Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

5 Things You Should Know About Concussions

This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them. Click here to read the first post in this series. 

Soccer is the highest risk sport for school-age girls.

Soccer is the highest risk sport for school-age girls.

What Happens During A Concussion?

A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain. This helps explain the symptoms associated with a time-limited injury such as a concussion.

This also explains why diagnosing and managing concussions can be frustrating for families and medical providers. Unlike a broken bone, we do not have imagining or blood tests that enable definitive diagnosis of concussion. Medical providers will sometimes order head CTs or brain MRIs to make sure that there is not a more severe injury, but the scans cannot diagnosis concussion.

Diagnosing concussion currently relies on a detailed history and physical exam. If an injury occurs when a child is playing in an organized sport, a sideline assessment should be performed to look for common post-concussive symptoms. In 2017, the guideline for sideline assessment for concussion was updated. Depending on the severity of the initial presentation, one may need to be evaluated in an emergency department to help rule out a more severe injury.
The goal is to prevent injuries, screen for potential head injuries when appropriate, and to diagnose injuries so that we can treat the symptoms and limit the impact.

How To Prevent Head Injuries

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Sore Throat Versus Strep Throat

When you or your child has a sore throat, it can be hard to tell if it might be something that needs medical intervention, like Strep throat. Strep throat is an infection caused by group A Streptococcus (GAS). When you confirm (by throat swab in the lab) that GAS is present, your child needs 10 days of antibiotics. If the test is negative, it’s unlikely you need any Rx medical treatment! More below:

  • Sore Throat
    • Tonsillitis refers to tonsils that are inflamed. Inflamed tonsils (and even when they have white stuff on them) doesn’t necessarily mean your child needs antibiotics. If enlarged tonsils make it hard to swallow or changes the sounds when your child breaths, they need to see a pediatrician.
    • Pharyngitis refers to an inflamed throat. Most episodes of pharyngitis are caused by infections from viruses. Some are caused by other bacteria that live in the throat that aren’t as problematic as GAS and don’t require antibiotic treatment.
    • Viruses, bacteria, allergens, environmental irritants (such as cigarette smoke), and chronic postnasal drip can all cause a sore throat. Most tonsillitis & pharyngitis will typically resolve on their own without prescription treatment.
    • Try acetaminophen or ibuprofen for pain, throat lozenges, warm beverages, gargling salt water and get lots of rest. In time, sore throats typically improve in a few days.
  • Strep throat is an infection caused by a specific type of bacteria, Streptococcus. Infections from the bacteria can be minor or severe. When your child has Strep throat, their tonsils are usually very inflamed, they likely have a fever and swollen lymph nodes in the front of the neck, a BAD sore throat, and sometimes a headache. Many children complain of lots of pain with swallowing. Strep throat symptoms typically come in isolation from other “cold symptoms.” With typical strep, most children do not have cough, runny nose or hoarseness (changes in your voice that makes it sound breathy, raspy, or strained). No one can diagnose strep throat just by looking at your throat. Instead, healthcare professionals use two tests to see if group A Strep bacteria are causing a sore throat. A “rapid strep test” involves swabbing your throat and gives results quickly, usually in about 15-20 minutes. The test is accurate about 95% of the time meaning only 1 in 20 people (5%) who have a negative test actually may have the infection. If the rapid test is positive, your doctor or provider will prescribe antibiotics. If the test is negative, your healthcare professional may likely send the swab for a full throat culture (to catch the 5% that falsely didn’t show an infection). A throat culture involves sending a throat swab to a lab for 1-2 days to see if bacteria grow from the sample. If it turns positive, then your child should be treated with an antibiotic for 10 days.

Great information from the American Academy of Pediatrics on the differences between a sore throat and strep.

E-cigarette Studies In Teens Bust Safety Myths

Two new studies out today on e-cigarettes showed e-cigs remain a significant concern for teen users. E-cigs were found to pass along carcinogens (cancer-causing chemicals) to those who used them and are associated with future tobacco cigarette smoking in teens. Data out today in Pediatrics finds that teens who used e-cigarettes had up to three times greater amounts of five volatile organic compounds (carcinogens) in their urine compared to teens who did not use e-cigarettes at all. Teens using fruit flavored e-cigarette products, often the preferred choices for teens, produced significantly higher levels of acrylonitrile (a volatile organic compound, known to be toxic). Teens who used both e-cigs and tobacco cigs had even higher levels of the carcinogens overall.

