Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Online Easy Access To Immunization Records

The digital health world recently took a step in the right direction when it comes to supporting access to your health care information. You can now be in charge of both your own and your family’s immunizations records in several states through a tool and online resource called MyIR (think “my immunization registry”). You can register yourself and your dependents and access to your official, consolidated immunization records on any device, any time. How great is that? No more calling your doctor’s office and asking them to fax your records over. Waiting for snail mail to deliver a copy is a thing of the past. For procrastinators with school paperwork, this is for YOU! With back to school rapidly approaching, now is the time to get your children up to date on their vaccines. And a great time for you to have unfettered access to the records.

New Immunization Record Access: MyIR

  • MyIR gives you access to your official, consolidated immunization records on any device, any time
  • Records get updated immediately after any new vaccine is given
  • Can be printed to give schools, athletic clubs and day cares
  • Available in: Alaska, Arizona, Louisiana, Washington & West Virginia

Here’s How To Get Your Immunization Record:

  • Visit: www.myir.net and register.
  • You can register yourself and any other family members
  • Verify: click Auto Match to have the site match your account with your state records
  • If Auto Match can’t find an exact match, click State Assisted Registration and follow steps (I had to do this and it was very efficient!).

myir auto matchmyir verify

2016 Vaccine Updates In Washington State

  • Last year, 85% of WA State kindergarteners had all required immunizations. Ideally we’ll get that up closer to 95%
  • Need 2 chicken pox shots documented this year. This year, schools are requiring documentation for all children in K-12 fro varicella vaccine. Parents need to make sure the school has the record to prove children have had both doses (given typically at 1 year and 4 year well child check-ups).
  • The flu vaccine is not required for school, but is safe and essential — flu vaccine is recommended for all children over 6 months of age.
  • Nasal flu vaccine not recommended this year — only option is the poke, but it’s the best bet at protecting your children from influenza!

HPV Vaccine Reminders

  • The HPV vaccine reduces the risk of cancer from HPV for boys and girls. It also reduces the likelihood of getting genital warts and lesions after teens or young women and men becomes sexually active.
  • All teens benefit: girls & boys receive 3 doses of the HPV vaccine starting at age 11. First dose at age 11 years, a second dose 2 months later, and a third dose at least 6 months after the first dose. If you wait a bit longer, the series doesn’t have to be restarted so get in to get the booster if you haven’t finished all three shots in the series!
  • No benefit in waiting!  The vaccine is proven more effective at younger ages (age 11 tends to give a more robust immune response than when giving the vaccine in later adolescence). There is no health benefit in waiting in immunize your teens — same pain with the poke but more time a teen could be exposed to HPV.

 

Read The Label And Know What Is In OTC Medicines

Quick reminders as we tidy our lives at the beginning of the school year. With little ones and children all heading back to school, we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the fall is upon us, it’s a great time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, and organize the cupboard! In some ways it’s combination medicines that make me worry the most — so this is a quick review on what you can do to feel confident when dosing and using OTC medications at home with your family.

Reading Over The Counter Labels & Dosing Liquid And Children’s Medicine:

1. Read the label.  Plain and simple get in the habit of always reading it as we don’t want to forget to make sure we really know what ingredients we’re giving and why. No question that sometimes we use medicines to “cure” children of illnesses, infections, or deficits (prescription antibiotics, anti-infectives, chemotherapy) but most OTC medicines only treat symptoms our children experience from infections or injuries. That makes them less necessary, although sometimes wildly helpful and soothing. Treating pain and discomfort is of course a priority for all parents when our children are uncomfortable! Consequently, we want to use OTC when they earnestly help and match the correct medicine with the symptom we’re targeting…the label can help.

reading labels 2

2. Know the ingredients — watch out for double dosing! So many products out there have combination medications. Many medicines for cough and cold will combine medicines for fever with medicines for mucus with medicines for cough. Some medicines combine medicines for allergy symptoms with medicine for fever. You might inadvertently be giving your child a second dose of acetaminophen (AKA “Tylenol”) when using a combination medicine without knowing it. Expert toxicology and pediatric emergency room friend, Dr. Suzan Mazor reminds, “that sneaky acetaminophen shows up in all sorts of combination medicines” so watch out! If you’re dosing acetaminophen for fever make sure you’re not double dosing if you’re also treating other symptoms with medicine.

