Archive for July 2012

Monthly Archive

Swim Lessons Before School

New data around the world has found that early swim lessons (between age 1 and 4) may confer added protection against drowning. Maybe a new rule should be swim lessons before the start of school?

Many parents tell me in clinic that they are terrified about their children drowning. If you’re one of those, arm yourself with information: read some of the links (below) and consider signing up for lessons. However, don’t use swim lessons as an excuse to decrease vigilance around the pool or lake or riverside. Young children between age 1 and 4 years of age drown the most. Drowning happens quickly, and sometimes it’s very quiet or even silent.

Information, Myths, Truths, And Opinion About Swimming Lessons And Water Safety

  • Never let an infant or toddler out of arm’s reach when swimming or playing in water. There is good data stemming from an article published in March of 2009 to suggest swimming lessons may prove to be protective against drowning. Drowning is the second most common cause of death from injury in kids less 14 or younger.
  • 6 myths about water safety  Read full post »

Katie Couric’s Biggest Accomplishment

Without question, for nearly all of us, parenthood is the center, the privilege, and the highlight of our lives. Like a glowing pin at the center of a large target in the middle of the night, our children are really our focus points. We often see that very clearly, even with dark glasses.

That’s why it’s not surprising that when Katie Couric interviewed this morning in Seattle at KING5 News, she responded that it was her motherhood she was most proud of:

 

I think I did a pretty good job

She meant raising what she described as her “nice girls with good values.” Her daughter is just 21 years and her younger girl is 16 years old. But out of all of her opportunities in the media, all of her fame and celebrity, all of her fundraising and initiatives in cancer prevention, and her very public life on the news, she is most proud of her motherhood.

I’m not surprised. The complexity of raising children draws upon our instinct, our wisdom, our decision-making, our education, our communities, our families, and our values. Getting our children to adulthood with judgment, respect, vision, and compassion is a enormous task. This job we parents hold demands extraordinary things–and success here is more respectable than any other accomplishment we complete. Parenthood is that important. Parenthood is that precious of a resource.

Katie listed her work to improve cancer screening and raise hundreds of millions of dollars for cancer research “dream teams” as her second biggest accomplishment.

After I did my live colonoscopy we saw colon cancer screening go up by 20%

She briefly discussed the role of epigenetics in cancer prevention and the exciting time to improve health. When asked about all of the work that we see–that public work like reigning on the Today Show for years and the CBS evening news–she said: Read full post »

Aurora Shooting: What We Can Do

It’s almost a relief that it’s summer vacation. For the sake of our children, I mean. The buzz about the horrific, deadening, jaw-dropping news regarding the massacre in Colorado may be slightly less focused at the center of their lives–they’re not congregating in the hall or at recess. Well, maybe. That’s the difference between 1999 and 2012–back when Columbine happened we all watched as television detailed the horrific events of a school shooting and the radio reported on the lockdown and a mourning community—but our children and teens weren’t on Facebook or Twitter or Youtube then. The stories weren’t quite as accessible–they weren’t in our pockets. Now we’re texting and streaming one video after another.

All this bad news takes its toll on us. It endorses the curiosity we have about tragedy and violence and it can trickle into present repeatedly. At some point, part of how we help our children and teens cope is by facilitating digital breaks. Unplug the phone, log off Facebook, and help your children mourn offline, understand how it may affect their plans, and encourage them to reach out for face-to-face support networks.

I agree with the American Academy of Child and Adolescent Psychiatry:

 There are no ‘right’ or ‘wrong’ ways to talk with children about such traumatic events.

The 24-news cycle is amped-up, accessible, and ever-present. It fills us with information by the second & minute, not the hour. Our children and teens learn, hear, and spread responses with unparalleled rapidity. Never before did we consume media and news like we do today. Even daily hours of television viewing are increasing. We’ve also piled our digital time on top of it.  This tragedy seeps into our centers.

