Archive for January 2013

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2013 Immunization Update

Screen Shot 2013-01-30 at 7.03.42 AMNew immunization recommendations come out every February. They’re released to assist parents and clinicians in keeping all children up to date and protected from life-threatening infections. The update reflects new science and discoveries, while improving the schedule of vaccines due to outbreaks of infection or improved understandings of how to protect children better amidst a potential resurgence.

This is relevant to every parent: every year the rules for what-children-need-which-shots-when can change. Just when we think all of our children are “up to date,” new science evolves that potentially changes their immunization status. For example, read about new information published this year for the Tdap shot–how & why our children’s immunity fades.

We have to do our best to avoid making false promises to children about “not needing a shot” when they go in to see the doctor.  Just when we do, we find our child is due for a necessary booster or missed vaccine. Commonly, children are missing the last shot in a series of immunizations (for example, to protect children and teens from HPV, they need 3 total shots or children haven’t had the second chicken pox shot). In my opinion, the promises broken break trust with our children and amp fear around going to the doctor. Much of the anguish around shots is the anticipation of them. So an update…

2013 Immunization Recommendations And Reminders:

  • This 2013 immunization recommendations have been simplified into one chart for all children from birth to age 18 (used to be 2 charts). It details  the timing for shots and the necessary intervals between doses for all children. The detailed footnote section explains rationale for all the rules. In my opinion the 2013 schedule is easier to read and easier to understand.
  • Tdap for every pregnant woman, every pregnancy: the biggest change to the schedule is the recommendation that all pregnant women get a Tdap shot (protecting against tetanus-diphtheria-pertussis or “whooping cough”) in the 2nd half of each and every pregnancy. This recommendation was made due to surges in whooping cough infections, epidemics, and a 50-year high in positive cases. Because whooping cough is most risky to newborns we want pregnant women protected. Ninety percent of those who die from whooping cough are infants. The strategy to vaccinate during every pregnancy takes into count how quickly protection from the vaccine fades after we get it. And the reality the vaccine isn’t 100% effective. About 80% of those who get it are protected. The best way to protect us all is to have all children and adults up to date on their Tdap. Read full post »

Can Soda Companies Help Fight Obesity?

Screen Shot 2013-01-28 at 10.38.06 AMI’m curious what you think. Do you think companies that make, sell, and market soda can improve the challenges we face with obesity? I’m asking sincerely. I was struck by the Coca-Cola ad (below) recently released. I’m a pediatrician and I’ve never worked for a beverage company or any company that sells products to children. I don’t like that these companies market salty, fatty, sugary products to children. As a pediatrician, I would suggest I’m very biased. The food industry spends $15 BILLION marketing and advertising to children every year. Food advertising, directly to children, is known to increase rates of obesity. Even familiarity with fast-food ads has been found to be problematic. As parents, this isn’t hard to believe; I’ve seen my boys introduced to a product on TV and then ask for it at the grocery store. Because of my bias, I’m asking you—do you think companies like Coca-Cola and Pepsi can help?

As the obesity problem persists, strategies have turned to protocols and regulation. Today, the American Academy of Pediatrics (AAP) released it’s first policy on managing weight-related diabetes. And in the past few years, the American Heart Association released a statement asking for increased regulation on advertising high-calorie, low nutrient-dense (“junk”) foods to children. In 2006, The Institutes of Medicine (IOM) said, “Food marketing intentionally targets children who are too young to distinguish advertising from truth and induces them to eat high-calorie, low-nutrient (but highly profitable) “junk” foods; companies succeed so well in this effort that business-as-usual cannot be allowed to continue.”  Similar sentiments are shared by the American Psychological Association, the Center for Science in the Public Interest (CSPI), Children Now, the American Medical Association, and the American Academy of Pediatrics. The public, too. Last fall, the majority (67%) of international readers polled in The New England Journal of Medicine believed we should regulate sugary-beverage consumption. This on the heels of New York’s regulation banning sale of large sugary drinks. This isn’t just about a tax. Can these companies help? Read full post »

Mindful Parenting

mindful and the skyThere was a moment, just after President Obama was sworn into the office earlier this week, that I’ve been returning to in my thoughts relentlessly. He turned amidst the regal archway of The Capital and stopped. His accompanying family and tribe of lawmakers waited. He said something like, “I want to take a look one more time.” And then he looked back upon The Mall and seemed to take it all in. A few seconds, maybe 1/2 a minute or so. Not long, no, but the moment seemed to take up enormous space. Quietly, eyes wide open, he looked out to the millions that had come to celebrate and bear witness to his honor and his responsibility. Instead of looking at him, my eyes migrated to his daughter, Malia. I saw her watching.

It may have been mindfulness.

