Archive for 2013

Greatest Hits & Greatest Inspirations 2013

Maui rainbow, December 28th

Maui rainbow, December 28th

I’m so thankful and humbled by all of the comments and dialogue here on Seattle Mama Doc. Since the inception of the blog in 2009, we’ve had more than 1 million different readers. For that I remain somewhat amazed and also astonishingly grateful. I really love detailing what I learn about caring for children and hold dear the opportunity to share what science holds. Writing about health care while wedding evidence with anecdotes remains a huge focus for me. I am so thankful to be a mother and doctor, practicing and writing, today. I am so grateful for all of your help.

I started 2013 blogging about my experience of being diagnosed with malignant melanoma, the process of renewal, and my hopes for 2013. I set out goals for the year:

 

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Peanut Brittle For Preggers

Photo from Edwart Visser Flickr Creative Commons

Photo from Edwart Visser, Flickr Creative Commons

“Children appear to be less at risk for developing peanut or tree nut allergies if their mothers are not allergic and ate more nuts during pregnancy,” according to a study published today in JAMA Pediatrics. And although this doesn’t mean that you need to run out for the peanut brittle the minute you’re pregnant, it may mean we can reassure pregnant women that if they have no allergies themselves, what they eat during pregnancy should contain nuts, among other things.

As you’ve likely heard, children with peanut allergies have more than tripled in the United States this last 15 years. Food allergies affect 1 in 13 children in the United States and up to 40% of children have had a life-threatening or severe reaction. Any family with a food-allergic child will tell you this is a BIG deal.

The rapid rise of food allergies is incompletely understood, but more and more research suggests that waiting to introduce “high allergy” foods (traditionally thought of as peanut, egg, or shellfish for example) may have actually caused more allergies than prevented them. As this was being discovered this last decade or so, flip-flopping recommendations on what to eat ourselves when pregnant and what to feed our babies have left many of us confused.

When Should I Start Baby Food?

New recommendations really encourage introduction of a variety of foods, including nuts, eggs, shellfish, wheat, and soy within the first year of life. The theory is that early introduction of the components of these foods allow a child’s developing body to create a tolerance to them, thus potentially avoiding any allergy or reaction to them later on. Read full post »

Alcohol At The Holidays?

Screen Shot 2013-12-22 at 10.12.17 AMOur children are growing up with mixed messages about alcohol and drugs, at least that’s how it feels to me here in Washington. It seems to me we’re grappling with using pot and what to do with alcohol as a community. As our state legalized marijuana use this past year, we sent a big flare into the sky. It’s possible we really do one thing and then say another in front of our children and teens, particularly at times of celebration. No question they are watching. Can you seriously imagine a pro football game without beer ads or a holiday party without booze? I can’t. The great luck is that we have profound influence over our children (tah dah!); we have a huge opportunity to help them survive.

One of the biggest mistakes parents to teens make is to believe that they no longer have influence on their kids — Lara Okoloko, LICSW

I read a tweet about a month ago suggesting that perhaps we should never drink alcohol in front of our children. At first glance it seemed somewhat absurd — that we’d ban a legal adult substance from our lives as parents to young (or teen) children that we can enjoy and drink (even in moderation) all because of the risk that our children may abuse it if they saw us drink while children. However when I read the statistics on teens and alcohol it got me thinking that perhaps I needed to be more thoughtful, not only how I talk about this but how I live with my children these next 15 years. At first glance, avoiding alcohol just seems like an inconvenient annoyance. Yet I started to read the data I recognized the incredible opportunity we all have to speak clearly and repeatedly about alcohol and risk with our children, early on.

Parents are the #1 influence on whether teens choose to drink (or smoke weed). Experts really stress we need to share data and opinions with our teens before they start drinking. The hope is that when we explain how we feel, when we share facts, when we clearly articulate that alcohol could kill a teen or their friends, that we can help our children understand their actions can greatly affect their happiness and their survival. I really don’t think I’m over-framing this in terms of survival. Teens are 3 times as likely to be in a fatal crash than older, more experienced drivers and the 3 main causes of fatal crashes among teens are drunk driving, speeding, and distracted driving (think cell phone). Alcohol-related car accidents are the leading cause of death for teens and young adults.

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Attempt To Maintain Mindful Gifting

cutting down the treeIt’s a commercial time of year, of course. It’s a challenge to help our children enjoy the holidays mindfully amidst all the products, gift-giving, and hopes for things. The rip-open-all-gifts urgency is seemingly innate to most young children. Amazing how our kids can stay on task when it involves opening awesome toys and gifts!