After a cafe shooting here in Seattle in June and ongoing mass shootings throughout our country, I think we’re profoundly scared. Our culture encourages and enjoys violence in movies and video games. Shootings are glorified and little babies and children bear witness to death (at early ages) via digital & traditional media and advertising. The NRA fights to keep guns accessible. Politicians have attempted (and failed) to censor conversations about gun safety in the pediatrician’s office. Even today, influential leadership avoids discussions about gun control. All this and then we chat, talk, tweet, stream, and absorb violence with a hunger. It’s just so horrifying that sometimes it’s hard not to watch. We follow along in bed, on the bus, in our cars (!), and during our face to face time with loved ones and family. This news is upsetting and torrential. Many of us are left feeling a bit helpless or vulnerable. So are our children.

Now is the time to be assertive with your children. Listen more than you talk. And maybe commit to turn off your phones as much as you can.

7 Tips To Support Your Children After The Aurora Shooting

  • Hearing about events like the massacre in Colorado makes us feel increasingly vulnerable. Read full post »

Fear Of Needles

Vaccine hesitancy comes in all flavors. It’s not always concerns about safety that causes children, teens, and parents to hesitate or even refuse vaccines. Sometimes it’s about pain. Or simply discomfort. Or anxiety. It’s perfectly natural, of course, to have a fear of needles. It’s rare that a child enjoys the pain of an injection (although those kids, even at young ages, are out there).

Sometimes the fear and anxiety of needles really can manifest itself as a sincere phobia. In those cases, the fear is so overwhelming that it changes family decision-making around vaccinations and leaves children unprotected. It can torture parents when they have to scoop their kids up from under the chair. And parents get embarrassed when their child/teen becomes combative with shots. Sometimes they avoid coming back to clinic simply to avoid the conflict. Makes sense in a hectic world.

However recently in clinic I took care of a teen soon after she’d had a terrible experience with Influenza (the “flu”) and it’s changed how I care for my patients. She was an asthmatic, high school student. Because of her asthma, her doctor had recommended a flu shot. Even though doctors recommend flu shots for all children between 6 months of age and 18 years, we work very hard to get high-risk patients protected. Children and teens with asthma are more likely to have a severe pneumonia after contracting Influenza. We worry about children who wheeze and have asthma (even mild asthma) because it can land them in the hospital and/or can cause a life-threatening illness.

Most parents with asthmatic children get flu shots yearly, early in the season. But not all.

When I saw the girl in clinic she was exhausted and stressed, confused and scared. Through the course of her Influenza illness she had missed 2 weeks of school and lost over 15 pounds. She was still coughing a few weeks later. I looked back to the chart note visit prior to her infection where her pediatrician had recommended the flu shot. “She’d declined,” it said.

“Why?” I asked.

Read full post »

Surviving Tantrums: The Anger Trap

We survived one of the biggest tantrums of all time in June. At the Oakland, California airport check-in of all places. Did you happen to hear about it? I literally had to physically hold and restrain my son from running off into moving traffic. The tantrum caused for lots of staring and avoidance. It does feel like judgment sometimes, which only makes us feel worse. In a low moment, I explained to my 3 year-old that he was acting like an animal. I got progressively more and more embarrassed and progressively more and more frustrated. It was one of those moments we never expect and have a hard time forgetting. The forgiving, that comes easy. Have you read the book, How Do Dinosaurs Say I Love You? That helps, too.

Same thing happened this weekend. I missed a meeting when I got stuck in a tornado-like tantrum and spent a big part of the weekend trying to optimize days to support my son to avoid tantrums. When it comes to tantrums, we all know we’re supposed to calm down, but it’s difficult to say the least. Our children find all of our hidden buttons and can escalate rapidly. You can’t avoid every tantrum, but some ideas to help you survive them more gracefully:

8 Tips To Survive A Tantrum

  • Giving your child enough attention and “catch them being good.” Provide specific praise in successful moments. However, don’t feel that if one child tantrums more than another that you aren’t providing enough attention. Personality is infused in behaviors, including tantrums.
  • During a tantrum give your child control over little things (offer small, directed choices with options rather than Yes/No questions). Read full post »

Sick Day

I had an unexpected gift this week: a not-so-sick sick day with my 5 year-old. And it really couldn’t have come at a better time.

