Archive for March 2011

Monthly Archive

Colic, Crying, And The Period of PURPLE Crying

Every infant cries. It’s a part of being a newborn, yet infant crying still puts many of us on edge. As parents, we want to calm our babies and prevent crying; it’s simply instinctive to want to make it go away. The period of time when our babies cry most (between 1-2 months of age) can be entirely exhausting, unsettling, and unnerving. As we transition into parenthood, one of the most difficult challenges can be learning to soothe our crying newborns. One expert, Dr Ron Barr, refers to this period of crying as the PURPLE period. I’ll explain, but first, let’s talk a bit about colic and news today about using alternative “folk” treatments, and ultimately what it may mean when someone, a doctor or not, tells you that you’ve got a “colicky” baby.

This morning I did an interview for Good Morning America Health about a Pediatrics systematic review evaluating 15 large studies (including nearly 1000 babies) to determine if things like infant massage, probiotics, chiropractor’s manipulation, herbal supplements, and sugary/glucose solutions really helped “colicky” babies stop crying. The results proved unfortunate. No, these interventions don’t tend to help infants who are crying/fussy/screaming their heads off. Two things to think about with the new findings: first, when you’re frustrated with a baby’s fussing/crying, don’t reach for these remedies as solutions or as “cure alls.” As we know it now, there’s not a lot of evidence to use any of these remedies. Secondly, don’t confuse the word “natural” with “harmless” or “safe.” Many of these herbal and complementary remedies come with labels that say “natural.” Natural doesn’t confer safety. Some limitations of interpreting data from the 15 studies reviewed was the reality that little time was spent reporting side effects to interventions and therapeutics. It may simply be because there were few, but researchers are unsure. We only want to use medications in infants that prove effective.

The most important thing to do for a fussy infant is to find ways for you to soothe your baby. But know that you won’t always be successful. Read full post »

New Rule: Be Without a Ceiling

I’ve got a new rule. And this is coming from a woman who grew up in Minnesota and who lives in Seattle. I’m stating clearly first: weather is no excuse.

I’ve talked in many places on this blog about the reality that there are only a few “rights” to parenting. In my opinion, as a mom and pediatrician, the “rights” include things like getting your children immunized and properly using car/booster seats. Beyond that, the rest of the parenting is a smattering of “doing right,” versions that vary and resonate from person to person and child to child. The thing is, most of us do it very well, without strict rules. That is, out of love and instinct, we parent our children well. We shelter them. Protect them. Feed them. Shield them from harm. Provide opportunity.

Often, the information we read about parenting does more to break our spirits than it does to bolster phenomenal, inventive ideas. And even though a physician friend recently told me that he subscribes to “‘good enough’ parenting,” and that I tend to agree, I believe this week I’ve stumbled upon the third possible “right.” Tell me if you think I’m wrong because I just can’t conceptualize the counter-argument to my claim:

Go outside with your children every day. Move in a space that has no ceiling.

With the rising digital demand on our lives and with technology seeping into every space, getting outside remains one basic and beautiful way to stay healthy, connected, and opportunistic with your children. And better yet, it’s a great way for your children to be afforded the luxury to roam, create, and play. Not only will your children move and exercise, they’ll experience nature. Nature, as simple as the sticks on the sidewalk or the grass in the boulevard–or nature, like the spaces where you see-hear-smell-touch nothing man-made. All of it, any of it, every day. It seems to me that nature is something we’ve nearly forgotten to prioritize with our time here on earth.

So don the coat, the mittens, the hat, or the sunscreen. Whenever illness doesn’t get in your way, do whatever you can to remain comfortable and protected, and then get outside each and every day with your children. Move in a space with no ceiling.

2 is Now Officially The New 1: Rear Facing Car Seats Until Age 2


Did you hear the news? The AAP has made it official. 2 is now officially the new 1.

Last year I wrote a blog post entitled “2 is the new 1″ that discussed my opinion that you keep your children rear-facing in the car seat until at least age 2. This week the AAP announced the official change in recommendations for car seats, which includes the rear-facing until at least age 2 years and also adds some additional pointers on how to keep kids safe at all ages.

Some highlights of the new report and policy that uses evidence to guide the best way to protect your infant or child from serious injury in the car: Read full post »

Radiation Disasters And Children: Why No Potassium Iodide Now

There is a lot of talk about radiation and radiation effects because of the ongoing tragedy in Japan. It’s a bit overwhelming and confusing, to say the least. Ultimately, fear motivates us to act in bizarre ways and this current catastrophe in Japan is no exception. I find myself a bit nauseated when my mind drifts to Japan, yet I can’t seem to curb the urge to watch the updates. I don’t normally watch live news because I sincerely don’t think it’s good for me. But this horrific human tragedy steals me away from my typical distance while simultaneously reminding me of two quotes, one posted earlier:

Disasters are about people and planning, not nature’s pomp.” ~The Economist

and

Human inability to detect radiation can pose more of a psychological threat than a physical one. ~The Washington Post

The ongoing tragedy in Japan will help motivate us to prepare. But fear of the unknown can eat away at us, too. Anxiety surrounding Japan’s struggle may be higher than what we experience typically with catastrophic events, in part because of the complexity in understanding the effects of radiation. Because radiation is invisible to the eyes and undetectable to the nose, its presence is difficult to detect. We know that fear and anxiety are common in children affected by natural and radiation disasters but its psychological effect may be the most lasting and intrusive to health.