3. The syringe or dosing cup -KEEP IT! Keep the dosing devices that comes with the OTC medicine you buy (use a rubber band as needed to attach it to the bottle)! No question that it is confusing to dose medicines based on weight. In the past, data finds that 98% of liquid OTC medications for children have inconsistencies, excess information, or confusing dosing instructions — thankfully this is changing and there is national push to have pediatricians write and explain doses only in milliliters or milligrams as opposed to dosing and explaining in “teaspoons” and “ounces.” As we work to standardize this there will still be some confusion.

TIP: Never use a “teaspoon” from the drawer to measure medicines and don’t let Grandma or a babysitter. Different teaspoons hold different amounts. Dosing devices typically measure in either milliliters or ounces, so always use the tool that came with the medicine you’re going to give a baby of young child. If you’re ever confused reach out. Using the dosing device that comes with the medicine will help ensure you won’t have to make conversions (mL –> ounces or milliliters to teaspoons) and you can follow instructions on the label more precisely. Dosing by weight (like we do for children) is very different than dosing by age (like we do for adults).

Know Your OTCs have created a few easy-to-read image to help better explain OTC labels. I’ve included a few below, but you can view them all here.

reading labels 3  reading labels 5

 

5-13 know your OTCs

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

6 Ways To Help An Anxious Child

No question it’s tough to keep our cool when our children are unraveling. It’s especially a challenge when our children are rattled and over-run with anxiety. I partner with parents on a weekly basis who feel their children are anxious. All of us want support in knowing just what TO DO in helping our children thrive while also not letting them suffer.

I partnered with Dr. Kathy Melman on the podcast to review tips and strategies for parenting when children are anxious or when our children suffer from anxiety. Dr. Melman is wonderfully steady and clear in knowing what we can do when we find ourselves amid a sea of anxiety. Dr. Melman explains how to improve the environment for our children, what we can do for ourselves as parents to protect our children, and how to help our children not only cope but thrive in the face of anxiety, disruption, fear, and challenge. Listen in and read her 6 tips below. Number four is a BIGGIE…

6 ways to Help Your Anxious Child:

  1. Modeling Matters: If a parent struggles with anxiety—get evidence based cognitive behavioral therapy (CBT) treatment with an adult anxiety specialist. Caring for your own anxiety will limit how your child models undesired behaviors.
  2. Intervene early and effectively! If your child shows signs of anxiety that is causing distress and/or interfering with functioning, seek CBT treatment with a child anxiety specialist. Don’t wait years for help because untreated anxiety can lead to problems including possible school refusal, lack of friends and opportunities to develop social skills, limited development of independence, healthy sleep patterns, lack of involvement in activities outside of the home, substance use and depression as one’s life shrinks with loneliness, low self esteem (“I can’t handle this”) and lack of building mastery. Anxious children often don’t get the help they need and when they do, they have often already suffered for years, other problems have developed, and they often don’t get the most effective, evidence based behavioral treatment.
  3. Acceptance and Empathy: Accept if your child is “wired together” to have more anxiety and be empathic, rather than invalidating, of their experience. Taking the moment to accept their feelings (even when they seem outlandish!) will allow you to both acknowledge and then support your child more effectively.
  4. Don’t Permit Avoidance: It is really hard to see your child suffer and parents often, meaning well, allow their child to escape and avoid anxiety provoking situations. As a parent, it is important to learn to tolerate this distress, remain calm and know that permitting escape and avoidance and providing excessive reassurance only strengthens anxiety, reinforces your child’s thoughts that the world is a scary place and the belief that they aren’t capable of coping effectively. This is an important dance parents often do with their anxious children and it is critical to change this pattern.
  5. Reward Brave Behavior: Instead of paying attention to anxious behavior, reward use of anxiety management skills (recognizing when anxious, which situations trigger anxiety, what happens in your body, what are your thoughts, calming your body, challenging unrealistic, catastrophic thinking with checking the facts to develop more realistic thinking along with coping and calming thoughts, and approach feared situations in a gradual, manageable, step by step fashion). We are asking our children to do what terrifies them so provide them with empathy, support, skills and coaching so they overcome anxiety by facing their fears and learning that they can, in fact, do this, nothing terrible will happen, and they can live a full life that is not limited by anxiety. Rewarding use of skills and facing fears (known as exposure) helps your child do what is challenging. Exposure is the most important ingredient in effective treatment of anxiety.
  6. Be Involved in your Child’s CBT Anxiety Treatment: Parental involvement is critical for many reasons including learning about anxiety disorders and their treatment, learning which parenting strategies increase and which decrease child anxiety, learning to coach your child in use of anxiety management skills in challenging moments, not permitting the dance of avoidance, modeling use of skills and brave behavior, learning to tolerate when your child is experiencing distress and responding with empathy and approach, providing many opportunities for exposures and rewarding brave behavior. Parents can also use their understanding of anxiety disorders and their effective treatment to communicate important information with schools, coaches, grandparents and other involved caregivers and settings.

