Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

No Kitchen Spoons! Correct Medication Dosing

OTC Dosing Image

Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools sometimes making it confusing for parents to ensure we are giving our children the proper dose. To add to the confusion, sometimes the recommended dose is written with different units (mLs, mg, or teaspoons) than the dosing device. For example, the box might have dosing in “teaspoons” and the measuring device be divided up into milliliters. This issue is not new but guidelines and protections around the problem are increasing. A win!

This has concerned me for a long time. To drive this point home even further, I gave a dosing conversion quiz on my blog to my colleagues in medicine (also parents) who even struggled to get the dosing correct. The dosing struggle is REAL to non-pediatric docs and parents everywhere.

For example, you may even see differences in devices that would seem to be standard across medications. The dropper that comes with liquid acetaminophen (aka Tylenol) may look very different than the dropper that comes with liquid vitamin D or infant multivitamins. And remember, the most important way to avoid a dosing error is to keep the original dosing device with the actual OTC medication.

Two Things To Do Now With All Your Children’s Medicine:

  1. Resist the urge to grab a kitchen spoon!
  2. Attach the dosing device to the bottle of medicine with a rubberband!

You can always reference the below table, or even print it out and tape it to your medicine cabinet.

new dosing

A 2014 study in the journal Pediatrics reported that every eight minutes, a child under the age of 6 experiences a medication error outside of the doctor’s office or hospital. This is an important call to action for parents to always exercise care when giving medicines to their children. If you are EVER concerned about dosing issues, don’t ever hesitate to call poison control for help (they are around 365, 24/7): 1-800-222-1222.

11 Tips To Ensure Correct Dosing:

  1. Always read and follow the label. When confused don’t hesitate to call your child’s provider or nurse for help.
  2. Always give the recommended dose BY WEIGHT and use the measuring device that came with the medicine.
  3. Only use the OTC medicines that treats your child’s specific symptoms.
  4. Never give two medicines with any of the same active ingredients. For example, if giving a OTC cough and cold medicine, make sure you read the list of ingredients before dosing it at the same time you dose acetaminophen. Sometimes the OTC combo medicines will have multiple ingredients you may also reach for in other forms.
  5. Never use cough, cold, or allergy medicines to sedate your child. Here’s my 2009 blog post on avoiding medicines for that reason on the plane.
  6. Never give aspirin-containing products to children and adolescents for cold or flu symptoms unless told to do so by a doctor. It is okay to use acetaminophen or ibuprofen for colds and flu-like symptoms.
  7. Do not use oral cough and cold medicines in children under four.
  8. Do not give a medicine only intended for adults to a child. Just doesn’t make sense and can lead to errors and mistakes.
  9. Stop use and contact your doctor immediately if your child develops any side effects or reactions to a medicine that concern you.
  10. Keep all medicines — and vitamins, too — up and away and out of your child’s reach and sight.
  11. Teach your child about using medicines safely. Tell your children what medicine is and why you must be the one to give it to them. And the big whopper: never tell children medicine is candy to get them to take it, even if your child does not like to take his or her medicine.

5-13 know your OTCsThis post was written in partnership with 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.

Why To Buy An Antibiotic-Free Turkey This Thanksgiving

Like I said last year, there’s one little thing we can do this month to change our safety and preserve the value of antibiotics. And although not all families can be without antibiotics on Thanksgiving due to chronic or even acute medical problems, we all can eat smarter turkey. This is an easy awesome.

I partnered with Dr. Scott Weissman this week for “Get Smart” week. On Monday we explained that we’re dependent on antibiotics for all sorts of medical miracles (bone marrow transplants, joint replacements, healing from a large cut, routine surgery, and chemotherapy). We when use antibiotics responsibly in the clinic, in the hospital, in raising food and in our agriculture we’ll preserve antibiotics for decades to come. Trends show if we don’t, we’ll contribute to more and more resistant and untreatable infections. Tuesday we explained how antibiotics are used in agriculture, Wednesday how to be a squeaky wheel in the hospital (speak up, ask about antibiotics EVERY day), and yesterday we reviewed 5 tips for avoiding antibiotics in clinic. Today…..drumroll…….we provide something super easy to be smart:

Make an effort to buy an antibiotic-free turkey this Thanksgiving. Animal agriculture uses four times the amount of antibiotics as human medicine, and mostly in healthy animals for growth promotion or disease prevention on crowded farms. It’s also worth noting that safe preparation is also key.

