Archive for March 2012

Monthly Archive

When Is It Okay To Fly With My Newborn Baby?

I think it’s okay to fly with your newborn baby straight away. After 1 week of age the Federal Aviation Association (FAA) says it’s okay, as does the AAP, but always recommends a separate seat for your infant whenever possible.

The biggest risk flying with a healthy newborn is exposure to infection. So, like any decision in life, you have to weigh the risks and benefits of a decision. Because we take fever very seriously in babies under 3 months of age, we want to avoid infections when possible. Take precautions, wash your hands frequently, and wipe down seat backs, tray tables, and seatbelts on board.

All that being said, I flew with O when he was just 6 weeks old. It was important for us to travel to see family in California for the holidays. I took precautions, loaded up on hand sanitzer, and backed extra diapers. It was a wonderful Christmas…

For more on traveling with children, check out:

TSA Tips For Traveling With Children

Is Air Travel Safe For an Infant (the short answer is “yes”)

What Is The Cinnamon Challenge?

I’ve been mentioning the cinnamon challenge in clinic with my teen patients after I learned about it earlier this month. Read this nice summary. The challenge is to swallow a teaspoon of cinnamon in less time than it takes me to explain what it in the above video (60 seconds). Reality is, my patients tend to know about the challenge, but their parents don’t. I usually talk about it along with a whole list of other topics while their parents are out of the room (bullying-the choking game-sex-drugs-violence-texting & driving or other threats to their safety). Recently, a patient was able to explain the challenge to her mom with me in the room right after her mom returned and joined us. We discussed the reasons the cinnamon challenge can be life threatening and stupid.  Teens don’t want to get hurt, but they really do want to be strong, and ohhhh, competition is seductive. Teens (like most grown-ups) love to preserve that feeling of invincibility. Precisely why the challenge has caught on.

The cinnamon challenge has its own website and has gone viral with the help of social media. The topic has been viewed online more than 60 million times with some pages boasting over 10,000 “likes.”  The reason? The challenge itself is so visual and so inexpensive to replicate, teens are capturing videos of the challenge and putting them on YouTube, Facebook, Twitter and on their phones. Pretty funny, right?

This is the part where I sound like a doctor. The dangers from the cinnamon challenge are real; multiple children have been hospitalized. Some children have had serious complications including loss of consciousness, collapsing lungs, ICU care, and days on a ventilator. Cinnamon is easily aerosolized but not easily dissolved. Once it lodges into tissue, it can cause great havoc and remain there. Coughing while gasping and/or choking on cinnamon can cause it to be easily inhaled or aspirated or swallowed leading into tissues in our bodies. We worry most about it collecting in the lungs.

The challenge is real. The side effects even more so.

Watch the 60-second video above. Check in with your school-age or teen child and explain the facts. Find out what they think about it and stop the allure of the cinnamon challenge now.

24 Hours Offline

I took 24 hours offline from Friday at sundown through Saturday at sunset. I didn’t use my phone, I didn’t text, I didn’t log onto a computer, and all the while I didn’t enter a single network. I didn’t blog, tweet, Facebook, or LinkIn. I was genuinely unplugged without entering the wilderness. I was at home in Seattle devoid of my devices on my second annual digital sabbath.

I went shopping for a friend’s birthday gift by myself, the quiet liberating. I went to a baby shower, I played  baseball with the boys outside, I cleaned up the back yard. And while the sun shone in Seattle on Saturday afternoon, F and I cuddled on the driveway. We laid down on the pavement and looked up at the sky. We didn’t talk much and even with the paucity of words, the moment takes up a big part of my long-term memory. Little F returned twice to join me on that hard surface, grabbing for my hand amidst the concrete. Presence is very soft no matter how hard the earth below you.

No beeps, dings, or directories distracted. It was a day much slower than the rest.

The lesson is simple of course. Twenty four hours without distraction are exceptionally bright. The loss from being disconnected online is overwhelmingly  surpassed by the gains acquired with being present offline. And although it’s easy for many of you, this unplugged time is an utter luxury for me in the time of exceptional connectivity and work online.