Do You Have An Anxious Child?

No question, hands down, I get more requests from friends, family, and acquaintances for help finding support and and advice parenting anxious children than any other pediatric issue in the school years. So it’s my sincere DELIGHT to introduce and partner with Dr. Kathy Melman on my podcast. Dr Melman runs the outpatient psychiatry and behavioral health clinic and has decades of experience advising families and supporting anxious children. She helps translate the facts around what causes anxiety, how to discern anxious behavior from clinical anxiety, and helps parents understand just what we know and what we don’t. Her tips and advice below!

Where Does Anxiety Come From?

1. Anxiety is a normal emotion and a natural part of life. Fear exists in all of us and there are typical fears that are seen at different developmental stages such as Stranger Anxiety (clinging and crying) at 7-9 months of age. This happens as the child goes through developmental changes such as the stronger ability to differentiate familiar faces from those that are unfamiliar. Anxiety is a normal and important emotion that is adaptive and protective. For example, anxiety helps us stay away from dangerous situations such as leaving or not entering a building when we see smoke or fire or smell something burning. Imagine living at a time or in a place without grocery stores or restaurants for securing food, without homes with locking windows and doors. Imagine that we instead have to venture out to hunt and gather food with concern about dangerous animals or people lurking behind a bush. In this situation, concern about safety is warranted and being vigilant, scanning the environment to pick up on danger cues would help someone survive. The rush of adrenaline that occurs when highly anxious is called the “fight or flight” response and it helps someone escape or avoid dangerous situations.

2. Environmental Stress: Anxiety increases in more stressful situations. This can includes fear of safety, homelessness, instability with frequent moves or other important life changes, loss or death of caregivers or other important people, war, hearing or seeing disturbing news, economic difficulties, abuse, sexual assault, bullying at school, high pressure, expectations and demands in school, home and/or activities. Even in healthy, safe environments, all children experience some anxiety. For example, occasional or short lived worries occur when a child is faced with an especially stressful or new, unfamiliar situation. These are real issues with all that is going on in the world right now.

3. Environmental Learning: Dr. Melman reminds, “Children Learn What Children Live.” Modeling matters. Listen to what Dr. Melman shares in the podcast about overprotection and the risks of being over-involved.

4. Avoidance. Anxiety is maintained and strengthened by avoidance. Through avoidance, you don’t get to see that your worst fears will not happen and that you can, in fact, do it! Let’s look at an example of a child invited for a sleepover at a friend’s house. Perhaps this child is not experienced with sleeping away from home and struggles with sleeping in his own room and bed at home. The idea of a sleepover sounds fun and then reality hits as the time to go to sleep approaches. The child becomes panicked, maybe with physical symptoms such as heart racing and pounding and stomach aches. He has thoughts that he won’t be able to fall asleep or that something bad will happen like a robber breaking in, and calls his parents to pick him up which they do. The child starts to feel relieved and no longer anxious as soon as they learn that they can escape this feared situation by going home. The child’s fear and desire to escape and avoid is strengthened because of the strong relief is experienced when rescued and by the fact that parents agreed that there was a need to come home rather than an ability to cope, ride out this wave of distress, stay the night and see that nothing bad happened and that he could, in fact, be courageous!

