Archive for March 2015

Monthly Archive

How To Safely Dispose Medications & One Thing NOT To Throw Away

3-27 OTC medicine disposal

Getting rid of unused medications is something all of us do at some point or another. How to do it safely, though, is another story. Typical parenting moment: you reach into the medicine cabinet for vitamins or you’re hunting for ibuprofen or acetaminophen for a child’s fever and you grab a bottle of medication that, on closer examination, has an expiration date from several years ago. You realize you won’t use it. Before you toss that bottle in the trash, there are some safety precautions you can take to ensure the medication doesn’t end up in your sewer water, water source, or worse, in the hands of a curious toddler looking for treasure in the garbage can. The FDA provides detailed instructions on how to properly dispose of medications, but for the busy parent in all of us, there are three key takeaways:

1. MIX the medicines with things that bind

Take a bag of coffee grounds or kitty litter and dump the medication into it. The medication will bind with grounds or litter and be less likely to leak or spill out of the garbage once disposed. This method also discourages those curious little fingers (and hungry pets) from ingesting or getting into the medication!

2. SEAL the mixture in a container

Make sure your kitty litter/medication mixture is properly sealed in a sealed plastic sandwich bag or a take-out food container with a sealed lid before throwing in the trash.

3. THROW the mixture away

Now you’re okay to throw the medication (and binder) into the trash safely. Don’t flush medications in the toilet or dump them into a body of water of any kind.

The One Thing You Shouldn’t Toss:

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Balance And Bad Parenting, Maybe

3-27 jumpingLast night four Swansons sat in row 6 of a little commuter airplane on the way to visit family, all plugged in. Four people who love each other with four separate devices hardly communicating for the two hours or so that we sped through the air. At first glance it can look like an utter failure — you can hear the criticism ringing in your ears — this family must not be connected, or these working parents, pounding out emails and prepping presentations while their children watch videos and play apps, really must have their priorities off, right? Right.

Maybe.

On that flight I read a beautiful blog post from tenacious pediatric researcher Dr Jenny Radesky that questions the new world in which children are being reared. The one where their parents are plugged-in, distracted, perhaps less attentive and less available while raising infants and young toddlers. It’s the same world today, where preteen digital natives may be connecting more by text than by talking. She cites data that found, “if you take away preteens’ mobile devices and make them hang out with their peers in the country for one week, they get better at reading other people’s facial expressions.” Perhaps these children and teens are swapping thumb skills for interpersonal ones. Radesky is the researcher behind the observations out last year evaluating parents’ use of mobile phones at dinner that alarmingly demonstrated children’s near need to act out to get their parents’ attention.  Are our parent-child connections forever changed because of the profound brilliance that digital devices have in capturing our attention? Radesky brings up the zone of proximal development (I’d not previously heard of it) and its profound value. She says,

In order to effectively teach children how to regulate their behavior, we need to interact with them in what psychologist Lev Vygotsky termed the child’s “Zone of Proximal Development (ZPD).”  This means  knowing their cognitive and emotional sweet spots: what they can do on their own, what they can’t do, and what they can do and learn with an adult’s help.  You can’t fit the puzzle pieces in yet?  Let me guide your hand a little bit until you figure it out by yourself. You can’t calm down when you’re frustrated yet. Let me help you identify what emotion you’re feeling and then show you some options for calming your body down. And I’ll slowly take my support away until you can do this skill on your own.

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E-Cigs And A Free App To Help Quit Smoking

Last week a proposal was introduced that would give Washington State the toughest e-cigarette laws in the country. If passed, House Bill 1645 would significantly raise the taxes on e-cigarettes, ban the sale of flavored vaping liquids, ban online sales to Washington residents and require producers to list ingredients on labels. And while opponents of the bill argue that e-cigarettes are “healthier” than tobacco, there’s no denying the dangers of having such a highly addictive substance in arm’s reach to children and teens in an unregulated manner. Washington isn’t the only state taking action. This week California released a campaign calling out marketers of e-cigs for targeting teens. Teens are using e-cigs more and more with 1 in 5 high school sophomores here reporting having used them in the last month. E-cigarettes and e-hookahs may carry an illusion of safety they don’t warrant.

What House Bill 1645 Proposes

  • Instill a 95% tax on vaping products similar to tobacco product taxes
    • Right now only North Carolina and Minnesota have imposed taxes on E-cigarettes
  • Make it illegal to sell flavored liquid nicotine or other vaping fluids
  • Ban internet sales to Washington residents
  • Require ingredients list on all labels

Curbing An Urge To Smoke: An App For That

Supporters of e-cigarettes and those fighting against regulation often claim the devices are helpful in helping tobacco users quit, so-called harm reduction. I certainly won’t and can’t argue with anecdotes that this is useful for those wanting to quit. While this concept hasn’t been entirely disproved or entirely proven, there is still a lot we don’t know about vaping and the effects of liquid nicotine. If you or someone you know wants to quit tobacco, there are some new digital resources available to help you kick the habit. The good news is we can be hopeful that dual-pronged approaches may help those wanting to quit earnestly succeed. Download this app?

3-23 smartquit

Image courtesy: Washington Department of Health

Washington State residents have access, for a limited time, to a free app called SmartQuit. Sponsored by the Department of Health, the app is a tobacco cessation program that proved three times more effective than trying to quit on your own, according to a recent study from Fred Hutchinson Cancer Research Center. SmartQuit users create a personal plan to become aware of their urges to smoke, they then learn new ways of thinking about those urges to suppress the desire to smoke. The Washington Department of Health is offering the app for free to a limited number of users. Because the funding is limited, please don’t download unless you’re serious about using the app as the number of free downloads will run out. Consider it? If you or someone you know does, report back on your opinions?

