Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Alternating Acetaminophen And Ibuprofen For Fever

Lessening a fever in your baby or child, with multiple medicines, can be tricky. And it may not always be necessary. Many pediatricians urge avoiding “fever phobia” and allowing a fever to stick around, especially if your child is acting well. See this recent piece, “The Case For Letting Fevers Run Their Course,” by Dr. Paul Offit, an infectious disease expert on this take, the data behind it, and why fevers can sometimes help children fight infection.

Lots of families consider alternating medications like acetaminophen and ibuprofen at home to treat pain and fever, but I’m unconvinced that this leads to better outcomes for kids and/or improved fever control. It’s not my recommendation that you try alternating medications, and this post is not here to endorse this approach, rather if you choose to, I’m hopeful that this will help you do it more safely.

It’s important to note that the dosing amount for one medicine AND the duration of time between doses for medicines can be different from one medicine to another. So it can get confusing, FAST. However, armed with a plan, alternating medicines can be a good way to feel in control of supporting your child with medicines that relieve fever, improving your child’s behavior and comfort.

First….and I know I said this but I gotta say it again: it’s not necessary to treat every fever. And it’s certainly not ideal to treat the numbers on the thermometer. What always matters most is how your child looks to you and how they appear. Fever is a natural response of the immune system — it’s a response to illness, not illness itself. Fever ultimately can be productive and may assist your child’s body in fighting off infection. There may be no reason to make a fever disappear if your child is otherwise acting well, playful, and staying hydrated.

Second…there are some fevers that do require a visit with the pediatricians. It’s important to seek care when fever persists after 3 days in infants and children, any fever in a baby 3 month old or less, and if fever is over 104 degrees it’s wise to get support. Talk to your doctor before giving a pain reliever or fever reducer containing ibuprofen if your baby is younger than 6 months. Talk to your doctor before giving acetaminophen to a child younger than 2 years to obtain the proper dosing instructions, or see charts below.
Before giving your child any medicines, make sure you know your child’s weight. Dosing is always based on a child’s weight, not age.

Last… trust your instincts! If your child looks unwell in the face of fever and doesn’t seem to be improving as you would expect, call your pediatrician for help! If the fever is unexpected in a way, consider calling in to get support and education.

Ok…now that we’ve got all that out of the way, here is one way you can alternate between medicines (acetaminophen and ibuprofen) every 3-4 hours:

Alternating Acetaminophen And Ibuprofen For Fever

  1. Check you have proper doses for both acetaminophen and ibuprofen for your child knowing the doses may be different.
  2. Make sure you have the proper dosing device (syringe, usually) for each medicine.
  3. Start with one medicine and then always offer the other medicine next, and so on.
  4. Offer a new, alternate med every 3 to 4 hours.

For example, if you give your child acetaminophen at noon, you can give them ibuprofen at 3 PM and then acetaminophen again at 6 PM and ibuprofen again at 9 PM. A safe reminder, neither medicine should be used for more than 72 hours without consulting a physician. If you get uncomfortable with the way your child appears during the time of fever don’t EVER hesitate to reach out to the pediatrician or nurse for support.

Additionally, here are the Seattle Children’s Hospital dosing charts for both acetaminophen and ibuprofen. Take a peek. If any concerns or confusion when dosing any medicine — or even if you chose to alternate medicines — reach out to your child’s pediatric team for help!

5-13 know your OTCs

This post was written in partnership with KnowYourOTCs.org. In exchange for our ongoing partnership helping families understand how to use OTC (over-the-counter) meds safely they have made a contribution to Digital Health at Seattle Children’s for our work in innovation. I adore the OTC Safety tagline, “Treat yourself and your family with care all year long.” Follow @KnowYourOTCs # KnowYourOTCs for more info on health and wellness.

After The Vegas Shooting: What To Do Now And How To Talk To Children About Firearms

In the wake of the recent Las Vegas shooting, I went on the Seattle NBC affiliate, KING5 News, to discuss how to talk to your children about guns and violence. Frankly, it’s not the first time I’ve covered this topic and as horrifying as it is, it probably won’t be last. I’m upset and sad that these shootings are becoming a part of American culture and I’m committed to doing my best to learn and translate what the experts advise us to do to decrease deaths from firearms.