5. Expecting Bad Things to Happen: Anxious thinking also plays a role in where anxiety comes from.

6. Genes: Anxiety Disorders runs in families. What can we do if our child has a genetic loading for anxiety disorders? While we can’t change genes, we can aim to reduce stress in our lives and change our own modeling and reactions. We can learn to understand and accept our child’s temperament/wiring and empathize with our child’s feelings while also teaching our children how to think more realistically about the world, to expect less danger in situations, and encourage our child to approach in a gradual and consistent manner the situations that he or she fears. We can give our children skills to cope more effectively with challenging situations.

Doing Something New

FullSizeRender (7)Over the weekend I took a trapeze lesson. Like a real one — one where in a matter of minutes an instructor quickly details how to get the safety harness on, how to jump up to the bar, throw your legs over, arch your back and fly through the air. The goal is to learn (rapidly) how to accustom yourself not only to the environment and to the sport but to let go of the bar, fly through the air, and catch a partner’s arms who is simultaneously swinging on another trapeze. All this WAY up in the air.

Within a few moments of some ground instruction we were escalating into the air up a ladder some I don’t know, 20 to 30 to 40 feet in the air. You lose perspective of distance the faster your heart beats. The instructions came quickly, the rapid-fired commands kept thinking to a minimum while also maintaining transitions with necessary momentum. For the first time in a long time I was really doing something I’d never done before. I’d never met these instructors, I’d never been to this place, and I’d not swung upside down by my knees since middle school. At the same time that I was asking my mind to override a great fear of heights I was demanding that my body acquire a new set of muscle memories and choreography. It was oddly taxing. Because of that, I suppose, it was also wildly rewarding when I was successful. There truly was a moment when I thought I may not climb the ladder.

We ask our children to do this constantly. I mean…..constantly. We drag them to new places, we meet new people, we ask them to rapidly acquire new coordinations, new social situations, new goals. And all the while we expect them to do so without much anxiety, without much complaining, without much of a margin for TERROR. This is childhood, this constantly newness, and I would like to say today I think we’re out of touch.

Exhibit A: Over the very same weekend where I trapeze-d through the air I piled my boys into the car Saturday morning after I mentioned we’d drive to a new place, meet with a new man who would instruct them in a music lesson both on a known instrument and a on a new one. I didn’t think it would be such a challenge. But when I heard the instructor quickly explaining what it meant to transpose from the key of C to G and my the neurons in my own mind went into a pretzel I wondered just why the little dudes weren’t curling up on the floor saying, “there’s no way I can learn this so fast.”

Sunday we did things we’d done before.

But then WHAMMMO, on Monday morning, less than 48 hours after Exhibit A, we drove to another place my boys had never been, we walked into a room full of complete strangers (we truly didn’t know a soul), and I left my two boys to this group within about 10 minutes. This was just a summer camp they’d never tried before: Exhibit B. But if we zoom out to a fair perspective it was also a foreign country of experience a vast ocean away (new camp, new people, new place, new skill requirement).

I walked to the car, tears welling up in my eyes, after seeing the look on my 7 year-old’s face as I left the room. It perhaps perfectly captured his reality. It was something like this:

I’m terrified, Mom, to stay here and do this but I believe you that it will be fun and I believe I am capable and I believe over-riding the terror I feel will lend itself to something good. I know I will reap the colorful reward of accomplishment, connection, new friends, and fun. But I’m scared and I am asking a lot of myself every single time I do this

And the trapeze reminded me. We ask our sweet babies to learn and reach and stretch and grow and start things new constantly. Think of a new school year. This post just a reminder, after a quick lesson at 30 feet, we have to remember the herculean tasks we expect and the patience we can have for nurturing tremendous grit but also the compassion we must also embody as we acknowledge the enormity of the challenge in doing something new.

How To Talk To Boys & Girls About Sex

I haven’t felt like a pro in knowing how to talk about sex with my boys. No matter that I was a middle school science teacher, I’m now a pediatrician and an ever-evolving mom of two. It’s a tough topic even for me as a “talker.” So it was a TRUE JOY and huge relief (let’s be honest) to podcast with two international pros in talking-to-girls-and-boys-in-building-up-esteem-and-confidence-and-knowledge around puberty and sex…

This past month I spoke with Great Conversations co-founders, Julie Metzger and Dr. Rob Lehman. They share their profound expertise and compassion in talking to boys and girls about sex and sexuality and supporting children growing into adults. We broke these podcasts up by age — what to say to a 9-year-old versus what to say to 12 year-olds and what we can say to our teens. I learned so very much from these courageous, kind, and amazingly brave experts — about our connection to the success for our children — and how we meet soul-to-soul with our children in conversations as they traverse life and sex and growing up.