When you buy and prepare raw meat (even if it’s organic and/or antibiotic-free) in your kitchen, you run the risk of contaminating the surfaces, utensils and cookware you’re using with bacteria. Raw meat products can transmit bacteria like E.Coli or salmonella but, also a more dangerous, antibiotic resistant bacteria. The CDC provides the following tips to keep you family’s food safer for consumption.

cdc safe food image

It will be a bit more challenging for the turkey industry to reduce antibiotic use like a few of the big players are doing in the chicken sector. Consumer demand has driven that change, so we need to push for the same thing across the entire meat and poultry industries by voting with our wallets. In the days leading up to Thanksgiving consumers should try to purchase turkey, ham or other meat products from producers who use antibiotics responsibly. The labels you can trust say: “No antibiotics administered,” “Raised without antibiotics,” “Global Animal Partnership,” “Animal Welfare Approved,” or “Organic.” ~Dr. Scott Weissman, Infectious Disease Expert

To help raise awareness take a pledge to purchase antibiotic-free turkeys this year. This is your chance for turkey greatness today. Boooooooom.

Once the holiday has passed, your company goes home, and you go back to your regular schedule, make sure you’ve read up on the Friends of Earth’s report, which graded America’s top restaurant chains’ policies and practices regarding antibiotics use and transparency in their meat and poultry supply chains, their commitment to purchasing meat raised without antibiotics, and ensuring safe tracing. Are the results surprising to you?

Chain Reaction

Click here for more on antibiotic stewardship.

5 Ways To Avoid Antibiotics At Clinic When Unnecessary

Most parents know that it’s not a good idea to beg your provider or child’s pediatrician for antibiotics — hoping to find a quick fix or relief for certain conditions doesn’t work when the medicines won’t help. Although we want to fix our children’s illnesses, antibiotics only help when an infection is caused by a susceptible bacteria.

Antibiotics are used specifically for infections caused by bacteria. In general, most common cold symptoms—such as runny nose, cough, and congestion—are mild and your child will get better without using any medicines.

Antibiotics should be used to treat infections like strep throat, whooping cough (caused by pertussis) and urinary tract infections. We just don’t want to use them for strep culture-negative sore throats, runny nose, most rashes or cold caused by viruses. When we use antibiotics at the wrong time we don’t improve the likelihood of a cure in the short-term and we set ourselves up for more antibiotic-resistant infections. Not only do antibiotics carry short-term side effects (diarrhea, rashes, sometimes allergic reactions) there is some data that early use of antibiotics in life changes long-standing risks for chronic medical conditions (things like Crohn’s disease).

Overprescribing  antibiotics affects both individuals and society as a whole. Each time a person is prescribed an antibiotic they risk having a severe reaction to the medicine. These reactions bring approximately 30,000 visitors to emergency rooms across the country every year. Antibiotics can also cause diarrhea or clostridium difficile colitis (C. diff), and early childhood exposure has even been associated with the development of asthma and Crohn’s disease. —Dr Matthew Kronman

5 Ways To Avoid Antibiotics

Read full post »

Ask About Antibiotics Every Day In The Hospital

Today’s main takeaway: if you or a loved one are at an inpatient setting, ask every day what antibiotics you’re on, why you’re on them, and when you can stop taking them. Every day. Your care team is likely doing the same thing but you bringing it up helps ensure it remains a priority.

