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Seattle Mama Doc Blog | Seattle Children's Hospital

Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Sleep Debt And “The Great Sleep Recession”

2-13 teen sleep photoTeens in the U.S. aren’t getting enough sleep and it’s not getting better as time unfolds. After days of too little sleep we accrue a “debt” of sleep. An article out earlier this month details the long-term effects of chronically tired teens, “The Great Sleep Recession” the reality that as teens progress from middle school and into high school, the majority don’t get the sleep they need. National Sleep Foundation has found that over 85% of teens lack adequate sleep. Sleep matters: deprivation and tiredness affect schoolwork, attention, mood, interactions, unhealthy weight risk and lifelong health habits. Teens need between 8 – 10 hours of sleep each night (imagine — that means if in bed at 10:30 a teen shouldn’t hear an alarm prior to 6:30am!) but the data out this month shows a growing number of teens from all ethnicities and backgrounds are getting less than 7 hours of sleep, 2 hours less than what is recommended. This has big effects on the culture we’re rearing. Typically teens won’t naturally get tired and drift off to sleep prior 10 pm, so one way to combat this sleep deficit is to push school start times to a later hour.

Why Teens Need Sleep

Sleep deprivation changes the experience of life. There an increase in risk for anxiety and for depression in young adulthood in those who don’t get adequate sleep and it’s harder to focus, pay attention, perform at school and make decisions when we’re tired.

  • Less sleep leads to more car accidents and poor judgment. Changing the time teens start school can improve safety:
    • Delayed start time lowered one county’s teen crash rates during study, while statewide teen crash rates (that reflected schools that stayed on the same schedule) rose 7.8% over same time period.
    • In a two county comparison in Virginia, the one with an earlier start time had a crash rate of 48.8/1,000 drivers vs the county with later start times 37.9/1,000 drivers.
  • Sleep deprivation can lead to substance abuse later in life and is tied to more use of caffeine and other stimulants.
  • Caffeine in the morning and afternoon, naps throughout the day and evening and/or sleeping in on the weekend help teens cope with fatigue but these band-aids and catch-ups will not restore brain alertness like sufficient sleep does.

“Sleep Recession”: Trends From 1991-2012

Graph data adapted from: http://pediatrics.aappublications.org/content/early/2015/02/10/peds.2014-2707.full.pdf+html

Graph data adapted from: http://bit.ly/1Gm8HbQ

The recession is here, teens are more tired than they were in the 1990’s.

  • Sleep recession trending
    • Teens who get more than 7 hours of sleep in decline
    • Largest decrease in sleep in 15 year-olds.
      • In 1991 72% got >7 hours of sleep
      • In 2012 only 63% got >7 hours of sleep
  • Gender gap in adequate sleep widening as girls getting less sleep than boys

How Later School Start Times Can Help

Read full post »

Cocooning For Measles

2-12 measles cocooningThe measles outbreak continues to spread, with 121 cases now reported in 17 states (CDC data as of February 6th). Many states are getting serious about detailing why exemptions for vaccines exist and looking at ways to better protect the population. This week in the Seattle Times three local pediatricians speak out for removing both personal choice and religious exemptions to protect the public and vulnerable children. And here, Dr Paul Offit writes about religious exemptions asking, “What Would Jesus Do About Measles.”

There’s no question vaccines are having their moment. We are working through tough questions. In the Seattle Times piece, Drs. Diekema, Opel, and Marcuse keenly point out:

We hold dear both freedom of choice and public health.

Finding an optimal balance is clearly of great import. This will take great advocacy and work to help continue to build trust in the MMR vaccine that is safe and highly effective at preventing measles infections.

Though I’ve been lucky enough to avoid seeing measles thus far in my medical education and career, this serious, uber-contagious disease has given some parents and caregivers pause when it comes to putting their unprotected (read: too young to vaccinate) infants in a situation where their health could be compromised. Many mothers have emailed, tweeted and Facebook messaged me asking how they can protect their little ones who haven’t received their vaccinations yet and my simple answer is this: cocooning. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections. Read full post »

Measles Outbreak With A Baby At Home

baby-O-e13075541951481Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe?”

I hate that I can’t completely say they are safe. Measles is wildly contagious and during an outbreak it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to you!). Some parents are also wondering about getting the vaccine before the baby turns 1 year because they’ve heard the recommendation for infants traveling abroad: infants traveling outside the U.S. are recommended to get an MMR (measles, mumps, rubella) shot if they are over 6 months of age (of note, babies who get the shot as an infant also get the usual shot again at 12 months of age). Without travel plans we wait to immunize babies with their first MMR vaccine until they are 12 months of age. Over 95% of babies who get the shot at 12 months of age are protected against measles and over 99% are protected for a lifetime after the 2nd dose (given at least 1 month later). Wow, right?

