Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Can’t Stop Time

photo (58)I take solace sometimes knowing I can’t stop time. When I look to the clock and trade panic for solace it’s a way to distance myself from the reality that as time marches on in its infinite human construction, I don’t have to think about moments with the boys lost. Every parent hears over and over again that, “it just goes so fast.” I find that advice never helps. Just makes us feel like time with our beloved little humans is slipping through our fingers and I can’t imagine a parent who feels good about that.

My little boy is no longer allowed to be entirely in my grasp as the doors of that big schoolhouse open forever next week. My 5 year-old starts Kindergarten and it’s pretty clear to me that from here forward there will be many forces facilitating his gradual exploration of the world away from our cozy nest.

The solace I mention is real though and it helps me. At moments I can feel the space and peace that comes in knowing I have literally no control over his aging and what it provides — like giving into the wind I can lean into this space and know what a privilege it is to witness this wild ride. It certainly helps that he clearly loves the speed with which life is hurling at him. I see it in moments where he looks at the Kindergarten class list and in the moments where he sticks his right foot out while standing next to his bike and poses as if he’s ready to take a big stage and I feel his thrill as he looks over to his older brother and realizes he finally belongs at the same school. Growing up really is quite a thing to behold.

Being a part of something bigger is a huge part of being human and school is an essential first (or second) step

And although that solace I just mentioned is real I can’t help but tell you that there is certainly a part of me that suffers in these waning summer days. I feel the excitement yes, I lean into the solace yes, but as a working mom I can’t help wonder, “did I do this all right?” Were the last 5 and 1/2 years exactly what I imagined for his time at home preparing for the onslaught of schooling? Was I present, available, ready, and everything I wanted to be? Well, surely not. It’s clear my iPhone got in the way, as did my job, and my ambition to improve children’s health. Thankfully there are ways he shows me he knows he’s got my attention but I can’t help but trip (and fall) sometimes knowing there are infinite ways to raise a child and I do look at those other paths with curiosity.

Today let me tell you this: I’ll hold onto the solace every single moment I see it and I’ll let it mix up with the suffering. I can gently mute the parts of pain that comes with aging and losing the intimacy found between mother and son during toddlerhood and the preschool years. I’ll find that solace when I feel the thrill from peering over the edge of this great big world ahead of him. One thing I know for certain is I’ll enjoy the first moments of Kindergarten next week, too. This little boy of mine is growing up to be a thoughtful, curious, kind, and happy little man. It’s his excitement for the next giant step that will tug me along into September…

Shifting To An Ideal Bedtime For School

We know children are sleeping less now than they did 30 years ago. Our children are unfortunately more tired and can suffer side effects in life because of it. Studies show that school-age children who create a sleep debt (chronic sleep deprivation) and are chronically tired have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible, they can have difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Even if your kids have already started school, you can provide a boost for your child’s attention, mood, and health by focusing in on sleep.

Starting out the year with better habits can help everyone at home (ahem, wouldn’t it be nice to avoid late evening battles?). If you’re not already there, think about moving to ideal bedtimes during the next couple of weeks.

How Much Sleep Do Children Need?

Sleep debt is created when we don’t sleep enough — it causes kids to crave “catch-up” sleep like those after-school naps, sleeping in until noon on the weekends, or falling asleep in the carpool on the way home. That being said, each child’s sleep need can be a bit different but in general children need:

  1. sleep needsPreschoolers: 11-12 hours of total sleep
  2. School-age children: 10-11 hours total sleep
  3. 12 year-old to teens: 8 1/2-10 hours total sleep

5 Ways To Support Good Sleep

  • Keep to an 8pm bedtime for young children. Move bedtime back slowly (move it by 30 minutes every 3-5 days) to prime your child for success and avoid battles!
  • 10pm bedtime for children age 12 & up is age-appropriate. More info here.
  • Habits: No screens 1-2 hours prior to bed, no caffeine after school, no food right before bed.
  • Exercise or move 30-60 minutes a day to help kids sleep easier
  • No sleeping with cell phones (create a docking station in the kitchen)
  • Don’t use OTC medications (cough & cold, for example) to knock your kids out and get them to sleep. Using medications that have a side effect of drowsiness can cause sleepiness to extend into daytime which can negatively affect school and sports performance.