4 Quick Tips For Talking About Sex With Boys and Girls:

Here’s a few takeaways but really, it’s better if you listen to Julie and Rob explain in the podcasts. Really.

  1. “Don’t over speak!” advises Julie Metzger. It only takes 1 minute of courage! Our kids and teens don’t want long-winded, hour-long conversations when questions come up. Keep it short and simple and don’t freak out. Julie teaches girls to plant questions when there isn’t even time for a big response so we adults can get ourselves together to respond. And she reminds: swift, authentic answers when children ask questions are likely best. Phew… one minute of courage. I can do that.
  2. Happenstance helps: Some of the best conversations happen because of what is happening in the world (dogs mating, Janet Jackson’s top falling off, buying tampons and children asking about it). And this is a series of a bazillion conversations throughout a child’s lifetime, not one BIG SEX TALK. Let the nuance and randomness of life support your conversations over time about sex, sexuality, their bodies, and their opportunities.
  3. Everybody wants this to go so well: So many people want puberty and “the sex talk” to go well but even more so, everybody wants a child to do well in their teen years as they grow up. These children are literally flanked by those who want the best for them. From teachers, to parents, to coaches and pediatricians, relatives and neighbors. You have a network of people who want to help and support your child/teen through this time period — remind your teen.
  4. Lead with the positives and avoid conversations that involve “don’t.” You can express your values without closing doors. Opening lines for sharing your beliefs without shutting things down for your child: “What we hope for you is……” or “in our family we believe….” And the other thing — if and when the puberty talk comes up or the sex talk floats in the air, talk about the great things in puberty first (getting taller, gaining independence, more feelings of love and crushes and lust for others) before delving into the tough stuff that may seem a bit unsavory.

Helpful Resources

Falling In Love With Reading In The Morning

IMG_8510A couple of weeks ago I read a piece entitled, “The Right Way to Bribe Your Kids to Read.” I was raised by two parents that scoffed at the idea of paying for grades and certainly never used money as incentive for habits and behaviors that were “good” for me. So I suppose like all of us, I am a product of parental molding, and therefore lean into that belief. So when I opened up the article in my hands it was with skepticism. Sure, it turns out, lots of you believe in using allowance or money, even in tiny allotments, as reward for the lovely habit of learning to love to read. That extrinsic motivation isn’t wrong — and there’s a bit to it, incentive-wise. The article reviews how it can work and how it certainly does for some families with somewhat hesitant, young readers. And although it didn’t convert me into pushing quarters around the house to urge the boys, the article really has changed the last week and a half around here.

Not all babies come out great sleepers and not all babies come out eager readers. That being said, even those of us who don’t come out that way sometimes learn to love it (I’m exhibit A). We really should read to our babies the day they are born.

I’ve got one boy in my house who can’t get out of the books. Wormy and delicious, he’s constantly distracted by the stories of the pages. Two days ago he’d announced he was saving the new Harry Potter book for a ferry ride we have coming up and then last night, sitting on our front steps, he whispered to me, almost as an admission, that he’d finished it. Just couldn’t not open it up…

The other little boy around here is a lot more like I was. He’s drawn to the vivid emotion of human interactions; he’s buoyant and wild. In his loudness with life he gets jet fuel energy from playing with people and their ideas, humor, and emotion. He feeds off reciprocity. The characters and stories and prose of books haven’t yet snagged him in a way that he reaches for those characters like he reaches for his brother or for me in the morning. He loves to see how his emotions change ours. And the characters and ideas in his books haven’t yet started talking to him.

So the article about bribing and reading together got me thinking I could help. And a little voice rumbled around in me after reading it urging, “Wendy Sue, no matter how ‘busy,’ it can’t just be books at bedtime, you have to sit together and read at all times of the day.”

