Archive for November 2010

Monthly Archive

Do You Believe In Vaccines? (Part I: Emotion)

I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.”  I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought.  I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?

I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well.  I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.

But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

We are all so similar.

We all want to do what is right for our children.  That’s why everyone is so nuts about this. Simply stated, we all care immensely.

This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.

I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:

  • Emotional
  • Evidenced
  • Experienced

These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.

As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.

Emotional:

Most of these doctors wrote me about listening more than about talking.  But here’s some of what they said:

Dr David Hill, a pediatrician in North Carolina wrote:

Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’

Gulp. His response to that parent’s viewpoint: Read full post »

Wednesday Before Thanksgiving

Be safe today. With travel defining many of our days, this is a day I think about safety every year. Now more than ever because of my kids. Motor vehicle injuries are the leading cause of death for children in the United States. The CDC statistics on child passenger safety state that child safety seats reduce the risk of death in passenger cars by 71% for infants and 54% of toddlers age 1 to  4 year of age. Car and booster seats are an awesome way to protect our kids.

Wednesday before Thanksgiving was changed for me forever while training in pediatrics.

Wait, a warning: this is a slightly morbid thought. So if it will do you no good, don’t read on. I share this only to show you how and why pediatric training and the profession of caring for ill children shapes how and why we pediatricians believe so strongly in preventing illness and injury. Terrible stories are instructive.

One year in residency, I rotated into the pediatric ICU during November. I was on-call the Wednesday before Thanksgiving until middle of the day Thursday. I was taking care of critically ill patients, some who were on the transplant list waiting for organs. I remember as colleagues left for the day on Wednesday afternoon and evening, one doctor mentioned she wasn’t worried. She knew the patients in the ICU were going to get the organs they needed shortly. It was the biggest travel day of the year, she explained, and organs were going to be much more available.

Entirely morbid, and then entirely hopeful, too. Yes, the organs did arrive over the weekend…

The memory of that conversation really stuck with me. I don’t know if it’s true that more organs are available soon after the Wednesday before Thanksgiving (biggest travel day defined) because of travel related accidents, but it comes into my head every year. Makes me double check the car seats, re-examine the buckles, and drive a bit more slowly.

Be safe today, all. Don’t take risks you don’t need to take, and buckle up. Ensure the carseats are properly installed, particularly if you’re putting a seat in a relative’s or a rented car while you travel away from home.

I like this USA Today article with tips about traveling with infants and children, too.

And here’s my take on why I don’t recommend using Benadryl on the plane if you were thinking about throwing it in the travel bag.

Be well. Enjoy time with friends, family, and your Thanksgiving traditions. I am so thankful for all of you…

Good Decision: Cough And Cold Medications Off The Market In 2007

Over the counter (OTC) cough and cold medications do very little for cough in infants and young children. There is a pile of research that supports this. Parents often agree after they try these tinctures. Because of the lack of effectiveness and concern for side effects (or worse: over-dose), makers of OTC cough and cold medications voluntarily took them off the market in 2007. This was an incredible step in protecting children. In getting rid of unnecessary (and ineffective) medication marketed for young children, we’ve improved pediatric care in this country. Today, some data backs this up. Read full post »

Two Minutes To Represent Vaccines?

Last Friday I was in line for a coffee and met a newborn baby. Her father asked me if “I believed in vaccines.” I answered him (hint: I do). But then I got to thinking…how could I have done it better? I wrote some friends…

Work-Life-Balance

I did a live radio show for the the AAP’s Healthy Children radio show last week.

Click the above link if you’d like to take a listen or below for individual segments (each about 15 minutes).

My favorite part of the first interview is when I mention magic. Of course, the hard work of raising young kids is simply so worth it. We get so much more than we give. Nothing about this is easy of course, and nothing about this static, either. Take a listen and let me know if what you think.

Work-Life-Balance Issues for Working Parents

Breast Feeding, Working, and Being a Working Moms

Evidence for Vicks VapoRub?