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Let Them Sleep, Start School Later

Over the past decade mounting evidence finds that teens are chronically sleep deprived and subsequently suffering significant health effects. Chronic sleep deprivation is becoming the norm for our high schoolers and is known to cause both mental and physical health challenges. In fact The National Sleep Foundation found that over 85% of high schoolers aren’t getting the 8-10 hours of sleep they need while over 50% of middle school students are already falling behind in their zzzzz’s.

The evidence is in: teens who don’t get enough sleep can have academic challenges, an increase risk for sleepiness-caused car accidents, inattention, risk for overweight, risk for anxiety, greater use of stimulants like caffeine or prescription medications, and mood disorders.

This is a biology thing not a laziness thing. That teenager who can’t get out of bed until 11am on the weekends is just tired and trying to catch up! Puberty changes all sorts of things in our life, one major biologic shift occurs in the brain as children morph into adults. Around the age of 12, instead of naturally falling asleep at 8 o’clock like children in middle childhood, tweens and teens’ sleep cycle shifts about 2 to 3 hours making it a real challenge to fall asleep prior to 10 or 11pm. That means those teens up and awake until 11pm are really just acting their age.

The causes of sleep loss for teens are complex. Early school start times, use of electronics, smartphones, and tablets interfere with sleep as do homework, extra-curricular activities, and sports. But so do misperceptions — the same research that found over 85% of HS students weren’t getting enough sleep also noted that >70% of parents to those tired teens felt their child was getting enough sleep! We have to make sleep a priority in our homes. Read full post »

On Motion Sickness

I really love this TEDEd video explaining motion sickness. What I find most helpful is the admission that we humans still know very little about motion sickness, why gender differences exist (women get motion disturbance more often than men), and how to put a stop to it. No question children get motion sickness well before they’re old enough to tell us exactly how they feel. Often it’s screaming or fussing only in the car or a series of vomiting episodes that clues us in. A few tips for families, planning that last-minute summer road trip, to help support children who are prone to get sick in the car, on the train, at the park, or up in the air during a bumpy ride.

Motion Sickness In Children

  • Disconnect: Know that motion sickness comes about when there is a disconnect between what our eyes see, what the fluid in our inner ears knows about our position and direction, what our skin senses, and what our muscles feel while we’re positioned wherever we are. This disconnect in all these sensors around our body leaves the brain “confused” and for unknown reasons we’re left feeling nauseated, uneasy or achy. This can happen quickly and can happen even on a swing at the park. It really doesn’t take a jet airplane or an automobile driving quickly on a curvy road to elicit this unease and malaise. This can happen in the back yard! There’s often another disconnect, for those who don’t get motion sickness there is often little insight into how horrible a child or adult can feel while experiencing this. This reality, of course, only increases the displeasure for the person ill. But know this, some experts observe that everyone, given enough mismatch and motion–say a group of people in a life-raft in turbulent seas–will get sick from motion.
  • Common: Motion sickness is fairly common with most reports stating that 1/4 to 1/3 of adults may experience it. In school-age children, a recent European study found the prevalence of motion sickness was 43.4 % in car, 43.2 % on bus, 11.7 % on park swing, and 11.6 % on Ferris wheel. Like adults, most children report dizziness, nausea, or headache when their body is triggered by motion. And although some research claims motion sickness doesn’t start until age 2, I’ve certainly learned from parents that some young children don’t love riding in the car and show it. More preventing and treating it:

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Knowing The Benefit Of MMR Shot

