Archive for 2012

Greatest Hits 2012

Screen Shot 2012-12-31 at 10.47.01 AM

I give thanks every day for friends, mentors, teachers, collaborators, and family like you. It’s been a sincere privilege to share thoughts here. I’m always amazed at the depth of reflection that washes over me as the year comes to a close. However pre-conceived this day seems for reflection, today has me in its grip. The end of 2012 is filled with far more information about being a parent, being a patient, and being a pediatrician than the beginning held for me. More on that tomorrow, but for today I just want to say thank you for reading.

Here’s a list of the “greatest hits” of 2012. The list is based on the number of views and shares but also the impact these posts had on discussions about pediatric health and parenting. One post is included primarily on the number of people who went out of their way in person to discuss it with me. Please accept my sincere thank you for your insights, reflections, contests, partnership, and loyalty to learning and growing into parenting and pediatrics with me.

May you welcome in a beautiful, healthy 2013 tonight.

2012 Mama Doc Greatest Hits

  • TIME Magazine And The Mommy Middle Road This is a reaction/reflection to the TIME Magazine cover with a preschooler actively (potentially) breast feeding while standing on a stool. It’s about motherhood, finding confidence in our choices and knowing that yes, of course, you’re Mom Enough.
  • 4 Reasons Toddlers Wake Up At Night A list of reasons toddlers awaken their parents at night and 100+ comments/explanations for parents seeking the solace of a good night’s sleep. Read full post »

Baby Dies From Whooping Cough

camping out with babyNews of a whooping cough death in the Seattle area rang out yesterday. By afternoon, many of my patients in clinic had heard the news. Although the epidemic levels of whooping cough have gradually faded since a peak of cases here in May, the risk is still very real.

A newborn baby died from whooping cough on December 13th here in Washington State.

Newborn babies are at particularly elevated risk for serious complications from pertussis (whooping cough) infections. Unlike older children and adults who often have cough & coughing fits with vomiting, babies can have severe respiratory distress, pauses in breathing, or even stop breathing. Rarely it can be deadly.

Infants are most likely to catch whooping cough from a parent. We have to cocoon newborns everywhere: surround them with people who are vaccinated and less likely to spread whooping cough infection.

This tragic death serves up a reminder for we pediatricians, family docs, and clinicians everywhere to maintain our efforts and amp up our passion to keep babies surrounded by immunized family and friends. We can’t let up.

Are You Up To Date On Your Whooping Cough Shots?

More than anything, we need to ensure family members (mothers, fathers, grandparents, and siblings) all are up-to-date on their whooping cough shot. The shot is imperfect (meaning not everyone who gets the shot is always immune — most estimates find that 80% of us who get the shot are protected) and we know some of our immunity to whooping cough can fade year after year. So the more people immunized the less likely we are to have whooping cough in our community. Read full post »

Going Back To School Monday

Sick day alleyAs Monday approaches and we ready our children for school, I would suspect most of us have a little bit of dread in our hearts. I do. There is unease as we return our children to school. This post covers information for supporting your children but also information on supporting yourself during these upcoming days, too.

The past few days have been bewildering. Making sense of the tragedy in Connecticut is a huge challenge, particularly as the details of the shooting simultaneously unfold along side the details of the beautiful lost children and teachers and protectors. There’s little to say more than this is tragic and head-shaking. There is just no sense to what unfolded here in America last Friday. And although there are stories of incredible heroism we are left mourning and aching.

In my 4 years using social media, no single topic has over-run my channels like this shooting. We are all aghast and terrified, sad and stunned. As President Obama said, “We’re heartbroken.” When I opened the Sunday New York Times this morning, I gulped and teared-up again—I simply couldn’t wrap my head around the number of 6 and 7 year-olds that we’ve lost. Especially as one sat next to me at the breakfast table.

The randomness of this event allows us all to relate to the details of the horror and loss with uncomfortable familiarity.

We can and will work towards a safer future for our children. Don’t ease up on yourself or those in your community for action–improved communication, access to mental health, examining gun control–as months unfold. The future comes quickly. Today and tomorrow are about the ongoing effort to bolster yourself and your child in feeling great about the days ahead, in and out of school at the mall, wherever you find yourselves.

Tips For Parents With Children Going Back To School

  • Your child’s school is safe. The fact remains that this random, horrific shooting is an anomaly. Your child’s school is a very safe place to be. Remind yourself, and your children if they ask, that this tragedy was an exception.
  • Get the information you need to feel safe this week. Send an email to the principal, your children’s teacher, and/or fellow parents–perhaps commit to participating in ensuring you have good safety measures in place at your school. Leaving a VM message, sending an email, and/or joining the community of families wanting to ensure safety as the days unfold will likely ease your fears. Get involved. Write a letter to The President (The White House/1600 Pennsylvania Ave NW/Washington, D.C. 20500) or your congressman. Action is an antidote to anxiety. Read full post »

One Foot In Front Of The Other

photo (22) It’s been a heart-wrenching 3 days since the news of the shootings unfolded Friday morning. Best antidote to my sorrow was a run in the rain this afternoon. I turned up the music far too loud and headed out for a quick run. I stopped thinking and spinning about the grieving families in Connecticut. I heard the music and felt the cold on my hands. It was a powerful switch.