“This is not going to be the end-all-be-all post on protecting your infant or child from measles'” Dr Matthew Kronman, a pediatric infectious disease expert at Seattle Children’s, reminded me as we chatted today. Advice and guidance for protecting babies and children will change as we learn again how to protect our population from measles infection while unvaccinated pockets of people remain.

The CDC warns that the outbreak could grow (there’s over 100 cases in 14 states as of today) and nationally there’s a palpable dialogue going on between the herd (those immunized) and those not. Politicians are involved — Governor Christie talked today about “choice;” Obama is urging parents to immunize right along side the president of the American Academy of Pediatrics who released another urgent statement. Pediatricians, family docs, nurse practitioners and health workers everywhere are encouraging parents to get shots up-to-date to protect their own children and vulnerable populations (this includes infants).  Here’s a bit of evidence and information that can hopefully curb anxiety for parents to babies. I teamed up with Dr Edgar Marcuse, a lifelong scholar with vaccines, former pediatrician at Seattle Children’s and an emeritus professor of pediatrics at University of Washington and Dr Matthew Kronman. Here are 7 tips about infants and families that may help shape your thinking: Read full post »

Enraged By 2015 Measles In America

Screenshot 2015-02-01 12.30.40I wept at the end of the movie I watched last night, The Imitation Game. The reason really was this: it reminded me how we’re just so terrible to each other at times. How much suffering occurs when we don’t think things through. The movie wasn’t about measles or vaccination, but injustices in it pushed me to leave my Sunday morning with my children to share this:

My patience with vaccine hesitancy has pivoted. I’m embarrassed to say it took an outbreak of measles stemming at Disney to move me from impatient and passionate to hands-on-my-hips fired-up and disappointed. Today I feel a bit of outrage that unvaccinated families are not pounding on the door to get their MMR vaccine, even on Superbowl Sunday. In my mind they should be doing so selfishly (for personal protection) and they should be doing so altruistically (for others who really count on them). I expect both from the public.

Read Charlie and the Chocolate Factory author Roald Dahl’s 1988 message about his daughter’s death from measles — insane that it rings true today.

I feel somewhat enraged that many parents with babies in the United States are nervous right now about their infants getting measles. The chance is small but it shouldn’t even be a chance when there is a vaccine that is nearly 100% protective for those milling around these delicious babies. I’m angry because a friend of mine has a child who got measles when she was too young to be immunized. I’m enraged that children who fulfill their “Make A Wish” trip to Disneyland — after a liver transplant or after chemotherapy or after a tumor is cut out of their bone — must feel a little shaky making the choice to go there now. Can you imagine getting a short straw like a liver that didn’t work like it should or a childhood cancer diagnosis and then getting another one (increased measles risk) just when you’re elevated to celebrate your life? Read full post »

Wellness Visits: A Magical Place To Communicate

As 2015 gets earnestly underway, many of us are working to keep resolutions we made to better ourselves and our family as the new year continues to unfold. In case health is a part of your resolution or focus, here are a couple very quick reminders for check-ups and interactions at the doctor’s or practitioner’s office (3 tips below). I’m going to sound very much like a pediatrician here: wellness visits and check-ups add great value to preventing things. So much better than having to do the hard work of reversing problematic changes. This isn’t just about vitamins (which children don’t really need) and shots (which children wildly benefit from). This is about communication.

Well-Child Visits And Check-ups

1-28 CDC BMI chart

Courtesy of CDC

Wellness visits often get forgotten when things are going well (hurrah!) yet they serve a grand purpose on tracking health and wellness by working to create prompts and services that prevent illness. The numbers (from vision, hearing, height, weight, body mass index, and vital signs –blood pressure, temperature, respirations and pulse) help track trends and provide alerts. They help reduce bias in our thinking as parents and pediatricians. As parents we can have a tendency to both unintentionally ignore warning signs of health risks or over-analyze perfectly normal developmental phases. Case in point: half of parents of overweight/obese children underestimate their child’s weight. On the other end of the spectrum, 1 in 7 parents believe their normal-weight child is too skinny. As a reminder, reading a growth grid has a lot less to do with numbers than it does trends. The import lies in following lines; is your child tracking, are they growing at the right rate, do they deviate or “fall-off” the curve? Here’s a quick video where I explain how to interpret the growth grid if you want to learn more.