A new study out today in Pediatrics reminds us that parents want information about the direct benefits shots have on their baby’s health and wellbeing. Not surprising, of course, but a good reminder for pediatricians, parents, and those who speak out on the value of vaccines to remember that primary motivation for parents in getting immunizations is to protect their child, not just protect the community. As a mom I feel the same way. As vaccination rates have decreased in pockets around the US these past few decades, and as non-medical vaccine exemptions (refusing immunization on philosophical grounds) increase, and as media coverage around the benefits of immunizing “the herd” remain a mainstay, returning to the individual benefit of vaccines makes sense. Parents really want to do what is best for their baby. They want to hear how and why to protect their baby. Vaccines do that.

The MMR vaccine protects your child from getting the diseases measles, mumps, or rubella or the complications caused by these diseases. After receiving this vaccine, your child will not miss school or activities due to these illnesses and will be able to play with friends during an outbreak.   — The message shared with parents in the research study

I like this study for two reasons:

  1. Parents Want To Know Why: In the study researchers went right to parents, mostly moms (80% of participants) between age 18 and 65 years of age, to share messages about MMR shot benefits to their baby and society and then gauged their intention to immunize their baby with MMR at 1 year of age. What I also really liked was the way the benefit was framed around a child’s wellness and their ability to play and be with friends!
  2. It Serves Up a Great Reminder:  We pediatricians, nurse practitioners, family docs, RNs, and MAs need to tell families what shots children are getting and we really need to stress WHY they are getting them in the context of life. We need to make the protection a shot provides relevant every time we order and administer the vaccine!

Pediatrics Study:

In the study, researchers compared about 800 parent responses in 4 groups (each group had about 200 parents). In one group parents got information only from CDC Vaccine Information Statement (VIS) about benefits/risks of MMR vaccine. In another group, parents got information about benefits of MMR shot to their baby and the VIS information. In a third group, parents got information about MMR benefit to baby and to population, along with VIS. And in the last group parents got information only about benefits of the shot for protecting the community along with the VIS.

Results: Parents were more likely to report their intention to get their infants the MMR shot when they heard about the benefit of the shot directly to their baby or when they heard about benefits directly to their baby and the population. When they heard only about risks/benefits of shot and risks/benefit to society, the information presented did not increase their intention to get the shot.

Conclusions: Parents are more likely to want to get their child up to date on immunizations if they know direct benefit on their child’s ability to go to school and play and be with friends.

Let’s focus on what matters to parents to young children when we talk about vaccine benefits — health, wellness, play, friendship, and opportunity.

For more on benefits of MMR shot for children and the diseases it prevents read here. Immunizations do cause optimism…

Very Sunny Out: 5 Tips For Safe Sunscreen Use

sunshine in seattleIt’s really very sunny out these days in the Pacific Northwest. And although summer can be shorter up here we certainly compensate with idyllic, cloudless days. However, many of us can be out of practice protecting our skin. I’ve seen lots of tan lines and sunburns in clinic this summer. In fact, those of us living in Northern climates may carry an additional risk when it comes to the sun. One rarely known risk factor for skin cancer is living in a cool climate but vacationing near the equator. The reason? If your skin is unaccustomed to living in the sun, you tend to burn more when entering those areas of more intense sunshine.

Further, many people get confused about cool weather and sunshine. Sun intensity and Ultraviolet (UV) radiation (UVA and UVB rays) have nothing to do with temperature. No difference in intensity if it’s 60 or 80 degrees out when it comes to the sun’s effect. Reality is people burn more when it’s 80 simply because they have less clothing on and more skin exposed. As a reminder, UVB radiation varies throughout the year (it’s most intense during summer) and UVA radiation is constant throughout all the seasons.