How To Be Smart Using Antibiotics:

  • Take the antibiotic exactly as the doctor prescribes them and take them for the shortest duration.
  • Try not to skip doses or stop taking an antibiotic early unless your doctor tells you to do so.
  • Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Do not save antibiotics for the next illness — makes little sense and can contribute to resistance.
  • Discard any leftover medication once the prescribed course of treatment is completed. There are a variety of safe ways you can do this. No flushies!
  • Prevent infections by practicing good hand hygiene, cough in your elbow (not your hand), and get recommended vaccines (vaccines don’t contribute to antibiotic resistance).
  • Remember antibiotics have side effects. When your doctor or nurse says you don’t need an antibiotic, taking one may do more harm than good. Often walking out of the office WITHOUT a prescription is the best outcome…

Read full post »

Antibiotics Used In Meat Changes Our Health

Using antibiotics on the farm to raise animals contributes to the production of antibiotic–resistant germs or “superbugs.” All animals carry bacteria in their intestines and on their bodies. Giving antibiotics to animals will kill large amounts of bacteria, changing their microbiome (<–good explanation here) and regular “good” bacteria too. Because 60% of the antibiotics used in animals are also used to treat human diseases, with time when antibiotics are used routinely, the bacteria become resistant, survive and multiply. If those resistant bacteria are transmitted to people, we don’t have as many medicines to eradicate them. Therefore, risks develop to humans when these “superbugs” thrive in animals and are transmitted through our food source. Over time, more and more infections carried in the food we eat will lack proper treatments. What we choose to eat will shape our risk.

Susceptible and resistant animal pathogens can reach humans through the food supply, by direct contact with animals, or through environmental contamination. American Academy of Pediatric Technical Report

Antibiotics used for infections in animals should be encouraged but antibiotics used to promote rapid growth and weight gain in animals likely should not (overuse). The majority of tonnage of antibiotics used in raising animals are often used for growth promotion and efficiency meaning they are used to keep meat cheaper, not necessarily safer. Hard to find clear data on exactly what % is used for disease treatment and what % is used for growth. Read full post »

This Matters: Getting Smart About Antibiotics

Super smartness in the world of health care is always a goal. This week is Get Smart About Antibiotics Week, an annual observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use. This isn’t just about NOT begging for antibiotics when our children have a runny nose and this isn’t just about docs and nurses being smarter about using antibiotics only when we need them. If we want antibiotics to be around and useful for generations to come, this will take a multi-prong approach.

Antibiotic resistance — “the rise of deadly germs no longer stopped by the drugs that once controlled them” — will only increase over time if we use continue to use antibiotics at our current pace. At home, in raising the food we eat, and in health care organizations.

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics. That means their infections aren’t easily treated, can grow and spread in their bodies without cure and can potentially cause serious harm. Those bacteria can also spread to others. At least 23,000 people die as a direct result of these infections every year. So this stuff matters. What soap we use, what medicines we avoid, what medicines we use, what food we eat and how it’s raised all change the game. I’ll be doing a series of short posts each day this week to share what I’ve learned about the negative effects of antibiotics overuse. Read full post »

Bigger Peace: Let Fear Spur Presence

FullSizeRender (1)Friday afternoon the terrorist attacks around the world certainly took our collective breath away. The stunning, horrific realities and the wild insecurity we can feel when somewhere familiar becomes unsafe is a potent storyteller. There is something in this though, that we can really listen to.

Things tend to happen in slow motion after this kind of news, almost like they do in our memories during scary recollections of a car accident or a big fall, because when some beloved familiar place is deemed unsafe we can tingle with such scare it pushes us towards vitality. It’s awareness. In ways, the fear these familiarities provoke shrinks the world, changes the scope of what is at stake every single day for every single one of us, and connects us again to how similar we are. Sounds have been crisper under our feet since Friday, the breeze on our face more notable this weekend, and all of a sudden the moment we’re in takes on quite a significance. We can feel so alive and connected to each other in this fear.

