Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

No Benzocaine For Teething Babies

Hallelujah, I’ve been saying I don’t like teething gels since 2010. This is a PSA for all parents out there trying to help soothe their teething baby. Today, the FDA came out and said avoid using over-the-counter teething products containing benzocaine. That means no teething gels like Anbesol, Baby Orajel, Cepacol, Chloraseptic, Hurricaine, Orabase, Orajel, Topex or other generic brands. The agency said “products containing the pain reliever benzocaine for the temporary relief of sore gums due to teething in infants or children should no longer be marketed and is asking companies to stop selling these products for such use. If companies do not comply, the FDA will initiate a regulatory action to remove these products from the market.”

This is great news for parents (and pediatricians who have been advising against it for years). In general, I think most pediatricians think of teething as a developmental milestone, not a condition that demands medicine. That being said, we always wanna make our babies, who may look uncomfortable, more comfortable. But the last thing we want to do is reach for something that might cause harm.

The reason to avoid teething gels? Benzocaine use can lead to methemoglobinemia, a rare, but dangerous condition that is the result of elevated levels of methemoglobin in the blood which can lead to death. Basically, when methemoglobin is present in the blood, it changes the way hemoglobin carries oxygen around the blood, preventing it from getting where it needs to go. This can lead to decreased oxygen levels and even death. A horrible, rare problem that can be provoked by benzocaine.

Instead of benzocaine products, try following the American Academy of Pediatrics (AAP) recommendations to help soothe your little one as their chompers come in:

  1. Use pressure and massage! Try gently rubbing or massaging the gums with one of your fingers.
  2. Cool comforts are great like wash cloths in the fridge or even chopped up, soft frozen fruit in a teething strainer. Teething rings are helpful, too, but they should be made of firm rubber. (The teethers that you freeze tend to get too hard and can cause more harm than good.)
  3. Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the baby’s mouth within minutes. This includes the ones with benzocaine and the ones without!
  4. Stay away from teething tablets that contain the plant poison belladonna and of course as above, gels with benzocaine. Belladonna and benzocaine are marketed to numb your child’s pain, but the FDA has issued warnings against both due to potential side effects, and now they’ve gotten more serious with the ban.  Read my 2010 blog post on this topic here.
  5.  The AAP says, “If your child seems particularly miserable or has a fever higher than 101 degrees Fahrenheit, it’s probably not because she’s teething, and you should consult your pediatrician.” Here’s a short video on fever and teething. (Check out my short hair and bootleg video skills circa 2011).

5 Quick Things: Hot Cars, 13 Reasons Why, Marijuana Smoke, Single Sports, Co-Sleeping

I recently changed up the format of reporting I do with my local NBC affiliate station KING5 News. I’m doing more of a weekly roundup of pediatric studies, current events and newsworthy topics that I think are important for parents to know about. For those of you who aren’t able to tune in, I wanted to share a brief synopsis of what I’m covering. Let me know what you think! What topics would you want me to talk about?