I have lost people I love dearly to firearms so like so many of you, this is personal.

No question that we can feel helpless after horrific events. Focus on what you can do and share that with your children. If there is a gun in your home, keep it locked, unloaded & separate from ammunition. Remember that exposure to violent media and violent video games will change your child’s relationship with firearms – the “weapon effect” is real – so think carefully about what video and media your children use. Common Sense Media is a great site to help you sort out your choices.

Guns And Violent Media – A Toxic Mix With An Available Antidote. <— read this, it’s amazing. Basically the gist: violent media changes what children think of and may do with firearms and firearm safe storage reduces firearm suicide and accidental shootings by 75%. Seventy-five percent reduction of suicide deaths and accidents from firearms just with storage. Talk about it, do it.

As individuals we obviously can’t prevent mass shootings by what we do in our homes today, but we can communicate openly and honestly in age-appropriate ways with our children, we can build a safer culture with our firearms in America, we can vote, and we can remind children all of the things we do to increase safety in their lives. We can make sure that those around us know how much we want to keep firearms out of children’s hands, too. This will help.

Since 1970, more Americans have died from guns (including suicides, murders and accidents) than the sum total of all the Americans who died in all the wars in American history, back to the American Revolution. Every day, some 92 Americans die from guns, and American kids are 14 times as likely to die from guns as children in other developed countries, according to David Hemenway of Harvard. ~Nicholas Kristof NYT Op Ed

How To Talk To Your Children About Violence:

Early elementary

  • They don’t know reality vs. fantasy. Children under age 8 years may not exactly understand what’s real and what isn’t. Remember that when you think of what they should be exposed to on TV or in media or on the radio while in the car. What happened in Las Vegas may be confusing to them, surreal, or hard to understand. They don’t need to understand all the facts, risks, and repercussions. What they need to know is that you protect them and love them and will answer any questions they have.
  • Keep information simple & brief. State the facts and let young children ask questions if they have them. Delving into detail may be unnecessary and hurtful, scary or confusing to them. Basic data may be enough. An example: “In Las Vegas, Nevada there was an event where people were fired at with a firearm. People were seriously hurt. The police worked hard to protect people and got them to safety. Events like this are very rare. Las Vegas is very far from here.”
  • No need to introduce information if they don’t know. I explained to my boys in the morning that there was a horrible man who used a gun to hurt people in Nevada and I told them because I wanted to control how they first heard about it (as opposed to the school playground). I explained that the gunman used a weapon to take people’s lives and it was a very large event hurting more people than ever before in US history. I reminded them how rare this is. I explained what we do in our home (no firearms, no toy guns, no video games with shooters) to make sure we don’t promote the use of guns and what I do at work each day to help use science to assist people in keeping their communities safe. I asked if they had questions. They didn’t. I’ll keep checking in.

Middle school

  • Need help distinguishing reality from fantasy sometimes. Remember that middle-schoolers know less about the world of firearms and tragedy than adults, simply because of their years on the earth and exposures. They may distort facts or figures, and relative personal risk. They may feel under threat. They may romanticize or misunderstand the gravity of a tragic event. Help them keep the rarity of these events in scope.
  • May ask more questions about safety. These children will often need to know more about how to protect themselves and what you do and others do in their lives to keep them safe. Focus on all you know in your home and neighborhood and in their school that protects them from unexpected harm.
  • Give simple, honest answers. All children deserve the truth. Let them ask questions and remember it’s always okay to admit you don’t some things but keep answers truthful and simple. Keep a sense of control when answering hard questions as best you can and admit that there are some things you don’t always understand, too, when you don’t know how to answer.

High school

  • Know reality from fantasy. Because of the widespread media coverage they will likely have lots of exposure to the details of the events.
  • Can be easy to distort reality during events like this for these children. Help them understand the numbers of how rare this is and ways that officials and the community are working to protect them.
  • May form strong opinions about violence in schools. As well they should! Teens will often react with a strong opinion and a strong need to help make change after big event. Listen to their ideas for making their lives safe and help engage them in ways that give them a sense of control (volunteering, making sure friends are safe, keeping firearms locked up and unloaded away from ammunition).
  • Emphasize their role in maintaining safety. They have control of their lives in ways and they know that. Remind them all of the things they can do to personally keep their life and their family and friends safe.