Let’s be clear, e-cigarettes are not “safe” nor do they provide health benefits for teens. It’s our obligation to help teens and parents everywhere understand that…the data keeps accumulating as more and more teens use e-cigs across the country. E-cigs tend to increase smoking of traditional tobacco cigarettes, too. My worry is many teens believe e-cigs are safe to use. More and more, I’m certain they are not.

Relevant E-Cigarette Statistics:

  • About 95% of adult tobacco users started using before they turned 21 years of age. In the study out today, E-cigs were positively and independently associated with progression to being a regular, established smoker. Researchers conclude, “data suggest that e-cigarettes do not divert from, and may encourage, cigarette smoking” in teen population. Especially in those who have a tried a few cigs but not yet established a smoking habit. Rather than being a “safer” choice e-cigs enhance the choice to smoke traditional cigs in teens.
  • Use of e-cigarettes rose 900% between 2011 and 2015. And between 2014 and 2016, US middle and HS students used e-cigs more than any other tobacco product.
  • 85% of e-cigarette users ages 12-17 use flavors. In the study out today, carcinogens and toxic substances were increased in teens’ urine in those who used e-cigs compared with those who didn’t. Added risks may be in fruit-flavored e-cigs preferred by teens; even higher levels of a specific toxin (acrylonitrile) was detected.

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What’s The Right Age For A Smartphone?

What’s the right age to get your child a cell or a smartphone? I wish I had a concrete, data-driven, definitive answer for you. I think the answer is a balance between what’s right for your family and when you think your child is responsible enough to manage the risk that comes with opening up an entire new world online and the risk that comes with losing something expensive. Research from Pew Research Center out this month (Feb 2018) finds that when it comes to adults, nearly all of us (95%) have a cell phone and 77% of us have a smartphone. But when it comes to parents specifically, we’re different– we’re all in it seems, 95% of parents with children under age 8 have a smartphone (not just a cell).  What we’re modeling in our own lives with our phones makes this even harder. If we are addicted to our phones what does it mean for our child? When it comes to having a child get a cell or smartphone of their own, Techcrunch reported in 2016 that children, on average, get a cellphone in the US at age 10.3 years. You may have strong reactions to that number.

The biggest reality IMO is that the biggest issue may not be the age of initiation for a phone or device but rather how we help our children use it, follow rules, and sincerely work to avoid “addiction” to it in life. We just don’t want to have our children (or ourselves!) pulled away from life in meaningful ways…this being alive thing is just too precious.

Half of teens feel addicted to their mobile devices, and the majority of parents (60%) feel their kids are addicted, according to a 2016 Common Sense report on tech addiction. A recent study (somewhat contested) of eighth-graders by Jean Twenge, author of iGen, found that heavy users are 56% more likely to say they are unhappy; 27% more likely to be depressed; and 35% more likely to have a risk factor for suicide.

Common Sense Media launched a new campaign to protect young minds from the potential of digital manipulation and addiction. The campaign, called Truth About Tech, aims not just to help us as parents but also to influence the tech industry in making products less intrusive and less addictive.

In my family, I’ve told my boys we can talk about a cell phone at age 12. But we do let them use an iPod and an iPad and holy moly, it’s not easy….nor perfectly executed. When and how you introduce devices to your children will always be a personal decision — for you and your family — and it will always demand your longstanding attention and follow-along. The good news in the overwhelm, you can always change up the rules as you go, especially if the ones you make aren’t followed! The AAP Family Media Plan is a great tool to start the conversation together as a family and allows you to print it out and put it up in the house as an easy reminder of what was agreed upon.

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From The Mouths Of Babes: Read This Twitter Thread

I can’t stop thinking about this tweet thread. I think it may be one of the most precious threads on Twitter. Hopefully that’s saying something since I’ve been plugging along, almost daily, on Twitter since 2009.

Here’s my experience with it…I’m sure you have your own and I’d love to hear about it in the comments if you’d be willing to share:

Yesterday, I woke early with insomnia around 4am-something in the morning. Instead of doing what I should have, I grabbed my phone and found myself on Twitter. Just before 5am I read a beautiful series of tweets from a South African pediatrician who cares for children at the end of life. He’d taken to Twitter in the early morning hours (Seattle time) to share messages from children at the end of life. Distillation of what they enjoyed most. Things they knew. Worries, gratitudes, and love housed within them. Innocent and nearly angelic.

I read it. I cried. I re-read it. I sent it to a few people I love. For some reason I didn’t retweet it. I have no idea why except that I think I held it so dear I wasn’t even sure what to say. I plopped it into a blog post from 2 days ago, I sent it to some smart researchers who work with children and teens and think/study/intervene on ways to improve resilience, happiness, and stress.

