Archive for February 2013

Monthly Archive

Is It Really An Ear Infection?

Screen Shot 2013-02-26 at 9.46.22 AMEar infections cause significant and sometimes serious ear pain, overnight awakening, missed school, missed work, and lots of parental heartache. For some children, infections in the ear can be a chronic problem and lead to repeated clinic visits, multiple courses of antibiotics, and rarely a need for tube placement by surgery. For most children, ear infections occur more sporadically,  just bad luck after a cold. Fortunately the majority of children recover from ear infections without any intervention. But about 20-30% of the time, they need help fighting the infection.

Ear infections can be caused by viruses or bacteria when excess fluid gets trapped in the middle portion of the ear, behind the eardrum. When that space fills with mucus or pus it is put under pressure and it gets inflamed causing pain. Symptoms of ear infections include pain, fever, difficulty hearing, difficultly sleeping, crankiness, or tugging and pulling at the ear. This typically happens at the time or soon after a cold—therefore the fluid in the ear can either be filled with a virus or bacteria.

The most important medicine you give your child when you first suspect an ear infection is one for pain.

Antibiotics only help if bacteria is the cause. When a true infection is present causing pain and fever, antibiotics are never the wrong choice. Often you’ll need a clinician’s help in diagnosing a true ear infection.

Three’s been a lot of work (and research) over the last 15 years to reduce unnecessary antibiotics prescribed for ear infections. There has been great progress. Less children see the doctor when they have an ear infection (only 634/1000 in 2005 versus 950/1000 back in the 1990’s) and they’re prescribed antibiotics less frequently. Recent data finds that less than half of children with ear infections receive antibiotics (only 434 of every 1000 children with ear infections). However, the far majority who go in to see a doctor do still receive a prescription for antibiotic (76%).

The American Academy of Pediatrics(AAP) just released new guidelines to help physicians do a better job treating ear infections. Sometimes children really benefit from using antibiotics and new research has led to an update on the 2004 previously published recommendations. Over-use of antibiotics can lead to more resistant and aggressive bacteria so we want to use them at the right time. These recommendations may help improve care for children.

In my opinion, NPR published the best article I’ve read covering the new recommendations. I especially liked the balance provided: Read full post »

Baby’s Ears When Flying

First off, I have connected with a few engineers and pilots — I may be wrong on one point here: Commercial airplanes typically ascend/climb faster than they descend for a landing. My apologies. I’m clearly no pilot…

That being said, you can help support your baby or child’s potential ear discomfort during flying by having them suck on something like a pacifier, having them breast feed, or offer a bottle during take-off and landing. The motion of their jaw and mouth during sucking and swallowing will help them equalize to the pressure changes. When they move their jaw to suck and swallow this helps facilitate venting in the Eustachian tube that allows your child to equalize pressure from the outside world with the middle part of their ear. That click or pop you feel when you yawn is your ear drum moving back to middle after getting pushed one direction in your ear from a pressure change.

It’s true that discomfort is far greater during pressure changes when there is fluid in our middle ear (from colds to ear infections). Check in with your child’s doctor or nurse practitioner prior to flying if you’re concerned about a potential infection. If that’s not ideal, consider getting Cellscope (an iPhone app that helps you look into your child’s ear, and/or allows you to send the image to their doctor) if you’re a frequent flier and your child is prone to fluid in the middle ear.

Here’s tips for parents about fluid in the middle ear and nice summary about ears & pressure changes from Kid’s Health.

Something For Parents At The Park

Screen Shot 2013-02-16 at 5.37.00 PMThis is post from my friend, Anne Gantt. I love this concept and am inspired by the idea of parents pumping iron at the park. I’m hoping we can move this conversation forward. Please share ideas from your own neighborhoods in comments.

As a stay-at-home mom, I spend a ton of time at our neighborhood park while my 2 ½ and 4 year-old children zip down slides, scramble over the jungle gym, or chase each other in the woodchips. While they’re running around like little olympic athletes, I mostly just stand there doing nothing. A lot of nothing. Sound familiar?

That’s originally why I daydreamed about putting fitness equipment for adults in our park. I’d love to get a little exercise without having to resort to taking a turn on the monkey bars. The interesting thing is that installing adult fitness equipment will improve the park…for kids. This truly can be a win-win.

The park in question is here in Seattle– University Playground— it has a big grassy field, tennis courts, and beautiful new equipment for kids. It also has one of the very few public restrooms in the whole neighborhood–thus attracting a crowd. It sits in a tenuous location, one block from Interstate-5 and smack in the University District, which means the park sees a lot of illicit activity. Even worse, the illicit (I’m talking drug sales, etc) activity tends to happen in the section of the park right next to the playground.

Believe it or not, I’ve picked up more than a couple of used needles out of the woodchips myself.

Our park’s unsavory elements definitely scare some people off. I recently talked with a neighbor who refuses to take his 4-year old grandson to the park out of a concern for safety. This, even though their living room window looks right out onto the playground.

Something had to change. Urban dwelling can be better than this. Read full post »

Preschoolers Can Learn Good Things From TV

tv watching when 4Television programming for children is abundant. Screens are a luxurious fixture in most of our lives and I’m not here to tell you to turn them off. Well, at least not today. In fact, that tactic, the one where we pediatricians urge families to turn off the TV, really isn’t working. Children tend to increase their TV viewing time as they age and preschool-aged children in the United States spend over 4 hours per day watching television at home and in day care. My good friend, Dr Claire McCarthy, offers up her opinion in this week’s Pediatrics.