It’s really hard to celebrate the real bounty in life, that of friendship and generosity, in a world that really does focus so much attention marketing what we “need.” Holidays can get swept sideways if we don’t do a good job describing what they mean, why we celebrate, why we go way out of our way to stay home from work to ritualize things, cook huge dinners, and fly all over the country to be with those we love. I’m clearly not doing a perfect job. Exhibit A: Read full post »

Left To Chance With The iPotty

I got in a heated discussion with a researcher last week. We were chatting about strategies to improve challenges with overweight and obesity.  He mentioned it was media controls (automatic locks on devices) that would change children’s habits regrading screen time in the home — he just didn’t want to leave it up to parents anymore. As I understood his perspective, left to chance it’s unlikely parents will avoid screens when it comes at the cost of convenience. I mentioned to him that my young children watched very little television, that in fact, “They’d never turned the television on themselves.” He looked at me sideways, he called my bluff. I told him again they literally had zero access to TV or other screens on their own.

He didn’t believe me.

Why No TV Before Bed Is Better

I’ve carried this conversation with the researcher with me since. Not only because of how it rubbed me the wrong way  but how his presumptions are based in new realities. It was easier, even just 7 years ago, to rear our children screen-free. I mean, the iPhone didn’t exist when my 7 year-old was born. It’s far more difficult to moderate screen use now that the majority of parents have smart phones in their pockets, laptops in the kitchen, and tablets near the couch. Three quarters of young children now live in homes with mobile devices (like my children). Those of us who avoid or limit screens have created huge work-arounds in our world.

Earlier this year Common Sense Media published their Zero To Eight report detailing young children’s media use. The report is worth a glance as the stats are fairly mind-blowing. A snaphot shows us:

  • 3/4 of young children live in homes with mobile devices, some 38% of infants and toddlers have now used a mobile device.
  • 1/3 of children have a television in their bedroom (16% of infants have one) and the likelihood that one ends up there increases with age. For children between 5 and 8 years of age, nearly 1/2 (45%) have a TV where they sleep. Most noteworthy for me: the main reason parents report that a child has a TV in the bedroom is to, “Free up other TVs so family members can watch their own shows.”
  • Over 1/3 of families say the television is on “most or all of the time” in their home.
  • 63% of children have played a game on a smartphone or mobile device with 17% of parents reporting their children (0-8 years) use a mobile device every single day.

The stats go on and on and it can all feel a little reckless. I’m keenly aware that stats don’t really change behavior and I also really believe that if moderation is king guilt-free is queen. This post isn’t designed to inspire guilt. The American Academy of Pediatrics reminds us that there is no developmental benefit to screen time prior to age 2 . Sometimes learning what TV does to your child’s brain helps. I’m writing this because of 2 recent announcements: Read full post »

Simplifying Health Care

StrikeWe all want simple solutions to living a healthy life.

It feels like I was born at just the right time for my work in health care. I completed my medical training just as social tools were percolating out to the masses. Motherhood and my practice of pediatrics auspiciously coincided with the bounty of information that technology has distributed, offered up, and shared unlike ever before.

I can search and learn about health wherever I am –  at the park or in the walls of my own clinic or home. For me, using my phone, Twitter, my blog, apps, Facebook, activity tracker, and patient online communities to provide health care, consume it, and engage in it is my new reality. It turns out, amidst all the clutter and stress of health care reform and our reduced time with our own doctors I can see clearly that intuitive ways of learning about science wed with thoughtful technology will let us care, cure, and prevent illness and injury like never before.

A survey published today finds that more that 3/4 of moms search online for symptoms. The majority of mothers in the US also look up information regarding their child’s development online, read about a medicine, or track their pregnancy with online tools. I’ve done, or do, all of those things. Don’t you?

I’ve just started a new job in the hospital overseeing a group in Digital Health. Our goal is to rapidly improve the way we serve children and their family’s unique needs in the hospital, clinical setting, and community. I want to help facilitate elegant communication between parents, patients, families, and their clinicians & surgeons when they are outside the hospital or clinic. Reason is: it seems to me that the luxury of our time is the one-to-many communication we have in our pockets. Over 60% of all American adults have a smartphone in their pocket and  crowd-sourcing happens at virtual water coolers (ie Facebook) every day. Over 40% of Americans log onto Facebook everyday to listen, lurk, snoop, learn, and vet ideas. Read full post »

Yes, Vaccines Are Naturopathic!

Dr. Mary Alison HigiThis is a guest blog from Dr. Mary Alison Higi. Dr. Higi is a naturopathic physician in her final year of residency at Cascade Natural Medicine specializing in pediatrics under Dr. Candace Aasan. She studied at Bastyr University where she earned her Doctor of Naturopathic Medicine. She emphasizes the importance of the physician’s role in preventative medicine and public health. Dr. Higi has a special interest in implementing Naturopathic Medicine programs for under-served communities. 

I’m publishing this post because I think there is significant confusion about naturopathic physicians’ support of vaccines. I’m hoping this sheds a little light. Would love to learn more from you all about your experiences with naturopathic medical care and vaccines. Please leave comments!