A perspective from the front-line-end-line-solid-lines-of-meaning in being alive is an ever-relevant and precious gift. Hard to think of any other advice that matters more. When I read the tweet thread in the early morning hours it had something like 100 likes on it. There are now, as I type this, about 100,000. That’s a lot; clearly I’m not alone in meaning-making with this. Read full post »

Is It The Flu Or A Cold?

First off, in my mind, the goal this winter for your children, and your family, and your community isn’t perfect attendance at school or work. In fact, I’d suggest schools and families and principals who currently celebrate and reward perfect attendance may provide a disservice, especially when having a flu season like we are. The goal isn’t presentee-ism — the goal is thoughtful living. Staying home when ill, staying away from those who are vulnerable when you have cold symptoms (infants, pregnant moms, elderly), and taking care of yourself is a service to YOU but also to us all.

How To Protect Your Child From This Dangerous Flu ~ Summary from Consumer Reports

It may be hard to know when your child is having a run-of-the-mill “cold” and when they are having flu. So err on the side of caution — your child has a cough/cold/runny nose/sneezing/fever? Keep them home, please during this widespread flu! More on how to help decide what is going on (flu versus cold) in the CDC chart included below.

Doing my best to continue sharing what I’ve learned about this year’s flu season. Both the Centers for Disease Control (CDC) and Washington State Department of Health are reporting most recent data (info has been updated as of Friday afternoon February 2, 2018) that flu rates rose again last week in the most recent data collected. Here’s the CDC data for the most recent week:

  • WA Department of Health: 132 people have died of the flu this season in the state
  • 53 children have died in the U.S. (1 in WA State). 17 children died last week alone.
  • Every part of continental U.S. has “widespread” flu activity
  • In the last couple weeks, more than 7% of all people coming into clinics and emergency departments had an influenza-like illness. That’s the highest level of activity since the deadly swine flu pandemic nearly 10 years ago.
  • The CDC says this season’s epidemic is on track to rival the 2014-15 flu season and hasn’t yet peaked as of Feb 2nd. Kristen Nordlund a CDC spokesperson said Feb 2nd, “We have not hit our peak yet, unfortunately, it’s not going down yet. Really the bottom line is there is still likely many more weeks to go [in this flu season activity].” Back in 2014-2015, the CDC estimates 34 million Americans got the flu. More than 700,000 were hospitalized. About 56,000 died. Influenza is a serious illness.

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What I’m Doing Now – January 2018

It’s still (barely) January of 2018 and I’m doing my best to try to new things, take breaks from old things, be more strategic, practice tiny habits, and spend time with my sweet boys and family. I’ve even committed to a weekly early morning swim with a dear friend to just ritualize something beautiful for the year.

(added 2/1/18: Check out this palliative care physician’s twitter status update [read the whole thread — amazing] for any reminder for why we should just be with our babies when we can and why we should tell more stories, read more books, and perhaps, eat more ice cream!)

Many of you are familiar with my Seattle Mama Doc podcast which typically features parenting advice and pediatric experts sharing ideas for particular health topics. But I’m often asked about all the different hats I wear: mom, doctor, Chief of Digital Innovation at Seattle Children’s Hospital, Chief Medical Officer at Before Brands, reporter at KING5 News and more. So, this is my first attempt at detailing what I’m working on each month — the juggle — why I’m doing it and how it all feels. It was an idea inspired by my dear friend, Susannah Fox who updates her work list publicly, on her blog monthly. I recorded an ad lib take on the podcast (embedded below).

Tell me what you think, share ideas, offer advice or partner with our digital health team if you can!

Power on, People. Thank goodness, here comes February!! Maybe some sunnier days? Think weather and think metaphor, too.

Widespread Influenza in US: Ways To Protect Your Family

It’s flu season, no doubt about it, with widespread influenza infections all over the United States (see the CDC updated maps with high-levels of ILI [Influenza-like illness]). Influenza is a virus (there are many types or “strains”) that cause terrible fever, cough, respiratory distress, pneumonia, ear infections, and sometimes hospitalization and death. As you’ve likely heard from the media blitz the last week or so, it’s shaping up to be a pretty nasty year – and some public health workers are concerned not only about this surge or “peak” of flu season coming early, but that it may be bigger and more dangerous than we expected. Washington is still bracing (we have lower levels) but many areas are inundated and hospitals and ERs are full. Any Google search on “flu” will give you headlines like this: Hospitals Face a War Zone, Flu Season is Bad But Might Get Worse (which is true, it might), and this with the data update this week: Flu Season Has Killed 30 Children (which is also true and dreadful).

