Archive for March 2013

Monthly Archive

Why Do Babies Wake Up At Night?

Most babies wake up at night. And although some superhero babies sleep 10-12 hours straight starting around 3-4 months of age, most infants wake up during the night and cry out for their parents. There are scientific reasons and some developmental and behavioral explanations for these awakenings. I spoke with my friend Dr Maida Chen, a pediatric pulmonologist, mother to three, and director of the Pediatric Sleep Disorders Center to put a list together regarding why babies do this. Leave questions and comments below if we can explain more. I’ll author a follow-up blog on ways you can help your baby when they wake up, too.

10 Reasons Babies Wake Up At Night:

  1. Sleep Cycle: Babies wake up during the night primarily because their brain waves shift and change cycles as they move from REM (rapid eye movement) sleep to other stages of non-REM sleep. The different wave patterns our brains make during certain periods define these sleep cycles or “stages” of sleep. As babies move from one stage of sleep to another during the night, they transition. In that transition, many babies will awaken. Sometimes they call out or cry. Sometimes they wake hungry. It’s normal for babies (and adults) to wake 4-5 times a night during these times of transition. However, most adults wake up and then fall back to sleep so rapidly that we rarely remember the awakening. At 4 months of age, many parents notice awakenings after a first chunk of deeper sleep. This is normal, and often due to development of delta wave sleep (deep sleep). The trick for parents is to do less and less as each month of infancy unfolds during these awakenings; we want to help our babies self-soothe more and more independently (without our help) during these awakenings so that sleeping through the night becomes a reality. Read full post »

Chopsticks

Chopsticks

You don’t need much to play a duet if you know a piano player.

Although my boys don’t play piano, I was reminded this weekend how children really sponge-up opportunity. They’ll try most anything and catch on faster than we do. After we finished a delivery to my mom, our 6 year-old sat down at her piano. A few minutes later he was playing a Chopsticks duet, my mom providing the accompaniment.

Count to 6 and have 2 fingers– it’s possible. Perhaps he is a piano player, perhaps it’s time for lessons.

This was just another reminder that we often don’t plan the most precious moments of our day.

Free the child’s potential, and you will transform him into the world.
– Maria Montessori

Children With Gay Parents

http://www.people-press.org/2013/03/20/growing-support-for-gay-marriage-changed-minds-and-changing-demographics/

Headlines like, “Children Do Better with Committed Parents,” excite me. I feel proud to live in a time where we’re advancing understanding and safety for children and their health–I love being a part of it. Over the past decade(s) there have been big shifts here in the US. The Pew Research Center published data today that there has been a notable change in public opinion when it comes to the nation’s support of gay marriage: more people support gay marriage (49%) than oppose it (44%). In particular, 70% of “millennials” (people age 18-32) support gay marriage. Today, The American Academy of Pediatrics (AAP) stepped forward in support of gay marriage in hopes of improving child well-being nationwide. The AAP, a group that represents 60,000 pediatricians who care for families all over the US, did so not just for politics, but for children. There are mounting piles of research that the estimated 2 million children being raised by gay or lesbian parents are doing beautifully. In fact, the AAP says, Read full post »

Parents May Hesitate On Teen Vaccines

Since 2005, teen immunizations have been recommended at the 11 year-old well child check-up but rates of teens who keep up to date on their shots lag. In an ideal community, 90% of us would be up to date on shots to prevent disease spread most effectively.  Back in 2007, teen recommendations were expanded to include HPV vaccine for girls. In 2011, both boys and girls were recommended to get HPV shots. Although the majority of teens get the Tdap shot (tetanus and whooping cough booster) only around 1/3 of teen girls are up-to-date on their HPV shot when most recently surveyed.

Teen Shots Recommend at age 11:

  • Tdap (tetanus, diphtheria, pertussis shot)
  • MCV4 (meningitis shot)
  • HPV (human papillomavirus shot, requires 3 doses over 6 months)

A Pediatrics Study on teen shots revealed that parents may not get their teen shots due to concerns about safety or not understanding the shot was recommended. Not all shots are required by schools; I think some families tend to experience that as an endorsement for the shot being less important. In the survey conducted between 2008-2010, researchers sought to understand trends and rationale for lagging shots: Read full post »

Americans Text And Drive

text driveMore than nine people are killed and 1,060 people are injured every day in vehicle crashes reported to involve a distracted driver. Distractions include using a mobile device or eating, the CDC says. New data out last week on texting and driving has me fuming. This is a bit of a rant, just like the last time I wrote about data on texting and driving.