Even though I’ve only seen 15 minutes of news coverage about the shootings, I’ve been reading about how to support families in the aftermath and I’ve been consuming copious information since Friday. I’ve been allowing my own social networks and my own professional organizations to filter information I should read. Like most Americans, my curiosity for details is difficult to fully suppress. We all want to understand more. Even so:

Find time for yourself in the next 24 hours to have some release. Give yourself time and space (when you can) to get outside. Just putting one foot in front of the other helps. Without the news, without Facebook, without the conversations about Newtown, CT ringing in your ears. Get out and walk or run. Put in the music or simply tune out the masses. Be in a place with no ceiling and find time to repay all that has been drained from you.

One foot in front of the other helps.

More Than A Dozen Children Died At School Today

The news of the shooting in Newtown, Conneticut this morning is beyond horrific. Nauseating and troubling, it’s left me sobbing at my computer to think of the anguish families face. And the lesser anguish we all feel right now. To think of the lost hope and the lost efforts of all those that work so hard to protect children and those who work to educate them. And the loss of safety in another school.

The news from Newtown is agonizing. The loss is unthinkable.

And I’ll tell you this: there are days I wake up and wonder, “Am I doing this right?” or “How can I balance my life and work to improve the lives of children ?” or “Can I really speak my mind?” And then there are moments like this, where it’s clear.

Here’s my mind:

  • I believe we have an obligation to fight to protect children from guns in the hands of the crazy, the wild, the intolerant, and the careless.
  • I believe it’s really difficult to figure out who is crazy, wild, intolerant, and careless.
  • I believe gun control should have been yesterday’s topic, not today’s. Lives could have been saved. I believe politicians must put politics aside and create a safer United States now.
  • I believe the President of the United States has a moment to make change.
  • I believe that guns have no place in our homes.
  • I believe we must keep demanding improved understanding and education for we parents about how to get automatic weapons out of civilian hands.
  • I believe I am hardly alone on this. Even so, when I write about gun control I get angry responses.
  • I believe this: WE ALL WANT THE SAME THING—safe communities, healthy children, and opportunity for long lives.

Tell me what I can do to make a bigger difference. And please tell me what you’re going to do.

Tips from Pediatrician Dr Besser on talking with children about tragedy (this was filmed after Aurora shooting) and tips from Dr Robert Hilt at Seattle Children’s. Easiest first step is likely to just turn off the news…

Safe Holidays For Your Children

This is a wonderful time of year. It’s also a really stressful one for many of us. Some quick reminders about ways to stay safe while bringing holiday decor into your home, traveling, while arguing with your brother about gifts, and when potentially having more alcohol around than is typical…

  • FIRE: Be careful of lit candles and check the safety of lights you place on trees or around the outside of your home. Christmas trees are like kindling for house fires. Check out National Fire Protection Agency’s info or watch this video of a tree catching fire.
  • DECOR: Holiday decorations often bring hazards for young children. This include candle holders, Christmas tree ornaments, plants, decorative garlands, and hot liquids. I’ve cared for many children with scald burns from soups and hot liquids. With decorations, anything longer than 12 inches can pose a strangulation risk. Make sure your trees and larger decorations are mounted in a way that your child (of any age) can’t pull them down upon themselves.
  • ALCOHOL: With holiday and New Year’s parties fast approaching, it’s good to have a plan for alcohol–if you’re serving it or drinking it. Many sober alcoholics relapse this time of year and many small drinkers consume alcohol more excessively. We have to be careful with our guests and ourselves — for our children. Clean up after parties, too–don’t want toddlers finding the punch!

This kind of advice feels heavy-handed and self-evident. It’s not as if we wouldn’t have thought of most of this. Read full post »

HPV Shot Doesn’t Trigger Teens To Have Sex

In 2006, I entered pediatric practice. It was the same year that the Advisory Commission on Immunization Practice (ACIP) recommended to start giving 11 year-old girls the Human Papilloma Virus (HPV) vaccine. Therefore, I’ve really never practiced pediatrics (outside of my training) without the ability to offer up immunization and protection against HPV virus; I’ve been discussing this for about 6 years. We now give HPV shots to both boys and girls because it’s so common–about 50% of all adults who are sexually active will get one form of HPV in their lifetime.

HPV virus can come into our body and do no harm. But it also can come into our bodies and cause vaginal, penis, anal and oral/throat warts. Other strains of HPV also cause changes in the cervix that can lead to cervical cancer and can rarely lead to penile cancer and/or tongue/throat cancer. Teens and adults can get HPV from oral, vaginal, or anal sex. Condoms don’t provide 100% protection from getting it.

GREAT NEWS: Being protected (by the HPV shot) doesn’t trigger risky sexual behaviors in teens.

Nice to have an immunization to protect against the potential development of such disfiguring, embarrassing, and uncomfortable lesions. And what a windfall to have a vaccine that prevents cancer. I often say to my patients, “If my grandmother only knew that I’d see the day where we could prevent cancer.” I mean it—if she only could have seen the day (she died in the late 1980’s).