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Peanuts During Infancy To Prevent Food Allergy

Photo from Edwart Visser Flickr Creative CommonsThere’s new data out to support stronger recommendations for introducing peanuts during infancy. Like hemlines, it may seem like this data keeps changing. As time, the science and our understanding of risk unfolds we’ve seen shifts in advice about starting solids that have left many parents wondering what really is best when starting foods and wanting to decrease risk for food allergy.

Briefly, and in general, it’s best to start a variety of foods for your child during infancy, starting around 4 to 6 months of age. In fact its now believed that it may be protective to introduce things like wheat, egg, soy, fish, and peanuts even before a child takes their first step around a year of age. The 2013 recommendations (that exclude information about peanuts) are explained in this post, “When Should I start Baby Food?”

The recommendation to share diverse foods during infancy that includes fish and eggs may feel new to you. For example, when my babies were born (mid-2000’s) advice and consensus suggested that avoidance of peanuts until after a year of age was best — the thought that avoidance of peanut during critical development may be protective against severe allergy development. Now, concomitant with a doubling in food allergies, we face an utter and potentially embarrassing reality — perhaps medical advice and our work to improve allergy risk by restricting foods in  infancy did just the opposite. Perhaps avoidance was exactly the wrong thing to do. Maybe we’ve engineered part of the problem.

This kind of advice can feel intense when raising children. “Do this, don’t do that, do this now, don’t do this now!” Doing the right thing is what we all want but doing right can remain elusive, especially when recommendations shift. I remember a fellow pediatrician questioning my eating a peanut butter sandwich while I was pregnant with my second son. She couldn’t believe I’d made that choice. At the time I remember not only feeling judged but a little terrified too. Perhaps I’d not take the data seriously enough? Oh goodness, I thought, as I diligently didn’t introduce “high allergy” foods until toddlerhood for my boys. Today I realize that wasn’t all that right either. It can feel like another hemline change for sure and yikes these sure are shorter skirts!

Fast forward 7 years to 2015. A New England Journal of Medicine study out this past month systematically evaluated risk for development of peanut allergy in children who were at higher risk for developing the allergy in the first place. And they started with infancy and introduced peanuts early in some of the babies. Researchers found if infants were introduced to peanuts early in life (between 4 and 11 months of age) their risk of peanut allergy at age 5 years significantly decreased.

The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy.  ~ New England Journal Of Medicine

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The Inconvenience Of Prepackaged Baby Food

dv2159103Feeding a toddler is hard work because of all sorts of normal shifts that happen after the first birthday. But new data out this past month (see below) reminds us how pre-packaged baby food isn’t the best food source, despite package claims. Whole food, the food your family eats, and the fresh stuff is the way to go.

Infant hunger matches their rapid growth; we’re used to our babies ravenous and near consistent basis from day one yet as infancy progresses feedings space out and form meals. By a year of age most children go 4 hours or more between eating. Toddlerhood is a completely different story; growth slows after a year of age and toddlers start to test limits in profound ways. Food is no exception. It can be tempting to reach for whatever’s convenient that you know your kid will eat (fish crackers, anyone?) but in the long run making good nutritional choices for whole food regularly will exceed the nutritional detriments of pre-packaged “toddler” food.  In fact, a new policy statement released by the AAP this month is urging parents (and schools, daycares etc.) to take a “whole diet” approach to kids’ nutrition, namely focusing on a mix of foods from the five food groups and avoiding highly processed foods. Read more about the policy here from my friend Dr Claire McCarthy. These “fresh is best” ideas aren’t new to you I suspect but the data about food being marketed to us (and our children) is: Read full post »

Vaccines, Profanity, And Professionalism

Screenshot 2015-02-01 12.30.40You’ve likely seen the Jimmy Kimmel “public service announcement” on vaccines. Over 3 1/2 million people have viewed it on Youtube so if you’re not yet one of them you’ll likely add to the tally now. The first 3 minutes of the monologue are spot-on and they’re also very funny. Jimmy takes a stand against the “anti-vaxxers.” He mentions that some parents are more scared of “gluten than small pox” and references the reality that some schools in this country have 20% of students opted out of some vaccines. His monologue is followed by a series of pediatricians voicing profane frustration. Most people think the video is hilarious and many of us fired up about vaccines feel a rush when the safety and trust we have in vaccines gets the spotlight like it does here. Jimmy’s script is brilliantly written and his execution is direct.

Thing is, I didn’t like the video. I was left feeling somewhat uncomfortable and embarrassed for my profession. Immediately I wanted to explain that even though many of us are frustrated with where we are on vaccine hesitancy, we really aren’t interested in offending. We will always work to partner with parents –we won’t mock, swear, or intimidate you. Our goal is to support, protect, and cure children whenever we can and our privileged responsibility is to listen to parental fear and connect families with resources that soothe. This really is why we went to medical school.

It’s exciting when celebrities voice-up and stand to talk about vaccine issues that reflect science. It’s especially exciting when they include practicing physicians. Counseling families who are hesitant or flat-out refuse vaccines is a part of the job for every pediatrician. A study published in the journal Pediatrics this week found 93% of pediatricians had reported they’d been asked by parents to skip or delay vaccines in the last month. The current measles outbreak has changed the tone of these conversations for many of us; I’ve written about my new stance because I’m enraged pockets of measles can even occur in 2015. That being said, even though I really do like to swear like these pediatricians when I’m out of public earshot, I’m unsure the tactic of this PSA will do any good for those parents who hesitate to immunize their children according to the tested and safe schedule.

It seems to me that if parenting is governed by love, pediatrics is governed by respect for that love and for the integrity of children individually.

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