5 Simple Things To Do During Flu Season To Help Your Family

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How To Treat Lice And When To Ask for A Prescription

This is a follow up post to my recent post on treating head lice. It’s all just a major inconvenience. And worse than having lice is having lice again and again. And even worse than your child getting re-infested may be treating lice with an ineffective therapy. Enter…..”super lice.” Ewwwww. Although please know that their name exceeds their actual scariness. These lice are only different (aka “super”) in that some lice may have developed gene mutations that indicate they are developing resistance to a common class of over-the-counter (OTC) treatments (permethrin).

A 2016 study in The Journal of Entomology that got a bunch of media coverage found resistant lice all over the United States. Lice were sampled from 48 states at well over 100 different centers to evaluate their patterns of mutations that may render them resistant to OTC medications. Do note that the study was funded in part by the pharmaceutical company that makes one of the prescriptions, but nonetheless did find that lice are becoming harder to treat, coast to coast.

Do you have a super lice? It may be hard to know. If you’ve treated your child several times exactly according to directions and aren’t having success, you should explore prescription medications that may work better. But REMEMBER though, that sometimes you child is just getting re-infested from someone at school.  It is sometimes hard to decipher if the OTC medication is ineffective, or if your child has been re-exposed. Working with your school and with others where your child may have been exposed is always a part of this when a child continues to have lice after a treatment. There are some medicines (see section below) that may help if the OTC meds are not working. The chart below shows where the resistant bugs were detected (red is fully resistant, orange shows intermediate resistance, and green showed no resistance to OTC meds). Read full post »

How To Treat Head Lice

As parents, many of us have been there. You’re going about your day and BAM…fear and anxiety start creeping in as soon as you read the email, that perhaps again, there’s an outbreak of lice. Someone in your child’s school has lice and your child may have been exposed…blah, blah, blah. Nothing about this ever feels benign, even though it always is. Lice just feels a gross inconvenience. This post details the lice life cycle, the ways lice spread, and ways you can treat lice with both OTC or prescription medicines.

Lice infestation is common for US children and has nothing to do with cleanliness. The Centers For Disease Control (CDC) estimate 6-12 million lice infestations a year in the United States, but something you cross your fingers doesn’t make its way into your home or hair.

How Lice Live And How Lice Spread

Head lice feed on tiny amounts of blood from the scalp and if they are not on a person’s scalp, they can usually only survive about a day. This is good news for remembering that lice won’t crawl around your home for days — ever. They just can’t. Lice lay their eggs close to the scalp and when on the head can live about 28 days. They can multiply quickly, laying up to 10 eggs a day. It only takes about 12 days for newly hatched eggs to reach adulthood. This cycle can repeat itself every 3 weeks if head lice are left untreated.

Remember that head lice usually only survive for less than 1 day away from the scalp at room temperature. Their eggs cannot hatch at room temperature lower than that near the scalp. So once they fall off a child’s head, lice pose very little threat. You don’t have to vacuum the carpet, sterilize the toys, wash the house top to bottom after your child has lice. I mean you can, but don’t do it for the lice :-).

Lice is typically passed through close person-to-person contact.  Lice crawl, they can’t hop or fly (phew!). Lice mainly move from head-to-head and less commonly move from one person to another on a hairbrush or hat or costume.

Lice At School – Why Kids Don’t Get Sent Home Anymore

The American Academy of Pediatrics and CDC have fought hard against “no nit” policies in schools, in the interest of reducing the school absence associated with head lice. When recurrent infestations occur this can be frustrating but no child really ever needs to miss school for lice. Schools are increasingly unlikely to exclude children for nits, but still, in some schools, the policies persist. The rationale for not sending kids home:

  • Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as ‘casings’.
  • Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
  • The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice.
  • Misdiagnosis of nits is very common during nit checks conducted by non-medical personnel.


Over The Counter Lice Products

Most of the time the very best bet for lice are OTC, easy-to-use treatments. The FDA has approved over-the-counter (OTC) lice products as safe and effective when used according to the Drug Facts label instructions. There are 3 main ingredients used to treat lice: Permethrin, most commonly found in the OTC product Nix or Piperonyl Butoxide and Pyrethrum Extract, most commonly found in Pronto or Rid. Each product has different and specific treatment instructions, like if hair needs to be shampooed first or if dry hair is needed, the age a child has to be for these products to be used on their scalp and if and when a second treatment is recommended. If the thought of dealing with lice makes you light-headed, there are lice-removal services available. They’re not cheap (starting around $100 in the Seattle area), but some parents may find the expense well worth the piece of mind of getting rid of lice manually by professionals. Read full post »