We’ve never had a sick day like this before and he’s off to Kindergarten in September so the days were running out for preschool stolen-away sick leave.

In the past when he’s been ill he’s been well enough for me to head off to clinic or work and he’s been home with my mom or his nanny. I’ve ached in the absence but pushed through knowing it really wasn’t me he needed but rest and time away from school. Previously I knew that my patients needed me more.

This time he spooked me. Late Sunday night he developed a booming fever and complained about significant abdominal pain. He skipped dinner, plodded off to bed, and made a series of sweat circles on the sheets. My husband and I were both sitting on the edge of his bed hovering near midnight negotiating the logistics of heading to the ER. I went through the lists of the different diagnoses I imagined could cause his symptoms. I worried. We made plans for his brother, figured out who would go to the ER, and started solidifying next steps. Just then, he stopped complaining of pain and went back to sleep.

I didn’t lose my worry. I tossed and turned. I got up and organized my closet late into the night and tidied little piles repeatedly. I didn’t really sleep.

By morning, the fever was gone. The pain had improved and he joined us at the breakfast table. He downed his breakfast so we took his brother to school. And me? I got the day with my boy all to myself, I got to be home with him–worry changes everything. Read full post »

Hands-Only CPR

Although this video feels a little bit like a video game (and takes you back to the 1970’s), it’s 1 minute of your life you don’t want to miss. Recommendations for CPR have changed this past decade. If you don’t have time to re-certify, take 1 minute and watch this video. Don’t ever be afraid to help immediately in a emergency situation where a teen or adult has potentially suffered a cardiac arrest. Channel your inner-John Travolta. Your actions can only help. Check out the American Heart Association CPR page for more. You can take a CPR class IRL (in real life) or online.

Bystander CPR dramatically improves survival from cardiac arrest, yet far less than half of arrest victims receive this potentially lifesaving therapy.

Parents who have learned how to do CPR are often more confident about their ability to manage an emergency of any kind. As a mom, I always feel more confident after reviewing these recommendations.

CPR For Infants & Children Is Similar But Different

Click on these links for drawings and nice summaries of CPR recommendations. Hands-only CPR is not recommended for children. However, the rate of compressions for infants and children also matches the Stayin’ Alive beat…

Instructions for Infant CPR (babies under 1 year of age)

  • If alone, start CPR for 2 minutes, and then call 911.
  • CPR consists of doing 30 chest compressions (with your fingers) and then 2 gentle, 1-second rescue breaths, then 30 compressions again. Repeat.

Instructions for Child CPR (children under 8 years of age) &  Video Explanation

  • If alone, start CPR for 2 minutes, and then call 911.
  • CPR ratio is 30 compressions for every 2 breaths. This is the same compression-to-breath ratio as infants. However, the position of your hands for compression is different.

If you’re local, you can take infant, child, or adult CPR classes at Seattle Children’s.

Why Broad Spectrum Sunscreen?

I’ve written about sunscreen before (Protecting Children From The Sun, 10 Tips on Tanning, & the video on Protecting Infants included below). More important and than any granular, scientific detail about a sunscreen ingredient, UVA/UVB radiation, or it’s vehicle– a spray or a lotion or an ointment–is how you use it. The best sunscreen is the one that is used early and often on children. No sunscreen is waterproof and no sunscreen is play proof. For infants and toddlers, I’ve found the best trick for easy application is to put it on while they are strapped into the car seat on your way to the beach! There’s no controversy that it’s best to apply sunscreen 20 minutes before sun exposure and repeat the application head to toe every 1-2 hours during active play/swim.

Don’t be fooled– sunscreens marketed for children may not provide any increased safety or protection. You’ll see and hear conflicting reports on ingredient safety, particularly as differing groups discuss concerns about chemical ingredients versus physical/mineral ingredients. Trouble is, groups now warn about the physical/mineral ingredients (previously felt to be the safest) due to their particle size. And although the FDA warns against using spray sunscreen with children (concerns about inhalation of the fumes) most families love the convenience. Here’s a comprehensive, current review on ingredients & safety.