The reality is though, parents to teenage girls have consistently been hesitant in getting the HPV vaccine in my office.  Over the 6 years hesitancy around getting HPV vaccine has lessened, but many of my patients’ parents have told me they don’t want their girls or boys to feel that getting the shots is a green light for sexual activity. And many have worried that having their girls immunized will make them more likely to engage in earlier sexual activity. Read full post »

When Parenthood Exceeds Expectations

We surfaced the other day, my husband and me. Bobbed up after having been submerged in the challenges and complexities of stress, tantrums, hectic schedules, holiday crunch time, and career responsibilities. When we surfaced we found ourselves in one of the most luxurious moments of life. It was one of those spells I want to compound. More than just burning it on my brain, I want to relive that memory again and again. I want to hit play and repeat…I suppose that’s part of why I’m sharing it here.

Here’s what I mean: Have you had one of those meals or nights or walks or adventures with your children recently where you realize there is simply nothing better? Where you wake up in a moment and consider that it is for this moment, this one space in the continuum of time, that you were made to be? When you come to feel like it’s why you’re alive?

In my opinion it happens to all of us in profoundly new ways when we are lucky enough to raise children. And it’s usually unexpected. These pristine, magical moments with our children and family don’t come with proper planning. They don’t usually happen on vacation, at the fancy meal, or at the picnic we’ve planned for 2 weeks. We often don’t have our fancy shoes on. The moments tumble into our lives when we least expect it with absolutely zero material value. But like falling in love for the first time, these moments sweep us up off our feet and arrive without a hint of warning.

This is, I believe, the gift of the season of our lives. When parenthood exceeds expectations.

Recently I was talking with a good friend about these rare moments. The ones that happen where your children are enticed by conversation, fully engaged in a game or meal, where they get along with each other, and you realize there is nothing more precious or intimate. Often it seems these moments follow illness or fear. But sometimes it doesn’t take a trigger or challenge. Recently a moment appeared for my friend when she and her husband had cancelled a date night. They were too exhausted, decided to stay home and have dinner with their children and just crash. And it happened–the moment–they connected, their children were angels at dinner, delighted and laughing, present and mindful. She and her husband looked up at each other and realized they were woven into one of those meals they wouldn’t trade the world for. Really.

For us it happened late Thursday night on the floor of our living room. Our six year-old had received Mastermind (a board game) for his birthday and the four of us teamed up to play. It was the first time I’d played in 25 years and each of us presented to the game with excitement. We were enticed to win, eager, and we each giggled as we navigated and explored ways to outsmart the others.

And there we were, lying on a hard wooden floor, surrounded by the darkness of winter entirely together with only little plastic playing pieces between us. Momentous connection and family intimacy. I can barely articulate why and how I knew it was one of those moments except that I realized this is really as good as it gets.

Emergency Contraception For Teens

Stating that unintended pregnancy is a major public health problem, The American College of Obstetricians and Gynecologists (ACOG) recommended that birth control pills be available over the counter this month. And this past week the American Academy of Pediatrics (AAP) outlined use for emergency contraception use in teens girls while urging pediatricians to provide information and access to emergency contraception for sexually active teens.

All this may seem exceedingly “progressive” until you examine some of the realities. As many as 80% of pregnancies in teen girls in the United States are unintended. The birth rate for 15 to 19 year-olds is 34 out of 1000. Most pregnancies are a result of non-use of contraception or mishaps with protection (condoms breaking, pills being missed and/or forgotten or used inconsistently). We know teens don’t take their birth control as well as adults and lapses in pills or misuse can put them at risk. This is where emergency contraception can come in. I was taught how to prescribe emergency contraception to teens as a back up for contraception failure when I was in residency. I’ve been educating teens, discussing their options, and prescribing emergency contraception ever since.

What is “Emergency Contraception?”

Emergency contraception (EC) is the use of hormone pills after sexual assault, unprotected intercourse, or contraceptive failures.

Read full post »

Mix And Match: Goldilocks Formula

Often new parents are nervous about mixing and matching infant formula they offer their babies. They worry if they switch from one formula brand to another, they may cause their baby fussiness, stool changes, upset or worse–that they could put their baby at risk.

It’s safe to mix and match infant formulas if you are following standard mixing instructions. Really.

Although spitting up or gassiness is usually not due to the protein in formula (cow’s milk versus soy versus hypoallergenic), sometimes changing formula helps new babies and their parents who worry. Switching them up can even help clarify worries in some scenarios when a parent worries about excessive gassiness, intolerance, or significant urping or spitting up.

Experimentation with formula brands in an otherwise healthy newborn is okay. But it’s not necessary at all, either.

It’s fine to make a bottle that is ½ formula from the blue can and ½ formula from the yellow one. Fine to serve Simulac one week, Enfamil the next, Earth’s Best or Goodstart followed by Soy formula the following day. Fine to buy one brand that’s on sale only to buy the other brand next week. Read full post »