National Gun Statistics:

  • 1 in 3 homes with children in the US have guns. So firearms are fairly ubiquitous — we can just work to live with them, safer.
  • More than 40% of gun owning households with kids keep the firearm unlocked. Lock boxes and trigger locks can help! They are often affordable, easy to install, and provide huge protection.
  • Nine children and teens accidentally shot every day. Although mass shootings focus the nation’s attention, deaths from firearms are a part of everyday for someone here in our country.
  • 80% of unintentional firearm deaths of children <15 years of age occur in a home. Protecting your home and ensuring that where your children play is safe can make a huge impact.

Washington State Gun Statistics:

  • Suicide risk 9x higher where guns are kept unlocked (King County, WA data). If anyone if your home has mental illness, ensure firearms are unloaded and locked up. If someone in your home is severely depressed or suicidal it is my strong recommendation that firearms be removed from the home until the mental health issues are stabilized.
  • Nearly 40 percent of Washington households have a firearm present so firearms are in many homes. Making sure the places you and your family visit keep firearms secure is an important way to improve safety and contribute to making our communities safer at large.
  • 1 in 6 homes have guns stored loaded and unlocked — we can change this!
    • 35% of these homes have children living in them

 What Parents Should Know

  • Always ask if guns are present when your child visits another home. Just start doing it regularly so we all think of this as common sense. No judgment needed — we all want our children safe where they play.
  • Children who see guns in movies may be more likely to hold a gun and pull the trigger. Curiosity reigns. Here’s a phenomenal overview of the effects of virtual violence on aggression, what the research shows, and recommendations for what we can do. Consider thinking carefully about avoiding media and video games that include first-person shooters.
  • Keep your guns locked and unloaded stored separately from ammunition
  • Safe storage = 75% reduction in the risk of firearm suicide & unintentional shootings.

Resources:

10 Things To Know About 2017-2018 Flu Shots

The flu season is soon to be upon us and I hate to be so prescriptive but when it comes to influenza I feel like I have to be. I immunize my entire family and I think you should, too.

Hard to believe, but with our children going back to school and swapping snot around the classroom, it’s time to get fall flu immunizations on your radar. Last year during the 2016-17 season, more than 100 U.S. children died of the flu (influenza), and thousands more were hospitalized for severe illness or complications from the virus. Historically, more than 80% of children who died of influenza were not vaccinated. The flu shot is the best way to teach your own immune system to fight back if exposed to the virus. The flu vaccine “recipe” was changed this year (one different A strain compared with last year’s vaccine) to accommodate for predicted viral strains that will likely come and circulate around our neighborhoods.

The recommendations this year are the same as last year. Every child over 6 months of age should be immunized.

10 Things To Know About Flu Shots:

Here’s what you need to know based on my experience as a pediatrician, The Centers for Disease Control and American Academy of Pediatrics policies: Read full post »

1 Small Hack For Smarter Smartphone Parenthood

It’s the last official week of summertime around here. My babies love school and are eager about the beginning; it’s me nursing an increasingly bigger pit in my stomach as summer wanes and September nears. While my boys grow up I feel like I see more clearly the ways summertime affords juicy glimpses into the innocence of childhood. This summer I watched these little boys stay in their jammies past noon and watched as they dabbled in stories and books, make believe, competition, mindless daydreaming, Lego-building, risk-taking, and an earnest growing concern about safety in the world. To me the collection of those interests feels so earnest and utterly serene. Summertime is just slower.

I crave the de-clutter of long days without so much chaos. Without the stresses that the school schedule ushers in, the summertime-alarm-clock-free space lends priority to an actual circadian rhythm. We eat better, the days are less driven by rule following. I think we might laugh more. Less time spent rushing and shuttling from one thing to the next and more time listening. A lot more time goofing off. I mean my 8 year-old ran into my room first thing this morning in a cape! What life (with children) is ultimately about.

