Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

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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Women At Work

My husband is often in earshot when people probe, “I don’t know how you do it all with your family and your career.” In asking the question there is doubt, of course, that it’s possible. My husband is never the recipient of the same question regardless of the facts: we both have intense, high-demanding careers in medicine as physician leaders. Reality is, there may be little different in our level of responsibility, time commitments, and our opportunity to improve pediatric health care while there is no difference in our passion and commitment to raising our boys. So the calculus around the questioning doesn’t equate — nobody ever asks him about his balance with work and family.

My grudge with this disparity wavers in intensity. I bring this up now because of Matt Lauer’s controversial conversation with General Motors CEO, Mary Barra. He wondered if she could be a good mom and run GM on national TV. He said,

“You’re a mom, I mentioned, two kids, you said in an interview not long ago that your kids said they’re going to hold you accountable for one job, and that is being a mom,” he said. “Given the pressure at General Motors, can you do both well?”

It’s not only his egregious comment that aggravates, we’ve all gotten used to similar questions for women who work. What sets the interview on fire is his deflection of bias and responsibility. With this episode in the never ending media series on women and work-life balance we learn again that there is quite a bit of:

  1. Ongoing persistent cultural bias against women in leadership roles: we constantly wedge women and their success into the construct of balance with work and home when we rarely project men against the same backdrop.
  2. Ongoing anxiety about this bias coupled with a desire to eradicate it. Culturally, most of us don’t want to think about men and women’s responsibilities in the work place and home differently. We like to mature past our current realities when it comes to equity and sharing responsibilities for child-rearing and work.

Can we acknowledge the ongoing, profound cultural bias against women leaders and control that doesn’t exist in similar ways for men? Read full post »

Summer Reading From Day One

boys readingThe boys and I read two extra books last night — we almost skipped it altogether as it was late and we were beat from a long day and yada, yada, yada…you know the drill. But reviewing this data changed me, yet again. I knew some of the value of reading to young children before I had kids because of my experiences being a teacher and my training in pediatrics but the refreshers provided this week only compound my interest in screaming the value of reading from the rooftops.

It’s NEVER too early to start reading to your baby. Reading aloud before bed is always the right thing to do.

This week The Clinton Foundation with Too Small To Fail, The American Academy of Pediatrics, Reach Out And Read, and Scholastic got serious about ensuring our country takes reading seriously right out of the gate. For the first time ever the groups have come together to proclaim that parents should start reading to children “as early as you can” after birth. The new policy and partnership emphasizes the need for early reading to all infants and children while also emphasizing the necessity that all pediatricians promote this healthy habit at birth and through all preschool doctor visits. Profound health disparities currently exist for US children and book time. I suspect the numbers will surprise you.

It’s a no-brainer to most parents I talk with that reading books enhances development, literacy, and school readiness. What may surprise you is that reading has also been found to enhance the relationship between a child and parent. Reading books (or even the newspaper) to your infant from day one can have profound effects on how they live, how they talk, and how they learn — the impact extends well into adulthood. From the very beginning, though, some children are missing out. Children from low-income families hear fewer words in early childhood and know fewer words by 3 years of age creating the “word gap” early in their lives. The more words a child hears during early, critical times for language development, the more they’ll know. And although reading books can be a great resource to introduce an expansive, enriched vocabulary, less than 1/2 of children are read aloud to in this country every day.

All families face issues of limited time, limited parental understanding of the key role of reading aloud, and competition for the child’s interest and attention from other sources of entertainment ~  The American Academy of Pediatrics Council on Communications And Media ( 2011)

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You Mamas Taking Iodine?

A new policy statement from The American Academy of Pediatrics finds that many women, including up to 1/3 of pregnant women, may have low levels of iodine putting them at risk for iodine deficiency. The reason for the deficiency is the changing food source. Over the last 20-30 years our major source of salt has shifted away from table salt (supplemented with iodine) to salt from processed foods, sea salt or gourmet salts that have no supplemental iodine. This is especially important for breastfeeding and pregnant women as iodine is essential for thyroid function that supports fetal and newborn brain development.

This policy statement was news to me. I had no idea that the salt used to make most processed foods lacked iodine, that the majority of prenatal vitamins didn’t provide iodine, and the number of women who may have a deficiency. I’m not alone; when I polled my Mama Doc Facebook community most moms & many doctors also commented this was a newsflash. Here’s more:

Iodine Deficiencies– Shifting Sources Salt

  • WHY ARE WE DEFICIENT? Most processed foods made are with salt that is not iodized.  Since we get most of our salt from those foods we’re taking in less iodine than we used to.
  • TABLE SALT INTAKE: Table salt is iodized, many gourmet salts are not. Consider ensuring that when cooking in your home (ie putting salt in the pasta water or salting the veggies) you use iodized table salt so your intake of iodine goes back up. REMEMBER: this doesn’t mean you should eat MORE salt, just swap in the table salt for the fancy salts when you can.
  • WHY DO WE NEED IODINE? We need iodine for thyroid hormone synthesis as thyroid is essential in brain development and metabolism. The policy reminds us that even mild iodine deficincy can affect fetal and early childhood neurocognitive development stating, “adequate thyroid hormone production is critical in pregnant women and neonates because thyroid hormone is required for brain development in children.” The recommendations from AAP spelled out:

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