We all know fear hones priorities, even momentarily, and reminds us of the sincere gift of a day with those we love. With the news Friday the every day constructed problems at work or in our personal lives dim as the monumental relevance of connection, friendship, family, and freedom again takes on new light. This is a cycle, of course. We cannot hold the intensity and fears of our insecurity in our hands ALL the time to drive presence. Most of us can’t be mindful every single moment either. We’d be muzzled and paralyzed if we let this tincture of storytelling in too much too soon too constantly…but there’s this: Read full post »

U.S. Soccer Bans Headers For Kids Under 10

Soccer HeaderOur kids don’t have to play like the pros, even if we they think they’re ready. I mean really, what’s the rush?? I report this as a pediatrician & as a bona fide soccer mom to 2 boys under age 10:

The U.S. Soccer Federation yesterday announced a ban on “headers” for children under 10 years. There has been no new expert consensus (the new rule rose out of a lawsuit, not new pediatric expert opinion) that heading the ball causes changes/damage to the brain. Although headers have been found to cause concussions, more often children are concussed when hit by a falling ball or after a collision. Research published this fall in JAMA Pediatrics found about 30% of boys’ concussions and 25% of girls’ concussions in high school soccer are a result of heading. Regardless, more research is needed to determine the safety of heading the ball throughout young and late childhood. In the meantime there are 3 things we can all know (and advocate for)  as research teases out early head injury and the influence heading may have over an athlete’s lifetime:

  1. Headers require essential technique to reduce injury: If heading the ball, young players need to learn proper technique (head positioning, neck position, have appropriate muscular strength etc) so using their forehead they reduce likelihood for injury. Most pediatric sports experts opine that this is unlikely to be easy for little players to reliably learn this technique under age 10 years. It’s unclear what degree heading causes concussion and long-standing injury. “Collision,” pediatric experts wrote in 2010 for Pediatrics, “rather than purposeful heading, was found to be the most likely cause for acute head injuries in soccer players treated in emergency departments.” 
  2. Appropriate Balls: We need to reduce risk of injury by ensuring balls are appropriate size for players, that balls are NOT hyper-inflated and thus more firm, and that balls are water-resistant (so as to not take on water and be heavier). Smarter play, smart equipment. 
  3. Smarter Timelines For Rules: Graduated rules like this (no headers under 10, limited headers for young teens, and then routine headers thereafter) make sense. Not all 8 year-olds need to play by the rules of the pros. Why the rush?

Heading among pre-adolescents is usually a random act. Eyes shut. Head scrunched into neck. Shoulders clenched. ~

Read full post »

Quick Ask This Flu Season: Peer To Peer Protection

If our entire community got the flu vaccine we’d be MUCH less likely to share it. We’d also be much less likely to get influenza. Studies find that about 10-40% of children get influenza each season. Because their immune systems are a bit “naive” to influenza, they are at risk for more serious illness, especially if under age 5 years.

What if parents were the ones to endorse protection from influenza? What if we drove our schools and playgroups and community protection? I want our communities safe and healthy this flu season and our best defense is the flu vaccine, staying home when ill, and covering our coughs. It may be the mom-to-mom-dad-to-dad message that is most powerful…

The match between the flu vaccine (nasal spray and the shot) and circulating strains of influenza are better this year (including the H3N2 strain). That means the flu vaccine will likely be far more effective in protecting our families!

Data has shown us that nearly 1/2 of the adult population does NOT get their flu shot, yet 75% of parents to young children DO get their young children and toddlers vaccinated. Parents really do want their children protected and although pregnant moms are at high risk for flu only about 50% got their flu vaccine last year. Not only does mom get protection of her own health when she gets the vaccine, she passes on antibodies to her baby!

Will you share a video with your community? I created the below series of flu videos in partnership with The American Academy of Pediatrics targeted to specific demographics and age ranges. You can share them via email, social media or in-person. Help me make the case to ensure our kids are healthy and protected this flu season. I’ve provided the videos and links to share them below. Thank you for joining me in avoiding influenza this year. Share one of these videos?

8 & Under: Why Flu Vaccine Is an Every-Year Thing!

Link to share:

Read full post »

Teens Getting High: DXM Cough Medicine

OTC Cough MedsDrug abuse is on every parent’s mind. We simply don’t want our children to ever go down the road of drug addiction. To empower parents to spot the warning signs and help prevent teen abuse of over-the-counter (OTC) cough medicine containing dextromethorphan (DXM), the Consumer Healthcare Products Association (CHPA) is sharing the results of qualitative and quantitative research of teens. The quantitative (numbers-based) research began in 2013 and is conducted three times a year. Here’s some insight from that data: Read full post »