As this summer, in particular, wraps up I’m also recognizing with increasing fortitude the peril we’re under because of technology in our lives.

Nothing new or profound but I really feel it right now, more than ever. My work over the past years with The American Academy of Pediatrics Council on Communication and Media has shaped the study on device-use as a station in my work, but it’s my role as a mother that screams out louder in me right now. We could really mess this up. Not our kids, per se, I just mean how we all experience this precious gift. Read full post »

Tips And Facts For Families On The Solar Eclipse

I know, everyone is writing about the eclipse. I’ve got just a few messages. One is, this is gonna be cool. Two, the caution messages are real. The cool part is because when our world goes a little dark mid-day next week it will be fairly startling. Even the animals are expected to change up how they behave. And the cautionary messages just make sense. Our eyes and our vision are clearly worth protecting ferociously. Damage from the eclipse can be permanent so taking a few steps to understand how and why just makes sense. And for framing this whole thing up in life? Thank goodness many of us have children in our midst. Their enthusiasm about how BIG this event is can help scale how exciting it is when the sun disappears in the middle of the day. Children harbor amazing perspective of what matters. Monday is a great day to stop reading the news and stare up into the sky (carefully). Thank goodness.

Quick Summary Of The Total Solar Eclipse

On Monday, August 21, 2017, all of North America will be treated to at least a partial view of an eclipse of the sun. Anyone within the path of totality can see one of nature’s most awe inspiring sights (as I’m told) – a total solar eclipse, which has not happened in 99 years. This path, where the moon, the sun and the Earth all line up such that the moon completely blocks out the sun will stretch from Salem, Oregon to Charleston, South Carolina. The New York Times created the above video that captures the science and awe of this event. Even NASA created a website to provide a guide to viewers. Out West, people are talking of little else and Slate is reporting that Oregon is expecting 1 million tourists view the eclipse. People are changing up their weeks to view this. Two little girls from Seattle are getting real – they’re launching a weather balloon into space, in partnership with NASA, with live GPS tracking (and an Amelia Earhart LEGO) and some live video coverage links, too. I mean, it’s a big deal.

Can The Eclipse Hurt My Eyes?

Read full post »

New Breast Pump Cleaning Guidelines From CDC

Every tool can carry risk when not used properly. The story about breast pumps and infection risk in the media recently is no exception. Attention all breast feeding & pumping mamas out there (and all the lovely people who support moms who pump milk): The Centers For Disease Control (CDC) has issued new guidelines for properly cleaning your breast pump & parts. The new recommendations come in the wake of a devastating story of a premature baby girl who showed signs of sepsis (bloodstream infection) at age 21 days due to an unusual bacterial infection. She developed spastic cerebral palsy, developmental delays and later passed away. This case is an outlier, for sure, but did prompt learning that the CDC felt the public should know.

After a full investigation, the CDC traced the infection source back to the breast pump and parts. The way the breast pump equipment was cared for may have allowed bacteria to grow. The CDC reported that the girl’s mother typically soaked the collection kit from her personal breast pump in soapy water in a wash basin for ≤5 hours without scrubbing or sanitizing. She then rinsed, air-dried, and stored the kit in a plastic zip-top bag until the next use. It’s possible how she cared for the pump allowed for bacteria to grow and be transferred to the baby. Because the baby was young and born prematurely, the baby was at greater risk for infection that most full-term older infants.

In response to the investigation, we reviewed existing resources for women about how to pump breast milk safely, but found little guidance that was detailed and based on the best available science,” Dr. Anna Bowen, a CDC medical officer, told Parents. “As a result, CDC developed its own guidance.”