There’s nothing I would do to reverse my time offline. It was rich and it’s solidified the need to establish a new goal to make time for a more frequent digital sabbatical. I want to seek solace routinely from the deluge of content, information, exceptional wisdom, and friendship I gain while online and return to the spaces without distraction that house the same things.

Join me? Will you take earnest 24-hour periods of time without technology, too? Do you think your kids will notice?

Sudden Cardiac Death: What Parents Can Do

As a parent and pediatrician, any mention of sudden cardiac death leaves me feeling uneasy. The stories of young athletes dying or falling on the field are agonizing. All of us here on earth would like to do something to prevent these deaths.

Researchers and cardiologists are working tirelessly to understand predictors for sudden cardiac death in children alongside techniques to improve screening and prevention for young athletes. Dr Nicolas Madsen talked with me about recent work here in Washington State. There’s a video at the end of this post from the interview. I’m lucky, I met Dr Madsen when he was a medical student and now he’s an old friend. He’s one of those bright lights: a compassionate physician and father of three who just gets it and wants to solve big problems. He’s about to finish his fellowship here in Seattle and while completing his training, he’s uncovered some holes in the system. He’s helped me understand how to screen children better. As a parent, there are some simple things you can do to improve the screening your child receives prior to athletic participation.

“Sudden Cardiac Death is a needle in a haystack, but a very sharp one.” Read full post »

All Grandparents Need A Tdap

Some of my best friends are about to have a baby, the due date only a few weeks away. I’m teary thinking about it as my excitement for her arrival exceeds the speed limit. They asked my opinion this week for getting their extended family immunized in light of the recent Whooping Cough (pertussis) outbreak in our area. I advised them that all teens and adults (including grandparents) need a Tdap shot before they are with the baby. Even pregnant women are getting immunized after 20 weeks gestation to protect their newborns at and after birth.

Ideally, everyone should have the Tdap shot at least 2 weeks before the baby arrives.

My friends advised their parents. But both grandmas were turned away–one here in the US and one abroad. Each were told by a physician that they didn’t need the Tdap shot because they were over 65 years of age.

That physician was wrong. Whooping Cough (pertussis) knows no age. And immunization recommendations for pertussis protection have changed this past year because of rising rates of infection and infant deaths.

The best way to protect a newborn baby from getting Whooping Cough is to cocoon them with family and friends who are immunized against it.

Here is an overview on protecting your family from Whooping Cough.  <——Share this link with friends having new babies.

All grandparents, all adults, and all teens need a Tdap shot before holding a newborn baby.

Ask questions, please. And one more thing, can you suggest girl names? My friend is beside herself that they don’t have one picked out…I’ll buy you coffee if you suggest the name she chooses (hint: use a real email)

8 Lessons From Beginners

Sometimes health education comes outside the textbook or the hours required in medical school. On the plane this week I tripped on an extension class–a movie.
A movie every doctor, daughter, son, mother, father, dog owner, and caregiver should see. I’ve never recommended a movie here before but this one I consider a must-see. It’s R rated, just like health care. And parenting.

Beginners

There is a lesson every few minutes. Here’s 8 I saw:

  1. Medication is incredible. 70 years ago yesterday patients started to survive from previously incurable illnesses by using penicillin. When you’re giving a father or a mother or a daughter or a partner medicine, put it in a beautiful cup. It may improve the experience. Half way through the film, you can see examples. Providing reminders and offering mediations can sometimes be beautiful.
  2. When you’re a doctor, remember that your tone and every single word you chose can have lasting power. Not always (thank goodness) but sometimes. Listen to the doctor provide the diagnosis (even in the trailer below) and pause on the power of that particular metaphor. Metaphors and images can serve your patients beautifully. Or haunt them, too. I remembered listening to a voicemail from a doctor in 2004 over and over again. I wanted to hear the good news but all I kept hearing was the truth: the bad news. I listened to that doctor’s voice again and again. Chose your words carefully as best you can when providing news.
  3. Sorrow and mindlfulness in grief and anticipation of loss can create great meaning. Presence in our reality is a gift for being human. I can’t remember who said this to me recently, but I keep thinking about it: being a caregiver to a suffering or hurting individual may be the most meaningful experiences you have while living. Beginners reminds us we need no medical training to nurture and relieve suffering. Read full post »

A Dr, Patient, And An Insurer Walk Into A…

When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich).