I’ve got a loathing for the terrible American habit to text and drive. I loved Oprah’s 2009 pledge. I love the AT&T bumper stickers I keep seeing. But something has to change as these strategies aren’t getting people to put their phones down. The majority of us are using devices that take our thoughts, our hands, and our eyes off those obstacles that fly by at 60+ mph. In a CDC survey conducted here in the US and in 7 other European countries, residents of the US led the charge with texting and emailing while driving:

 

Over 2/3 of American adults reported talking on their cell phone and nearly 1/3 said they’d texted or emailed while driving in the previous 30 days

Americans are doing the worst job and we all tend to see someone texting when we’re on the road. Easy to spot them with their heads down and their weird braking patterns. In part, our habit and addiction to our devices may reflect the state-by state-variance in laws and permission. Only 33 states and Washington, DC restrict cell phone use in some way. The laws may be too permissive. Here in Washington, we can use cell phones if we have hands-free devices. I do my best to keep my phone out of reach (back seat) to avoid any temptation to grab it when I hear a beep. Yet this data makes me feel I should stop talking on it, too. I use my cell phone to talk via a blue-tooth device built into my car, but more than once I’ve had to hang up as I felt it compromised my level of attention. Data on hands-free cell phone use is looking decreasingly optimistic. There are studies claiming it’s no safer when your hands are free and The National Safety Council reports that “driving while talking on cell phones, handheld and hands-free, increases risk of injury and property damage crashes fourfold.”

I wonder if our pattern of device use reflects our incessant, demanding, intolerable work culture here in the US, too. Read full post »

Listening To The Periphery

hallway baconWe learn so much from our children. How to slow down, how to speed up, how not to behave. How to be present, mindful, and attentive to immediate needs. I’m not always entirely mindful and I certainly find myself easily distracted–it’s not just the phone I need to put down. Yet one low moment of distraction came to light late last summer when my 4 year-old literally put his body between my phone and my face to get my attention.

But ever since August I’ve felt more aware of the moments that pile on and feel more able to witness those I am lucky enough to work with and those with whom I am lucky enough to spend time. I enjoy clinical medicine more since I felt a more intimate proximity to my own mortality. I enjoy my children more and my time alone more, too.

It’s often those much younger and those much older and more experienced that clarify issues and help us focus the lens. It seems to me the simplicity of knowing what to do and what matters most stems up from those at the periphery. I’m not saying those of us stuck in the middle of this generational sandwich don’t have insight, I just think we draw heavily from those for whom we are indebted for their pace, their age, and their innocence.

I learn so much from children every day. In clinic today my stomach dropped at one point simply because of the story shared by a 6 year-old. The day had been laid out differently because at our morning huddle in clinic we review comments that come in. A patient had detailed in a comment card that he/she felt the nurse and medical assistant had spent more time listening to them than the doctor had. Sometimes we can do such a bad job showing those for whom we care we’re listening. It’s pretty obvious that as we work hard to witness our lives we often get more quiet. I feel so much more porous to the lessons in this wicked-packed-full-generational sandwich. Which reminded me of this: Read full post »

Salmonella From Food, Frogs, And Fido

African dwarf frog fr CDCSalmonella infections affect children more frequently and more severely than adults. Although most salmonella infections arise from contaminated or undercooked food (chicken, eggs, beef, and dairy typically), reptiles, pet foods and now amphibians are an important source of infection to keep in mind for our children.

Today, a new study published in Pediatrics links Salmonella infections to pet frogs here in the US. This is the first study to detail amphibians as an important source of Salmonella infections. 8 tips for preventing Salmonella are at the end of this post.

New research tracked an outbreak of a particular strain of Salmonella between 2008 and 2011. In 44 states, researchers identified 376 cases of Salmonella in children and adults with an average age of 5 years. Over 2/3 (69%) of the cases were in children under age 10. The source of these salmonella bacteria was tracked to a breeding facility that shipped an aquatic frog, the African dwarf frog, to pet stores and people around the country. Although the African dwarf frogs are not always handled, many people were presumably infected from touching the frog’s contaminated water bowl or may have been infected when aquariums and equipment were cleaned in sinks also used for food preparation.
The study uncovered an important truth:

Few patients and families were aware that Salmonella could be spread from reptiles and amphibians.