  1. 13 Reasons Why: Netflix released the second season of “13 Reasons Why” a popular show about a high school student’s suicide. A recent Pediatrics study that found hospitalization rates are increasing for suicide attempts and ideation (doubled between 2008-2015), so this show’s release was particularly untimely. I really appreciate the HealthyChildren.org page with strategies for parents to discuss the show with their teens. These portrayals in media matter: using Google Analytics, data found that there was a significant increase in online searches for suicide, including searches for how to kill oneself, in the days after 13 Reasons Why debuted. This increase reflected as many as 1.5 million more searches than expected, with a 26% spike in searches for the phrase “how to commit suicide.” Reminder that all teens should be screened every year for depression starting at age 12. Here’s a fantastic piece with 13 Things All Pediatricians Should Know About 13 Reasons Why but I think all parents should, too.
  2. Kids In Hot Cars: The weather is heating up and so are our cars. Remember it doesn’t have to be record heat outside to be dangerous inside the car. Especially for children. A child’s body heats up three to five times faster than an adult’s does. In just 10 minutes, your car can rise 20 degrees in temperature. So, for example, if it’s 80 degrees outside your car can heat up to 123 degrees in an hour. TIP: Put your cell phone, bag, or purse in the back seat, so you create a habit in checking the back seat when you arrive at your destination.
  3. Marijuana Makes 2nd Hand Smoke, too: A recent study out finds that marijuana use is increasing among parents who have children in the home. This means children’s exposures are changing. Cannabis use is nearly 4x more common among cigarette smokers. Because of this, second-hand smoke comes into focus again for big reasons: the combined use of cigarettes & marijuana ups 2nd hand exposure for children. Both are bad for little lungs.
  4. Don’t Focus On Only 1 Sport Prior To Age 16: Your child is unlikely to become a pro athlete (harsh reality for us all) and drilling down on one sport likely won’t ever help. Parents have falsely been guided that specialization and mastery in a single sport early in life is GOOD for their children. Indeed focusing early and often on one single sport may discourage, not improve skills, and leads to overuse injuries, burnout, isolation, and less love of lifetime sports play. I encourage parents to keep their children from specializing in a single sport until age 16. Here’s a post, podcast, and infographic that spells it all out with tips on how to take breaks and how to grow a life-long athlete who loves it!
  5. Do You Co-Sleep With Your Baby Because You’re Sooooo Tired? A recent NPR article opened up the door for discussing how impractical sleep guidelines for newborns can feel to new parents. Tired moms and dads may be co-sleeping and bed-sharing with their babies and not want to tell pediatricians. This is a complex challenge that involves not just infant risk for SIDS but parental risk with bed-sharing if parents are sleep deprived. I hate thinking parents don’t feel comfortable telling their pediatricians what they’re really doing. Closes down the opportunity to reduce risks in the reality. We don’t do a good job supporting families with paid extended maternity and paternity leave and it’s making us tired! Really tired mamas and papas shouldn’t be bed-sharing if they are sleep deprived, especially if dealing with the demands of full-time work at the same time. Here’s a post, “Is Co-Sleeping Safe?” where I mention a bit more and explain how I’m working with the head of our Sleep Center to think on some ways to help tired families more practically. Please do the poll!

Like this? Too basic? Good? If so, I’ll try to keep it up weekly. Please opine in the comments…

Is Co-Sleeping Safe? Do You Do It?

The short answer to the title is —- not really, and the risk varies. But I sure get why so many parents want to co-sleep despite most pediatricians urging against it.

I was up early yesterday morning listening to NPR when a story about parents’ love and desire to sleep with their babies grabbed my attention. The headline reads: “Is sleeping with your baby as dangerous as doctors say?” I mean, parents (like me) want(ed) to co-sleep and bond with their babies, of course, especially when their babies fuss and cry and especially when parents are exhausted. Every pediatrician hears and understands the parent who says something like, “By 3am I was just so tired I plopped her in bed with me after feeding and gave up on the bassinet.”

Parents ARE tired and want to make that crying, noise, and a baby’s sadness go away. The piece opened up the challenge in parents feeling judged or insecure about sharing truths with pediatricians who have strongly advised them to separate sleeping spaces. Many parents may feel that if they continue, in overwhelm, or instinct, or in love to bed-share and co-sleep, they have to keep it from their pediatrician.

The rub here is pediatricians want what is best for families and what’s best for the bond between babies and their parents. But they also want to protect babies as best they can with the evidence fueling guidelines and advice.  How we’re talking about this may miss some salient points in American family lives.

Putting babies on their back in safe sleep environments has proved so helpful for protecting babies. But the guidelines may have focused too little on the risk that comes with over-tired parents who just can’t follow the advice and the risks co-sleeping may pose particularly when a tired, working mom co-sleeps out of desperation. Sleep experts have helped me understand that sleep deprivation changes arousal and it may be riskier for an over-tired parent to co-sleep than a better rested one.