It’s of course never clear to an outsider who is mindful or not. Thinking and spending energy to be more present is a passtime that I was introduced to as a medical student because of the work of Dr Jon Kabat-Zinn. I use lessons from his work in my personal and professional life on a daily basis. Therefore, it was a sincere joy last night to sit amidst 1000 other parents and hear Jon Kabat-Zinn and his wife Myla talk about, “Mindful Parenting.” I was surrounded by my husband and friends, many colleagues and pediatricians, and I was lucky enough to sit near parents of my patients. It was community. To me it felt like a needed touchstone and a hearty reminder of how nicely being mindful fits into a busy, reflective, hectic, and imperfect life.

5 Lessons From Kabat-Zinns On Mindful Parenting:

  • Mindfulness is not the antithesis of anything. There is no single ill or evil that impedes it. In fact, the last question on the night from the audience begged The Kabat-Zinns to detail the biggest obstacle to mindfulness. They couldn’t answer it really. All this, precisely because mindfulness in its simplicity is openness, compassion, and love. At the opening of the talk, Jon helped us recognize the work that it took to bring us there, amidst the heavy Thursday raindrops, rush hour traffic, busy workweeks, needy toddlers or teens at home, and the truth that there was potentially something else we really should be doing. He reminded us all that is was LOVE that had brought us together to listen to ideas about mindful parenting. This we all share. This is why mindfulness is possible for everyone at every time in their life. Each new moment is evolving into something entirely new.
  • At one point, Dr Kabat-Zinn looked down at his watch. At first glance it appeared he was tracking the timing of his talk and then he burst out, “If you check your watch, it’s now again.”  A hilarious reminder that each and every moment that unfolds is always now. We have a chance to bear witness to time indefinitely. We are offered up the opportunity to be mindful, open, and present with an infinite number of “do-overs.” Oh, wow–it’s now again. Myla furthered this saying, “Every moment is the possibility of a new beginning.” Every single moment is a new chance to be aware. Read full post »

Using Your Phone To Diagnose Skin Cancer

Screen Shot 2013-01-23 at 3.23.43 PMYou know me, I’m enthusiastic about apps and online health content and innovating health care delivery. But we do have to be thoughtful about how we use and integrate new technology.

One in 5 smart phone users in the US has a health app on their phone. With over 50% of American adults owning a smartphone, that’s a lot of people with health apps walking around. Although the most common apps that people download typically tracks the food they eat or the exercise they complete, the over $700 million-dollar-a-year generating industry is teeming with new health products every day. In pediatrics, I see more phones out during the first newborn check and subsequent weight and feeding appointments than at any other time.

Most new parents that come to see me are tracking their baby’s poop, pee, feeding, diapers, or new milestones–and many are doing so using their phone. Subsequently, most of the children coming into our society today are not only tracked with technology, they will grow up with parents who use tools to help protect and support their lives. Using applications to prevent, diagnose, treat, and ultimately cure disease is not really just a dream anymore. It turns out these applications to support our own health are clearly becoming a part of the health care of the present-future.

The effectiveness of these apps remains imperfectly proven. Just last week, a study published in JAMA Dermatology found that apps advertised to improve diagnosis of cancer highly variable in their ability to help patients.  Researchers and doctors at the University of Pittsburgh set out to study popular mobile and web-based apps designed to help patients identify potential skin cancers. Specifically, they evaluated apps advertised to pick up the most deadly type of skin cancer, malignant melanoma.

Skin Cancer Apps: Unreliable But Quick

  • Researchers acted like patients, they searched app stores with search terms: “skin, skin cancer, melanoma, mole” to identify applications on the market.
  • They then selected 4 apps to study that allowed the users to upload photos of moles. Researchers used 188 photos obtained in clinic from patients just prior to mole removal. The researchers had the benefit of knowing the ultimate diagnosis of all the 188 moles they uploaded to the applications. Of those 188 moles, 60 ended up being diagnosed as malignant melanoma.
  •  3 apps worked by evaluating the photo and providing feedback (“atypical” versus “typical” or “problematic” versus “okay”).  One app included in the study sent the uploaded mole photo for review to a board certified dermatologist. Read full post »

Why No TV Before Bed is Better

Screen Shot 2013-01-18 at 12.14.09 PMTV before bed delays children going to sleep. We’ve all heard that TV isn’t necessarily good for our children right before bed, but something about that fact tends to go against instinct. In my experience, most of us feel like television and video-streaming is relaxing to our minds. Bum news is, it’s the opposite. Viewing TV or video or screens prior to sleep tends to rev up our brains, disrupt our sleep, and may even cause nightmares (especially for preschoolers). The light from computers and screens may inhibit melatonin, the hormone that helps us drift off to sleep.  A new study published this week reminds us about TV realities at bedtime.