So for the last week and a half we’ve been reading together at unusual times. Snuggling up on my bed after getting home from work, on the couch with the coffee, in the corner of the room reading together or outside as the sun creeps up. Ten minutes here, 20 minutes there. Sometimes my little extrovert reader reads out loud to me or sometimes we each read our own. And this bounty with him came from realizing, of course, that I could show him that someone just as desperate for the people I love to share my moments and experiences, my laughter and hopes for the world can also find a bit of salvation in story and poetry. That over time I could live out the truths in front of him that there is safety and solace, intrigue and escape, hope and helium-heart courage, and essential camaraderie in these books. We can stumble upon an even bigger sense of self from words in a book. And sometimes it can take our breath away.

Like today. This morning as we sat together as the morning unfolded and the minutes poured out, I fell in love with a poem I’d never read before. Fell in love with the words so much that I ran my fingers over them after I found them. And I especially danced around in a few lines of it.

Even this middle-aged extrovert is finding newness in words in the morning. Thanks to my little 7 year-old reading partner.

It’s a hot and dusty world. Glimmering , and dangerous. ~Mary Oliver in Prose Poem: Are You Okay?

Yes, it certainly is. Thank goodness we have each other and thank goodness we have the prose of these books and these writers. Thankful for this new habit of togetherness with words with my little reader. Hopeful and knowing you’re also finding similar pockets of stillness this generous summer, too.

Infants Turning Blue And Other Scary Things

EVERY new parent worries about their newborn from how much they are eating, sleeping, peeing and pooping to ensuring they hit developmental milestones. We also worry about how they breathe and how they sound. It’s a stressful time period and most aren’t running on tons of sleep themselves — so we’re more emotional baseline. Occasionally, a terrifying thing happens where your infant turns bright red, or even blue or pauses their breathing. They may arch in a funny way or get stiff in their arms or legs. We may wonder if something serious is going on. If your infant (under 12 months of age) has an episode where they have pauses in breathing for less than 1 minute, they turn blue and then recover to normal…chances are…it’s normal. Normal? Turning pale or blue doesn’t seem normal nor does having your baby get stiff, nor does a second where they pause their breathing, but it can be, and there’s a name for it: Brief Resolved Unexplained Event (BRUE).

No question we have to trust our instincts if we think something isn’t going well for our babies and I always suggest seeing your pediatrician or family physician or nurse practitioner if you worry about your infant’s health, for reassurance. No question! Go in, get reassurance and learn. Don’t ever feel bad if everything checks out — this is why your pediatric team is there for you and your family. However, when you do go in for an evaluation from a nurse practitioner or physician,  even if your baby has unusual breathing at times, or tenses, or even has a change in color, you may not need a lot of testing. Sometimes it’s normal.

Some Information About Breathing Patterns In Infants:

  • Periodic Breathing: Newborns breath less regularly than older infants, children or adults. This is in part because of their immature brain stem (the part our brain that regulates the drive to breathe). The majority of newborns experience some periodic breathing in first couple weeks of life and most infants don’t have periodic breathing after 4 or 5 months of age. The term “periodic breathing” captures behaviors where babies breathe rapidly for a few moments, then pause for a few, then breath rapidly again. Most of the time periodic breathing happens with pauses that last no more than 10 seconds. It can appear really unusual to a new parent or relative. The Academy of Pediatrics defines it this way: “Breathing is often irregular and may stop for 5 to 10 seconds—a condition called normal periodic breathing of infancy—then start again with a burst of rapid breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular breathing until the cycle repeats itself. The baby’s skin color does not change with the pauses in breathing and there is no cause for concern.”
  • Color Change: babies can change color with crying, eating, fatigue or movement. Most of the time parents notice that babies will get bright red or ruddy while other times parents worry their baby looks pale or even a bit blue. It’s true that color change can represent underlying heart or breathing problems so if ever sustained over 1-minute it needs to be evaluated promptly. However, color change in infants over 2 months of age that resolves within 1 minutes may not need any work-up after you check in with a clinician. Sometimes color change can come from things like gastroesophageal reflux, coughing or choking, too. If any concern about your baby’s color it’s worth checking in with the pediatrician for a physical exam. While in the office, a pediatrician will do a full physical exam and ask lots of questions, and they can also check a spot oximetry for oxygen levels (pulse oximetry is standardly obtained in first 24 hours after birth to check blood oxygen levels to screen for underlying heart problems), do a electrocardiogram (EKG), and have observation.
  • Noises: babies make all sorts of terrifying sounds! Gagging sounds, choking, gurgling, sneezing, and coughing. Most of these during infancy fall in the range of typical and normal if they don’t interfere with eating, breathing, and sleep. Sneezing is fairly common in the first couple months, again because of immaturity of reflexes. Some parents worry about babies who spit up and sound like they can’t breathe and want to put babies on their tummies. No evidence that is recommended and to lower risk of SIDS, we always recommend babies are put on their back in bare crib for sleep.