Importantly, these visits also facilitate a place to bring up the questions that nag at you. Often those things are about habits, sleep, anxiety, body size/shape, school work or mood — or just how a child sees the world. Use the prevention visit to squelch anxiety of your own. What parent doesn’t have something pulling on their sleeve of worry while raising another human? The task of parenting is always somewhat monumental and the job description is always shifting as our children grow. The stakes are high when a child’s life is guided by another. Read full post »

“I’m A Kid Like Everyone Else”


We all hope our children will get along with each other. Most of us also just want them to get the chance to be a kid amid a world of increased access, evolving speed, and constant digital communication. Immersed in the rigors of growing up right next to someone else, siblings can forge deep connection and of course deep divides. The connection part is gold…especially when it’s analog.

To foster this connection we can read Siblings Without Rivalry but we can also absorb the examples laid out by sibling units in our focus and in our own periphery.

Thankfully every once and a while something easy and authentic pops on YouTube in that periphery. For me, this week it’s the brother and sister, Nathan and Eva Leach, viral video from 2013. When I first watched it earlier this week it had 1M views, now it’s nearing 5M. Something works here. A set of siblings partnering to throw out a duet to the world. I mean in it they just LOOK like siblings! A regular kitchen in a regular life with glances to each other like everyday, regular kin. In typical YouTube form the familiarity, authenticity, and surprisingly beautiful strike is overwhelmingly refreshing in an over-marketed world. My favorite moment comes with the surprise about 2 minutes 45 seconds in and when Eva sings the line:

Baby I need some protection. I’m a kid like everyone else.

We’re all always hoping for a little harmony between our children, The Leach children hit it out of the park here. Although I am reminded this is just a tiny sliver into their lives, I’m thankful for its lesson and its reminders today. Happy Friday.

Legal Doesn’t Mean Safe: Marijuana

Legal never has meant “safe” but the two words may at times overlap in our minds. When it comes to marijuana I’d suggest there is quite a bit of confusion right now about safety, recreational and medicinal use, and the effects of use on our population. In general, as laws change and access to marijuana increases we have a responsibility to be clear about what is known.

The adverse effects of marijuana in children and teens have been well-documented. Marijuana use can impair memory, decrease concentration, and change problem-solving capacity. It’s not good for the lungs nor long-term health; teens who use pot have a higher likelihood of drug addiction later on in life, the risks increase the earlier they start using. Research also finds that teens who use marijuana are less likely to finish high school, are more likely to use other (illicit) drugs, and have an increase in suicide attempts compared to those who don’t. The more they use, the more the effect. I can’t help but think about what a mom to a teen said to me recently in clinic, “marijuana is everywhere now.”

One in 5 high school students says they have used marijuana in the last month and up to 1 in every 16 students says they use it every single day. Who are we if we ignore these numbers?

As legal may mean “safe” to some a strong statement from pediatricians everywhere from The American Academy of Pediatrics (AAP) was released today to set the record straight. The two things to know:

  1. Research has found marijuana has adverse effects on teen health. It’s now known that the brain isn’t fully developed until the mid-20’s raising real concerns about what the drug does while the brain is still forming. The effects of marijuana change how teens think in school, how safe they are on the road, and potentially how they act for a lifetime (lifelong addiction risks increase with use, teens who use are less likely to finish high school, teens who use have higher suicide risk).
  2. Use Coupled With Criminalization Can Change Lives For Good: Legalization for medical and recreational use may imply marijuana is benign; for children and teens this is untrue. History shows that teens, especially those of racial minority groups, are incarcerated at higher rates secondary to possession or use of marijuana. A criminal record can have lifelong negative effects — the AAP is advocating to decrease marijuana crimes from felonies to misdemeanors, study effects of legalization in states like WA or Colorado, Alaska or in DC, and strictly limit access to and marketing of marijuana to youth. The big concern here as well is that policies that lead to more adult use will likely lead to more adolescent use. Decriminalization is especially important in states where recreational use is legal for those over 21 years of age.

Read full post »

Friends And Bacon

At dinner tonight we had breakfast for dinner (genius meal when you’re stumped by an unending need to create something “new”). At the end of the meal we were all discussing our love for bacon. Without a beat this came from the 6 year-old in our midst:

“Mama, could I live a long time and still have a piece of bacon everyday?”

I thought about it. Yes, it seems, yes. Yes, every day with bacon!

“Yes, I said, “I think you can have bacon but only if you exercise everyday and if you have really great friends. The kind of friends that make you feel alive.”

I launched into some sort of summary of the art of moderation with bacon, pouring out facts about fats, cholesterol, and diverse food choices – the essential need to balance bacon with things that grow in the ground. As I waxed on with a macronutrient-level discussion the 6 year-old in front of me just kept moving with his idea. Turned out he wanted concrete responses for his life with bacon. He pushed into the friendship part.