We can do things to protect our health, too. First, if your children are watching TV, sit with them and provide honest, age-appropriate explanations. Turn the TV off whenever possible. Next, discuss what your family is doing to help prepare for unexpected emergencies. Preparing your home and family for disasters with both a communication plan and an emergency kit can be a great way to decrease anxiety for both you and your children and will arm them with tools to protect themselves. A great antidote to fear is to regain your sense of control. I hope this post, and ongoing ones, help us all calm down.

The bottom line is this: with what we know now about Japan’s current disaster, even with the possible worsening nuclear crisis, medical countermeasure such as potassium iodide (KI) are not indicated here in the US. Don’t pop the Potassium Iodide (KI). And don’t feed it to your kids! Although Japan is advising KI use in the close vicinity to the damaged reactors, the US Nuclear Regulatory Agency and the Washington State Department of Health have both said that harmful effects of radiation are not expected in Hawaii or the US West Coast.

I believe every decision we make in medicine is a balance between risk and benefit, from intervention to doing nothing. This radiation question is no exception. Potassium iodide can protect the thyroid gland from the devastating effects of high levels of ionizing radiation. But, when used inappropriately or unnecessarily, potassium iodide has the potential to cause very serious side effects such has abnormal heart rhythms, bleeding, nausea, vomiting, and electrolyte abnormalities.

The risk of using KI far exceeds any benefit right now. Read full post »

Play

Recently, I started asking a standard question, exactly the same way, to children during their 3 to 10 year old check-ups. This wasn’t premeditated. Like all physicians, I go through phases of what I ask kids to elicit their experiences and beliefs, listen to their language and observe their development. I learn a lot about my patients from what they choose to answer. Both in their receptive language skills (how they understand me) and their expressive skills (how they speak–fluidly, articulately, with sentences) to their cognition (how they understand concepts and theories). No one talks as much when in the exam room as they do at home. Pediatricians know this (of course!), but these questions are a great way to learn a lot about a child’s wellness and get to know my patients. It’s also the part of the day I enjoy the most.

But when I started asking a recent question something became utterly clear. I’d say,

“What do you like to do at home?”

I expected the usual suspects. Things like, “Watch TV,” “Play the DS,”, or “Play with princesses or doll houses.” Not that I expected stereotypes, I just expected specifics. But instead, there has been a uniform, single-word response. Breath-taking. These children are all saying the exact same thing.

“Play.”

One word. Read full post »

Japan Tsunami: Reminder For Parents To Prepare

I was up until nearly 1:30am today watching the Tsunami in Japan live online. Terrible for the psyche and hard on the heart, I simply couldn’t stop watching it unfold. It’s utterly terrifying to imagine the devastation and separation that catastrophic events like this cause for people. In the face of this terrible news, there is much we can do as parents. In addition to donating to relief organizations, we can prepare our families. We have incredible strength and insight as the proud providers and nurturers of our children. Now, today, is the time to utilize this reminder for good and harness your concerns into preparedness.

On the news last night, reporters kept repeating that every home in Japan had an emergency kit…that every family had a plan for an earthquake. They detailed how children knew at a very young age what to do when an earthquake began and families had communication plans to re-unite.

Today is a day to begin to create the same for your family. Emulate the universal emergency plans of families in Japan. I trust these kits and plans have saved many lives in the past 12 hours and lessened the worry of the millions of parents reuniting with their children as I type.

Last year, I made a disaster kit and blogged about the experience. Today, in the wake the Japan Tsunami, please consider doing the same. I’m re-posting some of the content here.

I’m gonna be honest, making a disaster kit completely stressed me out. I hope my experience will make it better for you. I guarantee with each step you take, you’ll feel an incredible sense of relief as you ready your family. I’m no expert at this but have learned a lot along the way. And there is no question, I feel so much better with my family prepared and my preparedness tidied.

As The Economist said last year when discussing Iceland’s volcano, “Disasters are about people and planning, not nature’s pomp.”

Prepare.

I believe in the 3 tiered approach you see everywhere:

Smoking At The Movies: Even When It’s PG

This week, Paramount released a new animated film entitled Rango. A film full of reptiles with cowboy-type roles, strong voices and adult choices. It’s an animated film marketed to and geared for kids and families. It’s rated PG. In the television trailer I saw last night, they specifically dubbed it a “family movie.” The movie had a great opening weekend, it turns out, but not without some controversy.

The film is full of tobacco imagery, where many characters use and play with cigars and cigarettes. And as I hear it, the hero of the story swallows a cigar at one point and subsequently breathes fire in the face of a villain. Funny. Silly even, maybe. But potentially instructive, too.