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Super Basic Reminders For Summer

Summer is upon us and we all want to do our best to keep our families safe and healthy. Some of the summer reminders can seem obvious. You’ve likely even heard the reports out last week warning against using a blanket to shade a baby in a stroller (those enclosed spaces can heat up like greenhouses). Heat waves, sun, vacation, time away from routine, summer is a time of typical increasing adventure and exploration. The product of exploration are bumps and bruises and scrapes and sometimes, even burns. Quick reminders here for why to use effective prevention medicines and how. Pretty obvious advice, but here’s 3 items you should have readily available all the time: sunscreen, insect repellent and maybe even antibiotic ointment — although bandages are a start. You can reach for the ointment once you get home!

1. Protecting Children From The Sun

  1. Use broad spectrum sunscreen that covers UVA and UVB rays with an SPF over 30. As a reminder UVA are rays that cause aging to the skin and UVB rays cause burns. Both are bad news, especially during childhood.
  2. Sunscreen isn’t the BEST protector for our skin– shade is. But being outdoors in the sunshine is the essesnce of childhood. Consider sun protective clothing like rash guards, hats and sunglasses – always better to use things that can’t be absorbed in the skin! And plan activities in direct sun to avoid the most intense sunshine of the day (between 10am and 4pm) when you can.
  3. Choose an SPF over 30 (SPF refers to the amount of protection the sunscreen provides against UVB rays), anything over that doesn’t make much difference. More than what kind of sunscreen is how you use it. Apply 20 minutes prior to sun and every 1-2 hours while in the water or high activity.
  4. Look for sunscreens that include zinc or titanium and avobenzone — these are physical barriers rather than chemical ones — that are less likely to be absorbed in the skin.

2. Preventing Insect Bites

  1. Summer brings out bugs including mosquitoes, wasps and flies. No question we’ve all been thinking more about mosquitoes than ever before with Zika in the news. Here’s a clear and easy-to-read resource on what repellents to use if you live in an area with Zika transmission.
  2. Children should wear long-sleeved shirts and long pants if in areas with lots of insects as that will help protect from bites more than anything else. On areas exposed outside the clothes, you can use repellent.
  3. Use Environmental Protection Agency repellents. All EPA-registered insect repellents are evaluated for safety and effectiveness.Reapply insect repellent every few hours as directed on the bottle
  4. Do not spray repellent on the skin under clothing and don’t use products that are a sunscreen and insect repellent mixed together — dosing intervals are different and areas they are needed often are, too. If you need both products, apply sunscreen first and then insect repellent over it.
  5. It is safe to use EPA–registered insect repellents if pregnant and/or nursing!

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The Penis Podcast

This is a podcast episode about one thing…the penis. Guest on the podcast Dr. Rob Lehman, the co-founder of Great Conversations and leader of the For Boys Only classes at Seattle Children’s hospital joins me to discuss what’s “normal”  and all the examples of “normal but different.” We dive into what parents need to know about care of uncircumcised/circumcised penis, thoughts on erections (they begin in utero!), boys with their hands down their pants, appropriate touching and ways to help boys deal with a culture focus on size. I often say that when I’m in clinic, I get the most attention from parents when I’m talking to them about their child’s genitals and many families are nervous to ask about concerns. It’s something everyone wants to know about, but a lot of people are shy or embarrassed to bring it up — do hope this podcast helps. Don’t hesitate to ask concerns you have from the very beginning — most often you’ll likely get A LOT of reassurance.

I am a mom to two boys and like every other mom I know was surprised from the beginning with the amount of “hands down the pants” moments that start even in infancy. A treat to have Dr. Lehman provides great tips to normalize and set appropriate boundaries for touching and clear up ideas for better understandings of normal development.