Although the best ways to protect your family’s skin from the sun remain seeking shade (umbrellas, trees, etc), planning long-lasting activities in the sun outside of the peak sun times (not between 10am and 4pm) and dressing right for the the occasion by wearing sun protective clothing (hats and/or UV shirts often labeled “UPF” for ultraviolet protective factor). Research finds that those who rely solely on sunscreen tend to burn more, so sunscreen needs to be thought of as just one tool. 5 tips: Read full post »

This Will Not Change Pediatrician Resolve

Screen Shot 2014-07-28 at 3.50.30 PMFlorida politicians will not change pediatrician resolve to advocate for and protect children. There’s no question that a gag order cannot halt a passionate child advocate. I’d call the recent Florida ruling a dull tool taken to a very sharp crowd. Consider this post an open letter to Florida politicians…

I live as far away from Florida as any continental American (you do the math) yet Florida politics this past week affect pediatricians and families everywhere. In my opinion, every parent should tune in and follow this case. Florida just restricted physician free speech and hindered a physician’s ability to help your neighbors, your relatives, and your family create a safe environment for children.

Guns In Your Home? Do you ask about guns at playdate drop-off? Have you seen the Moms Demand Action For Gun Sense In America online presence (and progress) or follow their feed on Facebook?

Florida may have gotten this wrong thinking that restricting a pediatrician’s words and inquiry about safely storing firearms meant that pediatricians were trying to take away guns. Not so fast.

The Florida Physician Gag-Order Law:

Last Friday The 11th Circuit Court of Appeals in Florida upheld the “physician gag law” in Florida, a law that violates the First Amendment rights of pediatricians and family doctors and threatens their ability to counsel parents about how to protect children from unintentional injury and death. This started way back in 2011. Then the law was appealed. Now the appeal is overturned. This ping-ponging is just politics but the waste here is distraction from protecting children. In 2011 I explained the gag-order for pediatricians — basically it’s this: Florida says it’s illegal for pediatricians to ask about how families and guardians store firearms in their home even though we know about 4,000 American children die every year from firearm injuries. Read full post »

Fitbit Motivation, From Anecdote To Evidence

I wear both a FitBit and Shine Health Tracking Device on my wristOn Sunday night I left the house for a quick run. It was 9:20pm. It’s been years since I ran in the dark and likely a decade or more since running at night made any sense in my life. As every parent knows, we’re jailed in our houses around 8pm when the kids go to bed — if exercise hadn’t yet happened it gets pushed off until “tomorrow.”

Sunday night the Fitbit was 100% of the driving force behind me putting on my running shoes. I was about 500 steps shy of my 10,000 step goal and couldn’t go to bed, in good faith, that close to success (see image below).

Crazy or perfect? I wear 2 devices now. This month I added a Fitbit to my wrist; I’d already been wearing my Shine for a year or so and had certainly had seem improvements in self-awareness, a better understanding of my sedentary days at work, and the rewards of having daily data about my movement. I exercise a lot more now compared with a year ago. The reasons are multi-factoral of course (turning 40, losing loved ones, craving exercise) but the device has unequivocally helped. Adding the Fitbit to my wrist was designed to help hone an understanding for the level of consistency 2 devices can have (on the same person). The other reason was Fitbit would allow me to “compete” and/or compare daily totals with my husband. This is 40, my friends.

Seattle Mama Doc Tweet

before and after runNo question that in short order the Fitbit has helped me understand the difference between my movement and my activity, something I’d not really spent time on previously. For example, Sunday was a day of housekeeping. I’d moved around all day doing errands, going to store to buy hangers, cleaning the closet, goofing around with the boys, but I hadn’t been out for a run or bike ride — my first glance my Fitbit was about to give me a false sense of security. I nearly got my goal (in steps) without any real, active “exercise.” Like almost 1/2 of American adults, I hadn’t gotten the 30-60 minutes of moderate-to-vigorous activity (walking briskly, running, cycling, swimming) we all crave and need. All the sudden it dawned on me — it wasn’t just the number of steps I’d had on Sunday that mattered it truly had to be about how I got them. I was 500 steps shy of my goal of 10,000 steps but the Fitbit also told me I’d only had 2 minutes, the whole day, of active time. YIPES! Read full post »