I’m as guilty as everyone else. I love to let my children watch a TV show after dinner in the hour before bed. We all crave that downtime with our full bellies and the work of our day behind us. We all want some quiet. Here’s the thing:

Researchers surveyed over 2000 children between 5 and 24 years of age. They inquired about the last 1 1/2 hours of their day–not surprisingly they found that TV before bed was common. Across all ages, watching TV was the most common activity for children before bed, about half of the children watched TV for at least 30 minutes. When they surveyed what time children went to sleep, they confirmed the concerns about TV and bedtime. The children with more TV viewing went to sleep later. Conversely, those with an earlier bedtime had significantly greater time in non-screen sedentary activities and self-care prior to going to sleep. Most research shows that our children’s sleep deprivation is due to late bedtimes, not early rising. Children sleep about 1 hour less now than they did 100 years ago. Consequently, we’re also more fatigued, distracted, obese, and hyperactive these days–all things associated with sleep loss. Strategies that help us go to sleep on time are essential for our very tired country…

TV Tips To Improve Our Children’s Sleep:

  • If your child is having trouble falling asleep, work hard to make sure they don’t spend any time in front of a screen 2 hours prior to bedtime. Explain to them why you’re doing this–the TV winds them up, not down.
  • Get all screens out of the room where your children sleep. No TVs, cell phones, tablets, or iPods in bedrooms or in bed with children. Make rules for a sleeping station for phones in your kitchen. Phones go to bed at say, 9pm.
  • Buy a new alarm clock if a child says that their phone must wake them up in the AM. I find alarm clocks online for less than $15.
  • If your child loves TV, shift the time of day they watch television. Consider using all screens as devices of privilege. Let children earn an hour with their TV or video game while you prepare dinner for great citizenship at home and/or school.

About Violent Video Games

“We don’t benefit from ignorance. We don’t benefit from not knowing the science of this epidemic of violence.” Obama said. “Congress should fund research into the effects violent video games have on young minds.”

Only a month after the Newtown, CT tragedy I was pleased to hear the President’s plan today to decrease gun violence and his steadfast effort to improve the safety of our communities by decreasing violence, death, and suffering from firearms.  Delighted to hear that the government is looking to ensure that it’s safe to talk about firearm safety in the exam room (at a federal level) and also that he’s implored Congress to study the effects of video games on young minds. That being said, we do know a bit about the effects of video games on young minds. An American Academy of Pediatrics (AAP) 2009 Media Violence statement noted, “The strength of the correlation between media violence and aggressive behavior found on meta-analysis is greater than that of calcium intake and bone mass, lead ingestion and lower IQ, condom non-use and sexually acquired human immunodeficiency virus infection, or environmental tobacco smoke and lung cancer—associations clinicians accept and on which preventive medicine is based without question.”

To be clear, the $10 million that Obama is granting the CDC to investigate the effects of violent video games on our children is not a ton of money. And their tone, according to Stephan Dinan of The Washington Times places more responsibility in our hands — “But overall, the White House said that while limiting guns is the role of the government, controlling what Americans see in movies and games is best left to parents.”

As parents and pediatricians, community members and mentors, and American citizens, there are things we can do now to improve our children’s exposure to and absorption of violence.

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Thoughts On Children’s Massive Exposure to Violence

  • Data finds that witnessing violent acts in the media (in a game, TV, or video) can contribute to aggressive behavior, desensitization to violence, nightmares, and fear of being harmed. Research finds, “Consistent and significant associations between media exposure and increases in aggression and violence have been found in American and cross-cultural studies; in field experiments, laboratory experiments, cross-sectional studies, and longitudinal studies and with children, teens, and young adults. Read full post »

Have You Been In To See Dr. Google?

Screen Shot 2013-01-15 at 9.45.29 AMFor practicing physicians, there’s a tricky balance in believing that the internet can help save lives.

I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the internet. Many clinics block video-streaming sites and don’t allow for traditional email exchanges between clinicians and patients. It’s hard to “send” patients information discussed during the visit. In the 10 or 20 minutes we have together, time is precious. Truth be told, health care remains wary of doctors and patients communicating when they’re not in exam room. Most insurers won’t reimburse or pay for electronic communication between patients and their clinicians. So doctors are often forced to bring you into the office to provide expertise. New data today may help change this paradigm. Reality is, many of us are using the internet as a tool for health care.

For at least 1/3 of American adults, the internet is a diagnostic tool

Yet, it’s not just insurers who may be wary of online info. Recently I read a patient review (online) from a parent who was frustrated I’d encouraged them to read the content on this blog. The comment implied that perhaps I was “pushing it.” And that’s the tricky part–when I first started writing this blog I was bashful to mention it in clinic. I wanted patients to feel comfortable NOT pressured. But now that I have over 350 blog posts showcasing research and pediatric health information it’s tantamount that I share it.  I mean, if I’m in the midst of a 15-minute visit and we touch on topics like getting a carbon monoxide monitor, the choking game, the Tdap shot, and the effects of TV on their kid’s developing brain, how could I not augment a parent or teens’ understanding by offering more information online?

