 brands. The Centers for Disease Control (CDC) notified the company that 7 people from 3 states have become ill and were hospitalized due to listeria, likely stemming from the consumption of contaminated frozen fruits and vegetables.

The FDA has a complete list of brands and products that are being recalled. Note that this recall affects all 50 states. All affected products have the best by dates or sell by dates between April 26, 2016 and April 26, 2018.

The bottom line: check your freezer for frozen fruits and veggies and then check the FDA’s list!  Throw out frozen fruits and vegetables if they are on the list. You can go back to the store where you purchased them and ask for a refund. Keeping them in your freezer is certainly not worth the risk of a Listeria infection. Children who ate contaminated foods and have normal immune systems are not at high risk of listeriosis, and no special testing is needed. Also, foods eaten more than 2 weeks ago are not worrisome, as the incubation period is 1-14 days.

What Is Listeria?

  • Listeria is a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes.
  • Common symptoms include fever and muscle aches, sometimes preceded by diarrhea or other gastrointestinal symptoms (vomiting). Most of us do okay after getting listeria and heal up without intervention but some people can have bigger risks (see below).

Who Is At High Risk:

Read full post »

How About An Old Fashioned Family Meal

kid phone dinnerCompartmentalization is obviously a huge challenge for all of us, if we admit it or not. But clearly we have to have limits in our days — mealtime is one place that can be a non-negotiable, device-free space. Meals are gold for families. Breakfast, lunch or dinner…whenever your family is able to come together to eat and connect…the devices gotta go. Even toy companies are partnering with restaurants to help keep families engaged with one another. Here in Seattle this week a company called Fort Boards is providing families a $25 gift card for staying off their phone during a meal at a local restaurant (Phinney Market Pub & Eatery). Kind of nuts that you can get a coupon for toys just for putting the device away! But the gimmick and point is well-taken. While incentivizing our children every meal certainly isn’t sustainable, this is a great attempt to start fresh make a plan to stay off devices during meal time. Clearly it’s not just children who need support staying off phones/devices while eating, we do too.

A study from Boston Medical Center a couple years back comes to mind as it reveals that parents who are distracted on their phones with email, games, apps and texting have more negative interactions with their children & also may make their children feel like they’re competing for attention with these phones. We just aren’t the parents we want to be when failing at compartmentalization (I know this TOO well from experience). I like this TIME recap of the study and this quote from the author Dr. Jenny Radesky: Read full post »

Spring Cleaning: How To Dispose Old Medicines

PharmacySpring has sprung and many of us are feeling that familiar itch to tidy and purge our homes & closets. One more chore to add to the spring cleaning list: clean out your household supply of over-the-counter (OTC) medicines.

Just like the dosing instructions and additional information on the label, the expiration date on the packaging is there for reason. Once a medicine has reached its expiration date, it may not provide the treatment that you need. Smart to refresh the cabinet annually. Now is the time and this weekend, ideal!

To ensure the medicines you take are both safe and effective, keep an eye on the expiration dates and safely dispose of any expired or unwanted medicines. I talked with my friend and colleague, Dr. Suzan Mazor who is an expert in toxicology and emergency medicine about expiration dates and here’s what she had to say:

Drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.”

Traditionally, I counsel families to be really careful with life-saving medicines. Injected epinephrine (for life-threatening allergies) is a perfect example — after expiration it’s less effective. So it’s a MUST to replace those injectors at home and school after expiration as they are used in acute/urgent/life-saving situations (and I’m not exaggerating). Other products like sunscreen are less effective after expiration, too. Not life-threatening but what chore to use it wisely and well and then be using an inferior product. Read full post »

Tips On Avoiding Arsenic In Baby Rice Cereal

rice cerealWhat we feed our babies matters. No question one delightful and soulful part of raising our babies is introducing the world of solid food. I mean really, it’s hard to describe a competing parenting moment with feeding our children healthy food, at any age. For decades, rice cereal as a first food seemed to make sense but major groups reporting out on only feeding rice with caution. The Food and Drug Administration (FDA) recently proposed new limits for inorganic arsenic in rice cereals (think: potentially cancer causing toxin that is increasingly known to cause harm early in life). Many families start their transition from breastmilk/formula to solid foods by adding in rice cereal. Doing so is convenient, makes for great consistency, but rice cereal is a leading source of exposure to the toxin. Arsenic is an abundant element in the earth’s crust, coming in two forms (organic, inorganic), the inorganic form being tied to bad health outcomes. The reason rice has more arsenic compared with other foods is how rice is grown (in watery fields) and its unique tendency as a crop to absorb the arsenic while growing. Here’s what the World Health Organization (WHO) says about inorganic arsenic:

  • Arsenic is naturally present at high levels in the groundwater of a number of countries.
  • Arsenic is highly toxic in its inorganic form.
  • Contaminated water used for drinking, food preparation and irrigation of food crops poses the greatest threat to public health from arsenic.
  • Long-term exposure to arsenic from drinking-water and food can cause cancer and skin lesions. It has also been associated with developmental effects, cardiovascular disease, neurotoxicity and diabetes.
  • The most important action in affected communities is the prevention of further exposure to arsenic by provision of a safe water supply.