 

 

I have frequently heard from parents, “You give vaccines? I thought you were a naturopath!” I can only reply, “Vaccination follows three of our most important guiding principles”

1. Premum non Nocere — First do no harm; weigh out risks and benefits and follow the least harmful path.
2. Docere — A physician should be a teacher to her patients.
3. Preventir — Practice preventative medicine.

By providing routine vaccinations to my patients I have the opportunity to help them weigh risks and benefits of vaccine preventable disease versus costly, painful and the often dangerous consequences of preventable infections.

When I counsel and give vaccines I get to teach about disease prevention and public health; I get to help patients prevent some truly life threatening diseases. So yes, vaccines are naturopathic! In that light, following our naturopathic principles, there are a few vaccination myths that I’ve heard so often, I feel compelled to dispel them:

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Engage With Grace Today

Engage with Grace

Engage With Grace is a movement started by brilliant and thoughtful Alex Drane and Matthew Holt. The movement is an opportunity to come together at Thanksgiving and have discussions, even just for 2 minutes, about preferences in life and preferences you have for the end of life. Even if you’re unsure of your answers, take the time and live courageously enough to talk about this. If you’re healthy, youthful, full of verve, swishy and wrinkle-free—this is the perfect time to have this conversation with those you love.

If you need inspiration for why this is worth your time, read Za’s story. Parenthood makes this all the more relevant and essential. More thoughts on this from 2011 and 2012 but basically it’s this: print this out and do your best to engage with grace this weekend. So will I.

Happy Thanksgiving

Inspiring Gratitude

Gratitude — appreciating the positive aspects of life — may not be an innate, spontaneous daily emotion to you or your children.  Rather, appreciating what we have is a skill we cultivate, practice, and maintain. There is research that shows gratitude is far more than just a touchy-feely pop-psych term. In fact, people who practice gratitude have less anxiety and depression, better sleep, decreased levels of stress, better outlooks on life and kinder behavior.  Sign me up!

Gratitude is the emotion of friendship   ~  Dr Michael McCollough told the New York Times in 2011

5 Tips For Inspiring Gratitude In Your Family

  • Make lists: Researchers describe making lists as the “classic” intervention to practice gratefulness. Making a list can be as simple as a weekly journal entry where you list that for which you’re thankful. It can be more intensive and involve daily writing and reviewing of lists, too. Regardless, the research shows that keeping these lists is easier than other interventions for improving mood, more likely to turn into a habit, and one that can improve your outlook, mood, and health. I’ve taken to jotting down things I’m thankful for on post-its and sticking them onto the bottom of my computer screen.
  • Plan a visit: Dr Martin Seligman, one of the founders of positive psychology, studies interventions that improve happiness. He suggests planning a gratitude visit. Here’s how: Read full post »

Get Smart: 5 Reasons To Avoid Antibiotics

Smiling babyResearch shows that about 1 in every 5 pediatric visits for “sick visits” results in an antibiotic prescription. Now not all of those antibiotics are taken; many pediatricians now use the Rx pad for “wait and see” or “delayed prescribing” antibiotics. They give a prescription and allow the family to watch and wait — if a child is not getting better, they advise parents to start taking them. However, in total there are nearly 50 million antibiotic prescriptions written annually in the US. It’s not uncommon that prescriptions for antibiotics are written when children have “colds” or upper respiratory tract infections from a virus. That’s where we all have an opportunity to improve our children’s health. Nearly all of us know it’s good to avoid antibiotics when unnecessary. It’s the end of Get Smart About Antibiotics Week.

Studies indicate that nearly 50% of antimicrobial use in hospitals is unnecessary or inappropriate. ~CDC

In my experience, this issue really isn’t a tug-of-war between parents wanting drugs and doctors wanting to restrict them. Most parents I talk with in clinic don’t want an antibiotic if they can avoid it. However, recent survey data on adults found that 38% expressed a desire for antibiotics when seeking health care for the common cold. Determining when antibiotics are necessary is the tough part. This week, a clinical report was published to help pediatricians and parents know when they can avoid antibiotics given unnecessarily. Some of the data from the report included here:

5 Reasons To Avoid Antibiotics When Unnecessary

  1. Antibiotics can cause side effects. The reason: while you may be giving antibiotics to treat a possible ear infection, once ingested the antibiotics go to every organ in your body thus killing off some of the “good bacteria” living there. Some new research even suggests that bacteria that live in our gut affect our brain activity, mood, and behavior.
  2. Bacteria do good. Throughout our lifetime we accumulate a lot of bacteria to the point that of all the cells in and on our body, 90% of our cells are bacterial! These bacteria help keep our bodies happy – assisting in digestion and keeping a good balance of colonies for healthy skin and intestines.
  3. Every dose of antibiotics changes us. Each dose of antibiotics kills the normal bacteria that live in our body. The risk of taking antibiotics is not only the side effects (diarrhea, rash, or upset stomach, for example) but the risk that each dose changes who we are. Previous research from 2012 found that antibiotics, particularly when given to infants, may increase risk for chronic disease later on (inflammatory bowel disease). Read full post »