Good thing is, most everyone agrees that the ingredients in sunscreen are less risky than any significant sun exposure or burn in childhood.

The video above explains the need for broad spectrum protection. You’ll need to look for a sunscreen that has 2 or 3 ingredients to cover all the range of UVA and UVB rays that damage our skin. Here’s the American Academy of Dermatology’s tips.

A Little Science About UVA/UVB Light & Sunscreen:

  • UVA radiation causes Aging and deeper skin damage. To protect against the entire spectrum of UVA rays, you’ll likely need two ingredients in the sunscreen–most commonly you will see oxybenzone or avobenzone coupled with another (zinc oxide, titanium dioxide, for example) to cover the entire UVA spectrum of light. Although some people report concerns about oxybenzone’s irritation to sensitive skin, recent research finds when it’s only at typical 1-6% concentrations, skin reactions are unlikely. If using a sunscreen for the first time, apply a small patch of sunscreen to your child’s leg as a test before using it elsewhere. UVA radiation is constant throughout the year, regardless of season or heat index. Read full post »

4 Tips For A Healthy 4th

This post sounds a lot like it’s written by a doctor (I’m colored by the holidays I’ve spent working in the ER). I feel strongly about not using fireworks with children. Fireworks have always kind of freaked me out. When I was a child my father loved fireworks, he used to terrify us by surprising us with hidden explosions in the bushes and whirling bottle rockets off the deck. I like professional fireworks in the sky but I do tend to keep a good distance from the others…scarred for life, I guess.

The Fourth is one of those days we can do better. As the holiday week(end) begins, take a minute to plan ahead. The Fourth of July is one day where we don’t follow our typical routine, and each year July 4th marks a day with a huge bump in injuries. Talk to your children about ways to protect themselves and plan ahead to protect your young children from potential injuries:

  1. Children between the age of 5 and 14 are the highest risk for firework injuries—over double the risk of the rest of us. I don’t recommend you use any fireworks but if you do, make some serious rules. Ensure that adults don’t let young children light fireworks and supervise older children using any type of firework. Nearly 1/2 of all injuries each year from fireworks occur in children under age 15. Research finds that the hands (40%), eyes (20%), and head and face (20%) are the body areas most often involved. “Every type of legally available consumer (so-called “safe and sane”) firework has been associated with serious injury or death.
  2. Sparklers seem fairly benign, yet use caution with your kids if you let them hold them. Sparklers burn at 1200 degrees Fahrenheit–hot enough to cause a 3rd-degree burn.
  3. Remind your teen children and their friends about of risks associated with teens on the road for the holiday. Pull a parent and remind them to wear their seat belt, avoid texting and driving, and ban the use of alcohol for those behind the wheel. The Fourth of July ranks as the deadliest day all year for teen drivers according to AAA.
  4. If you think you’re too smart for injuries on The Fourth of July, hold on a second. Recent research found that higher levels of education do not protect against firework-related injuries. Even if you’re part of Mensa, this is a day to make back up plans.

‘Having It All': Stumbling

I read The Atlantic piece written by Anne-Marie Slaughter entitled Why Women Still Can’t Have It All this past week. Make sure you block off a 1/2 day from work if you want to read it. It takes a good number of minutes to get through and I found myself kind of staring at the wall after I’d finished. Slaughter does a beautiful job spelling out the glaring issues of our time for working women using her intense personal experience and her extensive education. She lays out her thesis for our inability to “have it all” as working mothers circa 2012 and she illuminates the traps so many of us stumble into as we work and raise our children. Yet knowing all this didn’t really help in the immediate.

Differing gender roles, division of responsibility issues at home, and the juggle (tug-o-war) many women feel with balancing the needs of their family and the needs of their careers aren’t new. But Ms Slaughter does draw us in. I haven’t had a chance to chat about it at any water cooler, but I have watched and listened and lingered online. The article was a huge success for the magazine; even my husband notices a dust cloud at work. A ripple in the lake of life for many of us, for sure.

Let me break down my response in a few chunks. This isn’t exactly steady and linear for me. This isn’t a thesis or rebuttal either, just a reaction. Read full post »