New CDC Breast Pump Cleaning Guidelines:

  • Clean your pump parts after every use. Don’t skip a single feeding. I know it’s yet another step in the long process of breastfeeding and pumping, but it’s crucial. Annoying add but the recommendations are based in experts evaluating risks.
  • Wash your hands before touching your pump parts or pumped milk.
  • Key: keep a separate wash basin for the parts, the CDC doesn’t recommend you use the kitchen sink to clean pump supplies as the sink may house germs and bacteria from other food prep.
  • Have a dedicated cleaning brush for your pump and parts. Clean that brush every few days. Don’t re-use the sponge you use to scrub food off your plates and dishes.
  • Use running water and soap to clean breast pump parts that come in contact with breast milk.
  • Then let each piece and part air dry.
  • For extra cleanliness you can boil or steam the parts to sanitize in either a microwavable steamer or use the sanitize cycle in the dishwasher (HOT water). You can use the sanitizing bags that you use in the microwave or you can bring a pot of water to a boil and boil parts in the bubbling water for 5 minutes.

Bottom Line: this news isn’t meant to scare or drive moms away from breastfeeding and pumping. We know the many benefits of breastfeeding for both mom and baby (see below). This is just a reminder to be diligent when cleaning and sanitizing your breast pump. Read full post »

Driving Under The Influence of Electronics: The New Law

Getting a DUI just got easier. Driving Under The Influence of Electronics (E-DUI) is real and will cost you as Washington State gets serious about reducing deaths from car accidents caused by distraction. The reason is clear: we know distraction from cell phone use increases risks of accidents over 20-fold and we know the habit of using a device has quickly become the norm. Here’s to hoping the new law helps us think of our cars as the sanctuaries they can be for those we cart around and for those we love. Of anything I’ve learned from researchers about vehicle safety and distraction it’s the reality that finger-wagging and telling-us-to-change type advice won’t affect our habits — we have to be motivated to change the culture of our car. We have to want to connect there or we have to be fearful of being fined. Since I made the podcast with Dr. Beth Ebel (embedded below), whenever I get in the car with my boys I think of it more like I think of time at the dinner table. And I love thinking about the car in that way. It’s so much easier to make sure I won’t pick up the phone…

The New E-DUI Law In Washington:

Tomorrow a new law signed by Governor Inslee bans holding hand-held devices, like cell phones, while driving (and even when you’re stopped at an intersection). The law makes it so drivers can only use their phones to call 911 or by using one finger to trigger a voice-activated application on bluetooth. In addition to a $136 ticket for your first offense and $234 for the second within 5 years, these citations will be reported to insurance companies. Learn more about the law on Washington’s Target Zero website. The reason is pretty clear — just as we were seeing the death rate fall from good seatbelt use and clamping down on DUIs, there has been a rise in accidents and deaths. Many believe this is in part due to the rapid rise of device distraction.

Under the new law you can’t even look at your phone at stop lights. Reason is, you lose awareness of situations around you and many accidents occur when pedestrians are struck by distracted drivers in intersections.

Data Driving The New DUI Laws:

  • Fatalities from distracted driving increased 32 percent from 2014 to 2015 in Washington.
  • 71 percent of distracted drivers engage in the most dangerous distraction, cell phone use behind the wheel
  • One out of four crashes involves cell phone use just prior to the crash.
  • At any given time, 2013 research has found that about 10% of people driving are actually using a device and half are texting! Anecdotally it only seems to be getting worse. I mean we look around and constantly we see people flying down the highway while trying to send messages.

The law is a big step in the right direction for avoiding injuries and death from distracted driving. We know that it’s hard for us all (!!) to keep the phone off or in the backseat. And we know the fear of tickets — the ones that take away money but the ones that also increase insurance premiums — may change behavior. And that’s the goal. Public service announcements scaring us about risk clearly are not enough and are clearly ineffective as use of devices in cars rages on.
Read full post »

Chemicals In Macaroni And Cheese Explained

If you’re a parent whose child loves macaroni and cheese (and truly, it’s the rare child who doesn’t), you’ve most likely seen the NYT media blitz on chemicals found in popular, boxed mac-n-cheese brands sold in grocery stores. I’m going to break it down quick and simple. Here we go….