Television viewing is only on an upswing over the past 5 years as more and more devices interdigitate into our children’s lives. I’m a perfect example. When my first son was born 6 years ago we had one television in our home and one computer. Today, we have a smartphone, an iPad, a computer, and a television. The screen choices continue to grow, the television shows continue to become more alluring, and the opportunities for viewing with new convenience is abundant. It’s true: some of the stuff out there designed to delight our children is awesome.

But not all of it.

So as our children continue to tug on our sleeves and hang on our pant legs asking for the iPhone just after they beg for TV time before dinner, we need to think clearly about an action plan. We need to make a thoughtful “media diet.” We need to think ahead of time what time we’ll offer up the devices and what content we want them to see. We should care–it really changes how they think and what they do. When we use a media diet, I suggest we’ll improve both our own satisfaction as parents and our children’s lives. Dr Dimitri Christakis, a pediatric researcher here at Seattle Children’s suggests:

We often focus on how much kids watch and don’t focus enough on what they watch

New research out today by Dr Christakis finds that our time and energy working to improve what our children watch, not just how much they watch, can have a positive impact on their behavior. Even for children as young as 3 years of age. Read full post »

The New Norovirus

Screen Shot 2013-02-12 at 10.27.08 AMNorovirus is a nasty one. It’s the leading cause of epidemics of vomiting/diarrhea and causes over 20 million cases of gastrointestinal disease (“stomach flu” with vomiting, diarrhea, abdominal pain, fever and achiness) in the US each year. Our experience with Norovirus historically is worse in years with “novel” or new strains of infection. Unfortunately there’s an new strain circulating around the globe. “Sydney 2012” was discovered in Australia last March and just last month the CDC officially announced it’s causing the majority of Norovirus infections. Over 1.2 million people in the United Kingdom have had it and the FDA reports this strain may potentially cause more hospitalizations. Time will tell if we have more Norovirus this year, too.

When new strains arrive, we tend to see a 50% increase in the number of cases of “stomach flu.” Norovirus is remarkably potent and contagious. It often isn’t killed by hand sanitizer (see #3 below). You touch the virus and touch your mouth and you could get it. We can get Norovirus multiple times in our lives because our immunity wanes after infection and new viral strains develop which cause unique disease. We get Norovirus from contaminated food, contaminated surfaces we touch, and from other people who vomit or have diarrhea and spread the virus. This is the cause of the stomach bug that you often associate with cruise ship outbreaks or daycare outbreaks when everyone starts vomiting one afternoon…

Around the holidays a stomach bug swept through our home. It did so for many of my patients, too. During the first week of January, I had a day in clinic where approximately 75% of the families I saw in clinic mentioned someone in their home had been vomiting over the past week. Unusual. I can’t tell you what virus it was (I didn’t test any child’s stool or vomit in the lab), but my bet is on Norovirus… Read full post »

Soccer Mom

Soccer net

I had an unusually good time watching my boys play soccer this past weekend. It’s not always been easy to get our youngest on the field and I’m not the mom who’s really loved being there. There’s been years of standing on the cold sideline where I didn’t think the boys were getting much out of it. And there have been countless minutes on that sideline where I’ve been consumed, weighing the costs and benefits of the soccer class, while my coffee went cold. Fortunately, something has changed recently. I’m certain it’s not only me who’s noticed–the boys seem differently positioned as well. Although I look in from the net and see something that seems entirely clear (a soccer field, a group of children–excited and eager [or exhausted and angry], and a coach) these little boys have reminded me yet again of the diversity of vantage points we share. They really do see those green fields as a part of their future. A great coach can really make our children immensely proud and excited to be alive.

Wonder is priceless and the pristine innocence harbored within our children often delivers moments unique to childhood. Children often hold the gift of believing that anything is possible. So often when they share this perspective we get to see a glimpse of unconfined opportunity. We’re reminded of our own potential, too.

Two things recently passed through my ears I have to share. They’ve enhanced my soccer mom experience immensely. Read full post »

Help Your Anxious Child: Blow Colors

This is a little trick I use to help coach anxious children whose minds just seems to “spin.” Patients have given me great feedback over the years that “blowing colors” really helps. Sometimes it’s for children and teens who can’t drift off to sleep, sometimes for those who are worriers, and sometimes for those who get anxious or overwhelmed at school. Blowing colors is a great exercise to return to regular belly breathing patterns, buy time and space for mindfulness, and improve control over feelings of overwhelm. See if it helps…

Greatest thing is–this is a good tool for a child or teen to regain control.  They can use the exercise anywhere, at any time. Lots of children and teens who get anxious feel ashamed of their anxiety and don’t want to reach out for help. Reassure them that no one will ever know they’re blowing colors or changing the hue of a room. Practice at home before bed, in school during moments of overwhelm, or even remind a child or teen they can blow colors while out with friends or at a sleepover.

Let Us Break The Silence on Stillbirth

This is really beautiful. There’s little to say other than we can do a better job supporting parents in their loss and in the celebration of their children’s life and legacy.

Watch this and enjoy the amazing amount of love you will feel…

“I want the baby I didn’t have.”  “I feel like a bad luck charm around other moms.”

“I couldn’t understand why that happened to me…”

“His life was a good thing.”   “People say really sad, crazy things.”

“We said don’t come and they came….that was what we needed.”

“I love to tell people about my son…I don’t get enough chances to talk about him.”

“His life was a good thing.”

“I’m not afraid to mention him.”  “Why don’t they tell you about it?”

“You second guess everything you did, everything you didn’t do.”

“I don’t want another baby. I want the baby that I didn’t have.”

“I love to tell people about my son… I just don’t get enough chances to talk about him.”