Science and data have guided pediatric policies to say that co-sleeping and bed-sharing are not safe and should be avoided. The American Academy of Pediatrics states that “it should be avoided at all times.” Bed-sharing and co-sleeping can put babies at risk for SIDS, accidental suffocation, and/or accidental strangulation. About 3,700 babies die each year in the U.S. from sleep-related causes. These numbers and policies have urged pediatricians to help parents find ways to have babies sleep near-by, in the same room, but on a separate surface. But when parents can’t follow-through on the advice or don’t agree with it, they may just be staying quiet.

Parents are tired! Parents want to enjoy their babies! Parents want their babies to thrive! Pediatricians do, too.

But maybe it’s not as cut and dry as this. Maybe there are some co-sleeping scenarios that may be lower risk than others. Maybe we need to acknowledge this and help guide families to some of the nuance in the data and the risks. Eliminate all risks we can but take into account how families want to live (and will live) outside the exam room walls.

This morning, after the story I immediately got on the phone with my friend, colleague, and sleep expert, Dr. Maida Chen to discuss the topic. The guidelines, the need for them, and ways that we might consider supporting families and helping them understand all she does about sleep, risks, family, working parents fatigue, a lack of great maternity leave support, etc.

“Sleep deprivation makes co-sleeping unsafe. I consider full-time, working moms and frankly any mom with obligations beyond their newborn at high risk for sleep deprivation, and I would not recommend they bed-share with their babies. If you’re back at work, or taking care of other children, or going to school, or taking care of family members, you’re probably sleep deprived. In an ideal world we would have 1 year of paid maternity leave, but that’s just not the case.” ~Dr. Maida Chen

Other risk factors that increase dangers with co-sleeping include: having a premature baby, parents who consume alcohol, smoke and/or use drugs that would change their level of arousal or movement in bed.

Oftentimes our maternal drive, love, and bond with our child are what drives us to want to soak up baby snuggles. Or the fact that most babies just sleep better when being held. Or nighttime feedings are easier this way. Or all of the above.

This isn’t a comprehensive post – rather a post to acknowledge how complex sleep guidance can be when the advicde isn’t taken and the truths aren’t then heard. I want all parents to do the best they can and also always eliminate all the risks they can. Dr. Chen and I are thinking of building some digital tools to help families understand the data more, mitigate risk, and incorporate their real-life decisions and realities into decision-making. But we want to start by understanding where we find you, even today. Help us by first just answering this question? We’ll be back with some more (questions, and information). Stay tuned. And please share.

Car Seats and Booster Seats And Your Precious Cargo While Carpooling

A friend pulled me aside last week urging me to write about car seat and seatbelt safety. His family had been involved in a rollover accident on the way home from school — literally, just turning in an intersection, as I understand it, they were plowed into by another car which caused their car to flip. No one was seriously injured, thank goodness, but the children were left dangling upside down, hanging by seat belts, until the medics arrived. Clearly they were shaken…and reminded how precious our time is on this planet — and how the most dangerous thing most of us do everyday is drive. All the children had seat belts on and all the children were in the back seat. Phew!

Thing is, just after this dad urged me to write this, I mean literally, just minutes later, we pulled away from a group of parents at pick-up and I watched an 11 year-old get into the front seat of her family’s car and drive away. My stomach dropped. Children under age 13 shouldn’t be in the front seat and goodness gracious, the irony of the timing just got me in the gut. Hard to message and write about something that I feel parents don’t want to know more about. Something about a laxity here for many people remains…seems this is advice many already feel they know (and don’t want to take).

3 reasons children shouldn’t sit it front seat until age 13 years: 1) It’s always safer to ride in the backseat (it’s also illegal to ride in front under age 13 years in WA state), 2) children under age 13 years are at increased risk for injury from airbags (designed for a 140 lb male), and 3) children’s bone development at the hips and breastbone is immature leading to increased risk of more serious injury in front seat

When it comes to infants and little children, maybe it’s different — I feel like parents are more interested in the data and reminders. Research out last week confirms what pediatricians have been recommending for years: rear-facing car seats to keep children safer in rear impact collisions. “We found that the rear-facing car seats protected the crash test dummy well when exposed to a typical rear impact,” said lead study author Julie Mansfield. If you’re hit from behind or the side or the front, we want children under 2 years of age rear-facing! Read full post »

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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