A Pediatrics study this past week starts out stating that, “Upper respiratory infections (URIs) are the most common acute illness in the world.” Wowza, that seems like a show stopper right there. But it’s true, anyone who works with kids or has kids or knows kids (let’s be honest) also knows that winter brings snot to little noses. And lots of it. I really believe that snot and mucus are a part of being a kid in the wintertime.

Kids typically have 6-10 colds a year, mainly between October and May, so if your child is snot-free today this mid-November, consider yourself lucky. Kids get upper respiratory infections (“a cold”) one after another after another and its often difficult to know when one cold ends and a new one begins. The far majority of these colds are caused by viruses. And because we don’t have treatments to impair the virus or kill the viruses that cause colds, we recommend supporting the machine that does: the body. Support your child as they fight off infections. Immune systems are amazingly efficient. Feed these immune systems the proper fuel: rest, hydration/liquids, energy, and most important, time.

We see many children in clinic with colds when families come in concerned about fever, cough, sore throat, congestion, or possible ear infections. Fortunately we rarely have to use antibiotics or other medication interventions. And although it’s nice not to have to prescribe medications for well children with uncomplicated colds, I hate not having much in my tool box to help a family. After a terrible sleepless night of coughing, hacking, fever, and snottiness, families come in absolutely exhausted. Pediatricians really do get this and we do want to do “something.” But often our advice comes off as “The doctor did nothing.” I look at it this way, we ruled our bacterial infection, provided ideas for improving cough (humidifier in the room, honey before sleep for kids over 1 year of age, nasal suction [love NoseFrida], and upright positioning to let the snot drip the right way) and gave guidance about why or when to return. But I do want more tools in my toolbox. This study may help.

As I mentioned last week, sleep is a major commodity while raising children (duh). The study on Vicks VapoRub surprised me. Read full post »

Happy Birthday, Blog

It’s crazy when people talk about themselves in the third person. Also crazy, when virtual projects take on lives of their own. Personification- isn’t that the term? You and me blog, we’ve been inseparable this past year. A proud mama, I am. Drained and exhausted, yup, that too. But to you, today, I say the most sincere, Happy Birthday.

Today marks 1 year for Seattle Mama Doc. It’s been wild– something akin to piloting a plane, taming a wild dog, starting a new business? For me, this last year has been the most rigorous of my life: raising my boys, seeing patients in clinic, writing, creating, and speaking about what I believe to be true in health care. All the corners of my brain are being accessed though, and on most days it feels really good. And today, I must say, I’m a bit teary eyed as I mark all the 1′s in the calendar (11/11/10 for a 1st birthday ain’t bad). In celebration, at the end of my long day in clinic, I’ll bake a cake. Sit at the counter in my kitchen and eat. Should be a nice way to mark the huge milestone for me. In lieu of gifts, will you please leave comments? What have you liked, what can I do better, and of what would you like to see more?

I’m so thankful for the success, the support from others, and the change I believe we are making in improving communication around children and health. Thank you for reading (silently) and for commenting (loudly). You truly feed me, too.

A Year In Review

Am I right? Do you remember this differently?

Here’s to another year. But wait…a day of clinic, and then a bite of cake, first.

Breast Feeding vs Formula: Mommy Sleep

Loved a study published today in Pediatrics. Researchers sought to determine if mothers who breastfed slept less than those who formula fed their babies. I hear lots of talk (at birthday parties to office visits) about how formula or rice cereal creates better infant sleepers. So far, science doesn’t back up these claims. But as every new mom (and dad) knows, sleep is the major commodity during your infant’s first 6-12 months. We really want our babies to sleep through the night. Desperately. Six weeks in, crying is at a peak for infants and mothers are utterly exhausted after a pregnancy, a labor/delivery, and a month or so of very fragmented and dwindling sleep. Not only are we at peace when our babies sleep, we often rest, too. Maternal rest is essential for familial functioning, enjoyment of a baby’s infancy, and simple recovery. Sleep is not just about feeling rested or perceiving that you get more (or less) sleep than the other baby’s mothers on the block. It is about wellness, too. The study asserts that, “a growing body of evidence shows that mothers may not, in fact, do fine with less sleep.” Maternal sleep may affect rates of postpartum depression and an infant’s emotional and cognitive outcome. Getting rest is something we actually CRAVE in the first few months of our baby’s lives. Sleep, at some point, has to be a priority.