Even when we parents are aware, some children still get infected. It’s essential that children who handle reptiles and amphibians always wash their hands after playing with the pets or help clean or care for their aquariums. This data hits close to home as my son had Salmonella gastroenteritis when he was just 4 months of age after a trip to Central America. Read full post »

Emily’s Entourage

EmilyThis is a guest blog from Emily Kramer-Golinkoff. I was lucky enough to meet her about a year ago & even luckier that she asked me to help her make a big impact with her final thesis for her Masters in Bioethics. Her story, insight, and strength are worth your time. She’s hoping to leave a big mark in understanding how to leverage the asset of empowered patients to advance science and healing. She’s working to integrate patient communities more intimately in the health system. Her post is about why she chose to be an empowered patient and it’s fairly clear why she’s attracted an entourage…

Truth be told, belonging to a disease community isn’t my clique of choice. An artist community, a running club, even a yogi enclave sound more appealing. But I’ve learned that when our hands are tied, we’re better off building muscles in our legs than spending all our energy trying to wrangle our hands free.

That’s the philosophy I’ve embraced as a 28-year-old with big eyes, a bright future, and an advanced, incurable and fatal disease called Cystic Fibrosis. Cystic Fibrosis (CF) is a progressive genetic disease that primarily affects the lungs and digestive system. It causes thick mucus to build up in the lungs, leading to life-threatening infections.

My winding path to patient empowerment started as a headstrong, sassy little girl who clashed with my pediatric CF clinic’s authoritative culture. My perpetual questions of “why?” and efforts to integrate my disease into my life were met with disdain and labeled “difficult.”

Read full post »

When Should I Start Baby Food?

first foodsWhen to start baby food? The timing on starting baby food may seem confusing. If you survey your neighbors, your own moms, the doctors you see, and the child care or daycare providers who help you, I bet you’d get about 4 different answers backed with 4 different theories and rationales. The reason is, the pendulum on when and how to start baby food has changed. Bits and pieces of old data mixed with contrasting new research findings are getting tossed around. Most new parents I talk with are a bit puzzled on what is truly best.

It’s okay to start your baby on baby foods or “complementary foods” when they show signs of readiness if they are at least 4 months of age. Signs of readiness include watching you eat (following your spoon’s every movement at a meal), lip smacking and licking when they smell food, and opening their mouths when you present them with a spoonful of food. Most babies ready to eat have also doubled their birth weight and started cooing and laughing, sitting up with assistance, and rolling over.

I used to advise families to wait until 6 months to start baby foods but new research over the last couple of years has caused me to change my tune. Read full post »

What You Should Know About Energy Drinks

I think of energy drinks as the new liquid accessory for many teens. Something to hold onto with nervous hands and something to spend money on when they’re really tired or need a “boost.” Teens report drinking them because of inadequate sleep, a need for energy, and wanting to mix them with alcohol. It’s big business to market energy drinks to those in high school or college and that big business is remarkably successful. More than a 1/3 of teens (39%) say they’ve had an energy drink in the last month and “jock identity” is associated positively with a frequency of energy drink consumption.

These drinks may really make you look cool…

College students may be even more compelled to drink them; one study found 50% of students had consumed at least one to four drinks in the last month. It’s hard to remember from our vantage point, adults aren’t really the target of energy drink advertising and sponsorships. Because of that paucity of advertising, only 15% of adults say they drink them.

Trouble is, there’s nothing really good for us in these energy drinks. We don’t ever need the caffeine, guaranine, ginseng, and sugar from these concoctions. Energy drinks can have 3-4 times the amount of caffeine in a regular cup of coffee but you may never know it. The labels can be opaque and misleading. The labels aren’t regulated and the content of caffeine isn’t mandated. A can of soda can have no more than 65mg of caffeine while one energy drink (Wired X505) has 505mg. I think this should make you mad.

A recent summary came out in Pediatrics in Review to help guide teens (and their doctors) on what they need to know. But many of us are still catching up. These are not “health” drinks although some of the claims on the bottle and advertising may suggest so. Most parents would prefer their athlete drink water over energy drinks. Thing is, their athlete would do far better. Caffeine can make you anxious, have palpitations, elevate your blood pressure, cause digestive problems, and increase insomnia. The sugar in these drinks will likely just add weight, not great energy, to your athlete.

Things To Know About Energy Drinks

  • Energy drinks are not regulated by the FDA like soda is. The FDA is investigating health effects but there are no current mandates in place for manufacturers. A can of soda is limited to 65 mg of caffeine. Energy drinks don’t have those limits and often the bottles and cans don’t even list all ingredients that have stimulant-like effects. Popular energy drinks have anywhere from 150mg of caffeine per bottle to up to 505mg. For reference, a typical 6 oz cup of coffee has about 100mg caffeine. Read full post »