This Makes It Tougher: LuluLemon’s False Claim

lulu lunch bagSometimes it can feel that a career of crafting prevention messages can be snuffed out in a moment. Every once and a while this work in media/messaging can take my breath away, for all the wrong reasons. Today, I realize my work educating parents and children about sunscreen use, UV radiation, aging, and skin cancer risks may pale in comparison to the potential power of a single quote on the side of a shopping bag. I mean, how can I compete with a company that sold $1.6B of merchandise last year and likely distributes tens to hundreds of thousands of reusable bags around North America everyday? Shopping bags have the luxury to walk around for years and tuck into peoples lives in remarkably intimate ways. Even I use these bags (or used to) to carry my lunch on a daily basis. It wasn’t until yesterday that I realized I’d been carrying my lunch around in a bag that goes, in part, against my entire mission. When I read about recent dermatologist outrage for Lululemon bag quotes I literally turned my head to my kitchen counter (see photo) and there sat my lunch bag on my counter just staring at me. Under the tote’s handle was the devious myth, “Sunscreen absorbed into the skin might be worse for you than sunshine. Get the right amount of sunshine.”

Now, that’s not true. In fact there is no “right” amount of sunshine and absorption concerns for sunscreen haven’t proved more dangerous than sunshine. Also, absorption varies with age and body site, here I review information about why to use physical sunscreens (and sun protective clothing) in infants when possible to reduce any risk from ingredient absorption because of their more immature barrier. That being said, I’d always recommend sunscreen over sun exposure for infants and children. The conversation about getting sunshine is centered around getting enough vitamin D. Although minutes (not hours!) in the sun provides vitamin D, we can safely get vitamin D entirely from the food we eat or a daily supplement (all children are recommended to have at least 400 IU Vita D daily). We don’t need to consume sun. In fact all sun exposure comes with UV radiation that contributes to mole production, aging, and skin cancers– even the most deadly kind, malignant melanoma. Sun protection keeps skin looking beautiful (prevents aging) and prevents skin from discoloration and cellular/immune changes that can lead to cancer.  Sun-protective clothing, seeking shade, and sunscreen are our best bets for beautiful, healthy skin. Read full post »

It’s Hot Out But The Water Is Still Cold

igram lifejacket jumpThere have been 4 teen drownings around here just in the last week. I’m left with a pit in my stomach that as the sun shines and our region heats up we lose children to preventable injuries at rapid-fire pace. This happens every year; drowning is the 2nd leading cause of injury-related death in childhood (and the #1 cause of injury death in toddlers between age 1 to 4). In general there are two groups of people who drown the most: toddlers and teens. The spaces and places (and circumstances) for typical drownings for those groups are different but the foundation is the same: water, especially cold water, is always lovely on a hot day but always poses unacknowledged dangers.

This really isn’t meant to be a finger-waggy post. This is meant to inform us all with refreshers to the opportunity we all have when living near water with children in our midst. Forward these reminders to anyone you can think of who may benefit. We may never know if we prevent a death but it sure is worth the effort to keep trying…

Drowning Statistics & Risks:

  • Drowning is second leading cause of injury-related death in children in our country following motor-vehicle crashes. In general, the risks come from improper attention to the risks of water, improper supervision, and surprise (i.e. the current moves faster than expected, the water is colder, the child toddles into the pool while no one sees in a matter of seconds).
  • Toddlers AND teens are the most likely groups of people to drown; risks are higher for boys than for girls. Toddlers drown because of improper supervision, teens tend to drown because of improper awareness of risks. In fact it’s also where you are that matters. Data has found, for example, that you’re at a 6-fold increase risk for drowning when visiting a friend’s home with a pool.
  • Cold water, alcohol & drug use (for teens or supervising adults), and distractions increase risk for a drowning or near-drowning event.

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