Researchers in West Virginia wanted to figure out if mothers of formula fed babies got a better night of sleep compared to those who breast fed or partially breast fed. The motivation behind the study was to dispel any perceived disadvantage of breastfeeding. Before you get up in arms about how bad your night sleep was while breast feeding compared to baby Jane next door who was chugging formula, look at what they did. Sometimes understanding how a study was performed helps you interpret how much weight you put into the results. Read full post »

6 Tips For Successful Shot Visits

Getting shots, or the pain and fear associated with them, is one frustrating association children have with seeing their doctor. There are some ways to make this better. Diminishing shot anxiety is a huge goal for parents and pediatricians. If expectations are clear, everyone can leave a visit after shots feeling more successful.

  1. Prepare: Do your best to prepare yourself for a visit where there will be shots. Bring your husband/wife/partner, friend, or relative with you for support. If you act or feel nervous, your child may pick up on this. Even infants pick up on nervous cues. It is well known that parental behavior influences the amount of pain and distress from shots. In one 1995 study, 53% of the variance in child distress during immunizations was accounted for by maternal behavior. Geesh! So, if you’re freaking out, your child may be influenced. A Pediatrics review article in 2007 found that excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. First shots for new parents are often nerve-wracking. Layer your support and tell your pediatrician you’re nervous so they can provide reassurance and support. Bring a new toy for your child, plan a joke ahead of time. Scripting may truly help.
  2. Distraction: Use distraction whenever possible. Squeeze your child’s hand during shots, sing songs together, blow on your baby’s face, or talk about plans you have later in the day during the injection. Discuss your favorite spots or places you’ve been together. Also, consider the “cough trick.”  A study in Pediatrics out earlier this year found that children (age 4-6 and age 11-13) who were coached to cough during the injection experienced less pain from the shot. Read full post »

Understanding Immunizations

It’s my true fortune that I spend the majority of my days with children–my patients and my own. But as a mom in the year 2010, I find I worry a lot. As a pediatrician, my job is to reassure. My experiences with these divergent, and then entirely interwoven roles, converge at one issue in particular: immunizations.

The reality is, we live in a vaccine-hesitant world. With my patients, my friends, and even my family, I hear many myths about vaccines. I hear truths, too. Mostly, I feel and witness worry. When it comes to getting shots, most everyone wants to know a little more. There’s no doubt that the things we read online and in the paper, or the mutterings we hear on the news and in line at the grocery store, have left us frightened about immunizations. I remember the fearful stories more than the reassuring ones. Don’t you?

Despite this worry, I believe that alongside the challenge of overweight/obesity, hesitancy about shots may be the biggest issues facing children, parents, and pediatricians today. I spend more minutes (hours) per day with vaccine-hesitant families than I ever imagined I would. So this is a part of my every day. But hold on a minute, this is not a post about the “rights” of doctors or vaccines or the “wrongs” of another group. This is a blog post to help illuminate your right to earnest, research-based information regarding immunizations. You need to have compassionate care rooted in scientific evidence; you need to know what science holds. What I mean is, you have a right to really understand why doctors recommend immunizations.

Vaccines are discussed nearly everywhere by nearly everyone. As a parent, be selective about what you read and with whom you discuss these issues. Not everyone at the water cooler has expertise in this area. And not everyone understands the enormity of the issue, let alone the repercussions of their advice. As the wise say, “Don’t believe everything you think,” either. Read full post »