Why are infants particularly vulnerable to arsenic in rice? The FDA says: “relative to body weight, rice intake for infants is about three times greater than for adults.” In their evaluation, they tested 76 different rice cereals and found that 1/2 exceeded the inorganic arsenic limit. Some companies and products are advertising for safety — for example Gerber rice cereal manufacturers announced that their products already meet the FDA’s proposed limits but it will be with time that the food source is changed for good in all products packaged and marketed for babies.

Knowledge about what exactly rice cereal does to babies and their developing bodies continues to unfold but infancy is a time of profound growth and development. Also a time we really want to limit toxins that could change risks. Researchers in JAMA Pediatrics explain: Read full post »

Join In On The Seattle Mama Doc Podcast?

Always a work in progress here — trying to think on ways to share new data, expert advice & enjoy the journey of parenthood. I’m excited to announce we’re going to pilot a Seattle Mama Doc Podcast early next month. Since this blog’s inception in 2009 we’ve covered nearly 650 standard blog posts, vlogs, guest contributors, interviews and now I’m going to test out a podcast. I am a huge fan of crowd sourcing and co-design, so will you help create the look, feel and content of the podcast alongside me? I would love to know what topics you’re interested in, which you’re tired of hearing about, who you want me to interview and frankly, anything else you’d like to share.

My hope is to interview experts and researchers here at Children’s, parents, and patients when there’s interest in sharing the experience of raising children. We’ll include the smarts of friends and peers across the country working on preventing and preventing illness while raising children. We’ll highlight all the tips and tools we learn along the way, new evidence, expert opinion and ideas to feel better about our decisions while raising our children.

I’ve recorded 3 options for the introduction of my podcast (I’m well aware of kind of bootleg smartphone audio quality for these little demos — promise to record high quality content in studio for the actual podcast).

Which resonates and makes you want to tune in?

Tell me what to cover. And also, would you want to join me on the podcast? SAY SO, PLEASE!

Option #1

 

Option #2

 

Option #3

 

Take Me Out To The (Peanut-Controlled) Ball Game!

ThinkstockPhotos-508446509Having food allergies (specifically to peanuts) might prevent you and your family from attending certain events, but baseball in Seattle hopefully won’t be one of them. The Seattle Mariners are offering 5 “peanut-controlled” games this season at Safeco Field. No peanuts will be allowed in sections 313, 314 and 315 in the view box level during these games. And although fans should note that peanut-controlled does not mean the game will be entirely peanut-free, this does offer a new way to improve safety for children with serious allergies. The Mariners certainly deserve an “Atta Boy!” for this one. (More game information below).

While peanut allergies have doubled in the past decades and are reported to have tripled between 1997 and 2008, they are just one food allergy of the nearly 400,000 school-aged children who suffer from mild to severe reactions if exposed to an allergen. Some food allergies are serious and life-threatening.

One in every 13 children has a food allergy so this isn’t a rare experience for children or their families. How we support our own children and children in the environment, at school, in sports, and at our homes is also changing. We really are perhaps becoming more compassionate and sophisticated (peanut-free tables, thoughtful policies for birthday treats, more open discussions about how best to include children with dietary restrictions). The Mariners games are just a lovely example of how to do things better at scale.

When To Introduce Peanuts To Babies?

Data is still evolving for recommendations for all babies, but about a year ago (March, 2015), new recommendations (comprehensive blog post) were given regarding introducing certain foods to babies. The New England Journal of Medicine found if allergy-prone infants were introduced to peanuts early in life (between 4 and 11 months of age) their risk of peanut allergy at age 5 years significantly decreased. The current American Academy of Pediatrics policy on food allergy introduction (revised in 2008) states there is insufficient evidence to support delayed introduction of potential food allergens to reduce the risk of developing allergies. This means holding back on foods during infancy isn’t recommended! Try introducing things like wheat, egg, soy & fish before 12 months. We’re moving towards not waiting on any foods in late infancy and this data on peanuts is the beginning of understanding creating recommendations to start foods early. More data will help make these recommendations for all babies. Check in with your baby’s doctor with any questions or concerns, especially if food allergies run in the family. Read full post »