  1. The chemical detected in the mac and cheese were are called phthalates. Phthalates aren’t an added ingredient that companies are purposely using in their products. This isn’t an artificial ingredient, per se. It also isn’t something you avoid in your food when buying organic foods.
  2. Phthalates are chemical toxins that are used to make rigid plastics more flexible and less breakable. These plastics are used in processing plants and conveyor systems that our food and other ingredients travel THROUGH while being preserved and packaged. The phthalates can then leak from the plastics (tubing, conveyor belts, machinery) INTO our food or ingredients.
  3. Research links phthalates to possible genital abnormalities at birth and disruption of hormones, learning disabilities, and behavioral problems. Phthalate exposures during pregnancy can cause changes in estrogen and testosterone levels in fetuses. There isn’t a known “safe” amount of phthalates for our diets. So when we can reduce our exposure to them, we should.
  4. Almost all dairy products you consume contain phthalates. So it’s not just the mac-n-cheese that’s exposing us to phthalates. Milk, cheese, cottage cheese, string cheese, ice cream and other foods…any milk product contains them. Phthalates piggyback into our food and are stored in fat. That’s one of the reasons it’s smarter to drink low-fat dairy products over high-fat ones.
  5. We don’t know yet which brands the report surveyed and this work wasn’t published in a peer-reviewed journal. Some media outlets are reporting Kraft was included but I was unable to unearth which brands and what levels were found. To be safe, I’d assume most macaroni and cheese prepared products contain some level of phthalates because they all require processing.
  6. Buying organic mac-n-cheese isn’t saving you from phthalate exposure. Remember anything that’s been processed through tubing or machinery can have phthalates. Phthalates can also leave plastic products in our house (plastic food containers, plastic dishware, plastic surfaces) and enter our food, especially when heated. So the less we use plastic to store or transport our food the better!
  7. We don’t actually know what level of phthalates are safe for consumption so as the science and understanding of the risks evolve it’s best to think on diminishing exposures.

Read full post »

What To Do With Bug Bites and Itchiness

It’s July so we’re officially in summertime, thank goodness. My prescription: warm and outdoor adventures for us all! Obviously if we take the Rx seriously, we’ll all be more likely to get bit. When it comes to bug bites, the most important thing to know for your child (and yourself) is how they will react. Some children get bit all over and hardly react while others will have enormous, and tremendously ITCHY welts all over their body. There truly are children who are mosquito-bite sensitive and children who are not. Some get bit and hardly react while others of us end up with welts in minutes.

In general, bug bites cause a mild irritation to the skin. However, sometimes a more allergic reaction results and persists, even for days causing real discomfort. In these scenarios, it’s safe to use anti-allergy medications (diphenhydramine, etc) for itchiness from bites. It’s also safe to use over-the-counter (OTC) hydrocortisone cream or ointment on bites that aren’t scratched open or raw.

Some tips on how you can help keep your children bug bite free or help them when they do get bit: Read full post »

Pride: The Wellness Effect of Same-Sex Marriage Laws

Seattle’s Pride Parade is tomorrow, Sunday, June 25, and it has a great theme — Indivisible. Take the meaning of the theme as you like, but if there’s one thing that is true for Pride in Washington, it’s that there is an abundance of support. The majority of our people here, it seems to me, are building a community and will not be divided more. I feel so thankful to live in a community that is on its way to continuing to make all feel welcome, safe, and grounded in a sense of belonging.

As we come upon the 5th year since Washington State legalized same-sex marriage (woohoo!) it’s important to highlight the importance of what laws like this can do within the community. The legal changes here have had a lasting impact on thousands and thousands: there were approximately 15,750 same-sex marriages in Washington between 2012 and 2015.

These laws not only increase liberty and resources for families with same-sex couples, the laws may increase our community’s health and they may earnestly decrease suffering.

A study published by JAMA Pediatrics found that states with same-sex marriage policies had a 7% reduction in adolescent suicide attempts. The study analyzed data from 762,678 adolescents in 47 states between 1999 and 2015. Of the states included in the study, 32 permitted same-sex marriage and 15 states did not.

Evidence from nationally representative 2015 Youth Risk Behavior Surveillance System (YRBSS) data indicates that more than 29% of gay, lesbian, and bisexual high school students reported attempting suicide within the past 12 months, relative to 6% of heterosexual students.

Read full post »