Screenshot 2015-01-22 20.20.23A long life with bacon goes something like this: of course you need to eat a lot of other goodnesses with your bacon. We can borrow wisdom from the Mediterranean diet and reduce the red meat we eat, put fish on the table twice a week, eat lots of seeds and nuts and ensure fruits and veggies show up on every plate we serve. Debates will wage on about the magic foods we eat, today it was the complexities to the value of an orange over OJ so we always have to put food advice in the context of life. I told my 6 year-old tonight he’d have to exercise every day and get outside, twirl around without a ceiling, take a lot of steps, and be connected with nature.

But perhaps most essential to living a long life (with bacon), I repeated, is solid choices with whom he chooses to live his precious life. If you’re going to eat bacon every day you have to make great friends and forge partnerships with those who make the world feel possible. In my mind you need soul-fetching friends — the ones who literally make you feel like you can fly. We have to spend time with those who let us unpeel ourselves without judgment and urge us to take risks, help us take our time, and lend support to shelter whatever we consider dear. Read full post »

Influenza Hitting Hard: OTC Medications For Symptoms

Image courtesy: http://www.cdc.gov/flu/weekly/#S5

Image courtesy: CDC

Influenza is hitting hard this year thanks to a drifted influenza strain (H3N2) causing a more serious illness and one that is not included in our annual vaccine. Because of the hard hit, public health officials are reminding us to get high-risk patients into see physicians early if they have symptoms of “the flu” or influenza infections. Reason being, those at high-risk for complications may benefit from a prescription anti-viral medicine that can lessen the burden of illness and decrease risk for complications. Over-the-counter medicines you buy don’t fight influenza.

What Is “The Flu” And What Is Influenza

In general, in healthcare we use the term “the flu” when discussing an infection with influenza, a virus that causes widespread body aches, high fever, cough/cold symptoms, headache or even leg aches. Some children vomit with influenza infections as well (incidentally many patients with lab-confirmed influenza that I’ve seen this winter have also been vomiting) although in general influenza infections are upper and lower respiratory infections, and not the “stomach flu.” We worry about influenza as it’s in the list of top ten causes of death in the US and because it can cause severe symptoms, even in children. Infants and young children are at particular risk for serious infections as their bodies and their immune systems haven’t fought off influenza before.

High risk patients: 

  • Children 2 years & younger (their immune system not as robust and not as much “memory” to fight off severe influenza infections).
  • Adults age 65 year & older (their immune system is aging and not as robust fighting off severe influenza infections).
  • People with underlying health problems (including asthma) or other lung problems, other chronic health conditions (like diabetes, heart disease).
  • Pregnant moms or newly postpartum moms.
  • Those people immunosuppressed.

The Numbers So Far

According to the CDC, widespread influenza activity is being reported in 46 states. The most common strain is that drifted virus H3N2, accounting for over 90% of the more than 5,000 reported influenza-positive tests recorded last week (ending January 10). It’s still too soon to tell whether we’ve reached the peak of flu season, however there are early signs that the virus is lessening in parts of the country. So far, this year the influenza vaccine is estimated to be about 23% effective, clearly not as effective as usual but still providing some protection.

What Over-The-Counter Medicines Can Help With Influenza?

It’s important to remember that over-the-counter (OTC) medications cannot cure “the flu” nor shorten your suffering with symptoms. They’re designed simply to help you get through the illness and should be taken within the proper guidelines. In general children under 4 should not be given OTC cough and cold medicines. 

That being said, there are four types of medications that can make getting through the flu a little more bearable. Read full post »

Sleeping With A Smartphone

460297347Turns out small screens in the bedroom may be worse for sleep than a TV. Little screens enter the room without much effort, stealing away in a pocket or backpack without notice; smartphones also grab our attention in novel ways. The light emanating from small screens is really close to our face (potentially interfering with that lovely melatonin spike before bed in ways a TV across the room cannot) and small screens are often interactive, requiring us respond or type back, provoking alertness. The first study evaluating effects of smartphones and tablets on sleep in US children is out. While the news isn’t surprising it isn’t good either.

We may be raising a really tired generation of children.

I’ve been chatting for years about trying to keep TVs out of childrens’ bedrooms. Simply put, television adds little to a child’s life when viewed right before bed. In fact ,Seattle Children’s experts Dr Michelle Garrison and Dr Dimitri Christakis have shown consuming television just before bed can cause children to have more trouble falling asleep, more nightmares, and more awakenings during the night [here’s more info–> why no TV before bed is better]. Recently though, we learned what we all likely suspected: interactive, small screens may be even worse for a child’s sleep than the TV. Tablets, TVs, iPads, and smartphones are for most adults and kids a normal part of everyday life, even during infancy and toddlerhood. 2013 Common Sense Media data finds 45% of 5 to 8 year-olds have a TV in their bedroom and 72% of children from birth to 8 report using mobile devices during the day.

A study out this past week in Pediatrics shows small screens in the bedroom have a troubling effect on children’s sleep. Read full post »