Numerous studies find that what parents learn in the exam room with doctors isn’t retained. That’s where Dr Google comes in. Read full post »

What To Say About Pot

Screen Shot 2013-01-10 at 5.48.25 PMThis is a guest post from Lara Okoloko, LICSW, a clinical social worker who lives in Seattle area with her husband and two young children. She is co-founder and clinical director of Center for Advanced Recovery Solutions (CARES). CARES provides respectful, solution focused counseling to the parents of addicted young people. More about their services can be found at www.caresnw.com

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Well, it’s been about a month since marijuana became legal in Washington State and we haven’t gone to pot yet, although the national news circuits may suggest so… But all joking aside, many are wondering what the impact will be for children in our state. Will marijuana use increase because it will be perceived as no big deal? Or will rates of use go down because the taboo factor will be erased?

As a therapist working with parents of teens and young adults, I know that parents already face an uphill battle convincing their sons and daughters that marijuana use poses risks to their health and well-being. My hunch is that legalizing marijuana will only increase the challenge.

Pot isn’t a rarity in high school. According to 2010 data from the Washington State Healthy Youth Survey, one in five 10th graders have smoked pot in the last month. By the end of high school, almost half of all students have at least tried it. This makes marijuana the second most used drug after alcohol. Surveys of drug use show a clear relationship between the perception of risk and the likelihood of drug use. The 2010 National Survey on Drug Use and Health found that only 1% of youth who saw great risk in smoking marijuana had used it within the last month, compared with 10% percent of youths who saw moderate, slight, or no risk. I don’t think it’s a stretch to say that legalizing marijuana will add to the perception that it is harmless, which will in turn increase the number of teens who use it.

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

Read full post »

People Are Dying From The Flu

Screen Shot 2013-01-08 at 12.45.43 PMInfluenza virus causes “the flu.” It’s a crummy cold that spreads easily causing high fever, body aches, runny nose, terrible cough, and rarely it can cause vomiting and diarrhea, too. The flu isn’t the “stomach flu.” It’s deadlier than that. It’s more dangerous for babies and young children, and for the elderly. It’s also particularly dangerous for those with asthma, diabetes, and people with neurologic or immune problems. This post is a bit of a plea: people are dying from the flu and there are ways we can potentially save others’ lives. Click through to read 5 myths about the flu and watch a 3-min interview I did for HLN television yesterday.

The bad news: We’re having a bad flu season. More people have the flu this year than at any time last year. This is early—flu usually peaks in Feb or March. The most dominate strain of flu that’s moving around the US is the strain called H3N2—it’s known to cause more serious disease. As of today, we have over 80% of our states reporting widespread circulating levels of flu. Here in Washington many people have been hospitalized from complications of the flu. Further, in Washington 6 people have died, one of them a child under the age of 12. A healthy 17 year-old died in Minnesota just this week. Flu is not just your “common cold,” it can be far worse. Eighteen children have already died this season. As of November, we didn’t even have 1/2 of our population with a flu shot. The goal to protect us all is 90%.

I’ve never had a family in clinic get influenza illness and then refuse the flu shot the following year.  They come in early and often for their shots. It’s that bad of an illness.

The good news: We have a vaccine for the virus that causes the flu. The flu shot and flumist nasal spray are effective and that H3N2 strain that we’re worried about, it’s in the flu shot and the nasal flu spray this year. It’s not too late to get a flu shot. You’ll be protected against the flu somewhere from 10 day to 14 days after getting it. Go out now and protect yourself and your family. By getting a shot you protect yourself, your children, and all those more vulnerable in our community unable to get the shot (those infants under 6 mo of age, those on chemo, or those with contraindications to the shot).

Read full post »

Renewal, Intent, Intimacy, Reflection

Screen Shot 2013-01-04 at 12.36.15 PMI’ve self-prescribed a year of renewal, intent, intimacy, and reflection for 2013. Although I’m unable to etch those 4 words onto my forearm, I’d really like to keep them at the helm. Resolutions are exceedingly difficult to maintain. The bar is often too high, there’s little trigger to make a desired behavior happen every day, and the resolutions we choose typically demand profound change. I learned much of that from BJ Fogg and because I believe in his model, my 2013 resolution will have the aforementioned 4 prongs: renewal, intent, intimacy, and reflection.

This year, I’m easing into these resolutions by gradually making changes to how I work and how I live. I spent the end of 2012 bearing witness to our limited days on earth, reaping the bounty of commitment that family and friends give me, and sorting out my own role as a caregiver, writer, and advocate. However obvious it is that life is precious and limited, there are the rare instructive days in our lives that preach it to us. One for me unfolded in August. Read full post »