As most parents know, many animated films contain content, language, jokes, and plays in plot that go right over kids’ heads. These are cleverly designed to keep parents, adolescents, grandparents, and chaperons “stuck” in the audience, entertained as well. And to keep us coming back.

Problem is, it turns out not every theme goes over childrens’ heads as we’d like to believe. Read full post »

A little Bit Unhappy: $15 Well Spent?

I’m increasingly understanding that the busier I get, the more I find myself a little bit unhappy. This afternoon, I unscheduled the nanny in hopes that I would carve out 4 hours to be with my son O before I picked his brother up from school. He’s still sleeping as of now, so I remain tethered to the computer.

Despite the best of efforts, my son is having a marathon nap this afternoon, something I would normally be ecstatic about. But today, I’m not. I wanted to see him, play with him, have some time. But like we all know, parenting doesn’t work this way. Children don’t follow the script.

So here I remain, entirely plugged in. I’d had a nice conversation at the beginning of my day with an accomplished writer who was thinking of blogging for a cancer center. I gave her words of welcome, encouragement, excitement, and hopefulness for her proposed blog. At one point I said, “You’re the perfect person to do this!” (Because I believe this). But I still gave her warnings, too: this will consume you, eat you up, take over your mind. As any blogger (writer?) knows, the world becomes framed by your blog and every experience you have seems to vie for a possible leading role in your writing. I told her how I basically sleep with my iPhone (not kidding) and approve comments whenever I can and as quickly I can. It allows me to know exactly what’s going on on my blog and hopefully improves the readers’ experiences. But it comes at great cost. I’ve had a total of about one week entirely unplugged since I started this blog November of 2009. I really can’t remember what life was like before that time.
Read full post »

What To Do About Fever


Fever is often a part of life as a parent, particularly with young children in the winter time (read: 6-10 colds a year is the norm). Although I sincerely don’t like it and do feel naturally uneasy when my boys have a fever, as a pediatrician I know to take fever as one of many symptoms they develop when responding to infection. I certainly use medications like Tylenol when my boys are feverish, refusing to eat, punked out, and exhausted. Thing is, it works! And often they respond beautifully, bouncing back, regaining energy and improving their fluid intake and appetite. But I don’t treat every fever they have and I don’t recommend you run for the medicine cabinet when you feel that warm forehead. It’s not necessary to treat every fever. And it’s certainly not ideal to treat the numbers, themselves. Fever is a natural response of the immune system. Fever ultimately can be productive and may assist your child’s body in fighting off infection.

Fever phobia is pervasive though; we pediatricians are partly to blame. This week the American Academy of Pediatrics published a report on fever (and fever phobia) and the use of fever-reducing medications like acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). Listen to my take in the video. The main take home is not to treat fever per se, but your child. There is no reason to make a fever disappear if your child is otherwise acting well, playful, and staying hydrated. But do know there are some fevers that do require a visit with the pediatricians. It’s important to seek care when fever persists after 3 days in infants and children, any fever in a baby 3 month old or less, and if fever is over 104 degrees. Furthermore, trust your instincts! If your child looks unwell in the face of fever and doesn’t seem to be improving as you would expect, call you pediatrician for help!

What do you think; does fever freak you out? Do you feel like you need to treat fever immediately? Does this information help you feel more at ease with temperature elevation and fever in infants and children?

(Errata: The paper detailed above from the AAP this week isn’t a “Policy Statement” as I mistakenly said in the video. It’s a “Clinical Report.”…and well, that’s a different thing. I apologize if I caused any confusion.)

Tanning Bed Ban: 10 Tips on Tanning

I left the country, and went to a tanning bed, both for the first time while in 5th grade. I was 10 years old. Circa 1984, my parents had planned a trip to Mexico and my mom had been poorly-advised that it was a good idea to have my brother and me ready with a “base tan” prior to travel to prevent sunburn. This was unlikely to have come from a doctor, but who knows. It was the 80′s after all.

My mom took us to the local strip mall where I spent multiple 1/2 hour sessions in that warm, sweaty, purple glow encased between 2 rows of light bulbs, the grocery store to my left and the new VHS video store to my right. I remember the stomach sticker I used to obscure the UV light during tanning that marked the progress of our sessions. I remember how excited I got about traveling. I remember how this formed an initial groundwork for my skewed idea that getting a tan marked some sort of achievement. I remember how I used to get praised for my ability to tan when we’d return home to Minnesota.

I also remember that I got the only blistering sun burn in my life from a tanning bed while still under the age of 18. Not good.

I share this because tanning is a misinformation issue. Children and teens may have no idea what risk they take when getting a tan (or a burn) and some parents often have no idea the danger of these tanning beds pose. The argument for “this may cause cancer” often doesn’t resonate with a teen. It’s simply too remote, too far off, or too “grown up” a concern. I’ve found talking about the truth behind wrinkles may be a better angle…

This week the Academy of Pediatrics (AAP) stepped up. The AAP published a policy statement describing the effects of UV light exposure in children while pushing for a ban on tanning in children under age 18. The statement starts off by articulating that “sunlight sustains life on earth.” This time of year here in Seattle we’re particularly aware of this… Read full post »