The more I learn as a physician, the more I realize how little I know.

The great thing about the extensive travel I’ve been enduring lately is that I learn to see the world differently. This week I participated on a panel at SXSW (called: A Dr, Patient, & Insurer Walk Into A Social Network) where I had the opportunity to share my thoughts as a doctor alongside a patient advocate/technologist and an insurer.

The technologist sees the world like this:

We envision a world where information exchange between patients, doctors, pharmaceutical companies, researchers and the healthcare industry can be free and open; where, in doing so, people do not have to fear discrimination, stigmatization or regulation; and where the free flow of information helps everyone.  We envision a future where every patient benefits from the collective experience of all, and where the risk and reward of each possible choice is transparent and known.

The Insurer sees the world like this:

We believe we can help create a better health care system. This belief drives our daily decisions as one of the nation’s leading health care benefits companies. We work hard to provide our members with information and resources to help them make informed decisions about their health.

Read full post »

Cell Phone Parenthood

I loved a recent NYT article where Dr Eric Topol described Americans as surgically connected to their phones.  He also described the great opportunity that resides within the phones for getting and providing better health care. These phones are a part of our future and can be exceptional partners in measuring and preserving our wellness. These mobile devices and apps will increasingly put the patient at the center of their own care. Dr Bryan Vartabedian summarized Dr Topol’s book and reminded us that, “medicine is increasingly anchored by the individual.” Thank goodness.

But the balance of how we value and use these astoundingly powerful pocket tools remains mysterious for some of us. There is a growing body of work about the addictive properties of smart cell phones. And although I hear a lot about how we should advise our children and teens to manage their digital device use, I don’t hear as much about how we as parents can do the same.

There are countless blogs and loud rants that cross my desk (phone, I mean) shouting for moms and dads to get off their phone when they are with their children. They look a lot like this:

Now Mr Palmer wasn’t yelling at me this morning (or maybe he was), rather he was responding to some data I shared about cell phone use: 1 and 3 adults say they frequently use their cell phones at the dinner table. Read full post »

18 Months: Seattle Mama Doc 101

18 month-olds are extremely determined,  constantly challenging, tenacious, adorable, witty, and ever-aware. By 18 months, most babies have really figured out how to get and hold a parent’s attention! As they explore their widening world, an 18 month-old’s curiosity leads while their judgment lags well behind. Providing your child with a safe and consistent environment is paramount. Development in all areas (gross motor, personal and social, fine motor, etc) is highly variable but the video reviews typical milestones your baby’s clinician will review around 18 months of age.

What Should My Baby Do At 18 Months?

In general by 18 months, your toddler will be very curious. They will be demanding. They will be communicating wants and needs through words, motions, and imitations. They will be pointing out objects in the sky. They will be calling you by a name just as they run the opposite way…

 18 month milestones

“Mr No” – I found this extensive list of milestones and observations both very entertaining and educational

What Parents Can Do For 18 Month-Olds:

  • Give your 18 month-old their space. As they crave more and more autonomy, provide them times for a bit of freedom.
  • Let your child mimic you. Give them toys or safe objects you use in the house so that they can pretend to be an adult.
  • Let them help. Start finding daily or weekly “chores” for your 18 month-old (ie bringing napkins to the table or moving stuffed animals to a bin). They’ll love their role!
  • Offer puzzles, matching, and sorting games.
  • Read to your 18 month-old every single day. Point out objects in the book. Ask your toddler to tell you the names of animals or toys in the book. Get them involved. And get ready to read the same book over and over and over again!
  • Keep rules to a minimum. Rather, define “right” from “wrong” for your child and remember to praise your 18 month-old for doing things right. Catch them when they are being good!