Archive for 2018

From The Mouths Of Babes: Read This Twitter Thread

I can’t stop thinking about this tweet thread. I think it may be one of the most precious threads on Twitter. Hopefully that’s saying something since I’ve been plugging along, almost daily, on Twitter since 2009.

Here’s my experience with it…I’m sure you have your own and I’d love to hear about it in the comments if you’d be willing to share:

Yesterday, I woke early with insomnia around 4am-something in the morning. Instead of doing what I should have, I grabbed my phone and found myself on Twitter. Just before 5am I read a beautiful series of tweets from a South African pediatrician who cares for children at the end of life. He’d taken to Twitter in the early morning hours (Seattle time) to share messages from children at the end of life. Distillation of what they enjoyed most. Things they knew. Worries, gratitudes, and love housed within them. Innocent and nearly angelic.

I read it. I cried. I re-read it. I sent it to a few people I love. For some reason I didn’t retweet it. I have no idea why except that I think I held it so dear I wasn’t even sure what to say. I plopped it into a blog post from 2 days ago, I sent it to some smart researchers who work with children and teens and think/study/intervene on ways to improve resilience, happiness, and stress.

A perspective from the front-line-end-line-solid-lines-of-meaning in being alive is an ever-relevant and precious gift. Hard to think of any other advice that matters more. When I read the tweet thread in the early morning hours it had something like 100 likes on it. There are now, as I type this, about 100,000. That’s a lot; clearly I’m not alone in meaning-making with this.

I love twitter for this reason – I love that we have a tool to scale the wisdom in children.

Nothing better online, in my opinion, than gifts from the profound about what matters most to us all. Such a different harmony compared to the political and divisive garbage songs we’re constantly exposed to online right now.

I thought about the tweet all day. Then, after a work party last night, where we coincidentally celebrated a new Seattle Children’s app we’ve just begun piloting with teens (designed to improve resilience, gratitude-finding, goal-setting, and stress management — more on that to come!), I went home to my boys. We ate cake in the kitchen, I over-exuded expressions of love, and we read extra chapters together of our current out-loud book, The Wild Robot.

If you do anything today, I suggest clicking on his twitter thread and learning from these experiences. Even if you don’t use – or don’t like – Twitter, you’ll like this. Thanks, Dr. McAlpine.

Is It The Flu Or A Cold?

First off, in my mind, the goal this winter for your children, and your family, and your community isn’t perfect attendance at school or work. In fact, I’d suggest schools and families and principals who currently celebrate and reward perfect attendance may provide a disservice, especially when having a flu season like we are. The goal isn’t presentee-ism — the goal is thoughtful living. Staying home when ill, staying away from those who are vulnerable when you have cold symptoms (infants, pregnant moms, elderly), and taking care of yourself is a service to YOU but also to us all.

How To Protect Your Child From This Dangerous Flu ~ Summary from Consumer Reports

It may be hard to know when your child is having a run-of-the-mill “cold” and when they are having flu. So err on the side of caution — your child has a cough/cold/runny nose/sneezing/fever? Keep them home, please during this widespread flu! More on how to help decide what is going on (flu versus cold) in the CDC chart included below.

Doing my best to continue sharing what I’ve learned about this year’s flu season. Both the Centers for Disease Control (CDC) and Washington State Department of Health are reporting most recent data (info has been updated as of Friday afternoon February 2, 2018) that flu rates rose again last week in the most recent data collected. Here’s the CDC data for the most recent week:

  • WA Department of Health: 132 people have died of the flu this season in the state
  • 53 children have died in the U.S. (1 in WA State). 17 children died last week alone.
  • Every part of continental U.S. has “widespread” flu activity
  • In the last couple weeks, more than 7% of all people coming into clinics and emergency departments had an influenza-like illness. That’s the highest level of activity since the deadly swine flu pandemic nearly 10 years ago.
  • The CDC says this season’s epidemic is on track to rival the 2014-15 flu season and hasn’t yet peaked as of Feb 2nd. Kristen Nordlund a CDC spokesperson said Feb 2nd, “We have not hit our peak yet, unfortunately, it’s not going down yet. Really the bottom line is there is still likely many more weeks to go [in this flu season activity].” Back in 2014-2015, the CDC estimates 34 million Americans got the flu. More than 700,000 were hospitalized. About 56,000 died. Influenza is a serious illness.

Is It Influenza Or “A Cold?”

The CDC has a great chart to help decipher between the common cold and influenza. Sometimes you’ll never know what is in your house and body (!) unless you go in and get tested to identify the virus of cause. But in general, influenza causes more abrupt onset of illness. You’re fine and then, BAMMO. Influenza often causes severe “cold” symptoms, high fever, runny nose, cough, congestion and can lead to things like pneumonia, ear infections, long-lasting fever, dehydration, etc. Young children are at higher risk for more serious disease (and hospitalization) than older children, so parents should check in with their physician if they are concerned about their infant or toddler’s infection when flu is peaking.

Most of the time children just look crummy when they get flu: tired, clingy, feverish, coughing, and lack energy. If this comes on suddenly or parents worry about dehydration, rapid breathing, high fever or lethargy, they should call their child’s health care team. Abrupt symptom onset, fever, aches, chills, fatigue, cough and headache are common. So are muscle aches, especially in the lower legs. I often tell families that influenza makes people feel so bad that patients will complain their hair hurts or even their skin…

Lastly I will say…it is of course NOT too late to get the vaccine! In addition to avoiding exposures, and staying home when ill so you don’t share germs, you can layer protection with the flu vaccine. We want all children to have the benefit of protection from the vaccine, especially as influenza season peaks. Often we continue to recommend flu vaccine well into May. Call you doctor’s office, go to your local pharmacy and use the CDC’s Vaccine Finder to find the vaccine available in your zip code. Remember if you have a baby that they will need two doses (separated by 28 days or more) and if your child is under age 9 years and they have never had a flu vaccines before, they’ll need 2 doses this year, too!

What I’m Doing Now – January 2018

It’s still (barely) January of 2018 and I’m doing my best to try to new things, take breaks from old things, be more strategic, practice tiny habits, and spend time with my sweet boys and family. I’ve even committed to a weekly early morning swim with a dear friend to just ritualize something beautiful for the year.

(added 2/1/18: Check out this palliative care physician’s twitter status update [read the whole thread — amazing] for any reminder for why we should just be with our babies when we can and why we should tell more stories, read more books, and perhaps, eat more ice cream!)

Many of you are familiar with my Seattle Mama Doc podcast which typically features parenting advice and pediatric experts sharing ideas for particular health topics. But I’m often asked about all the different hats I wear: mom, doctor, Chief of Digital Innovation at Seattle Children’s Hospital, Chief Medical Officer at Before Brands, reporter at KING5 News and more. So, this is my first attempt at detailing what I’m working on each month — the juggle — why I’m doing it and how it all feels. It was an idea inspired by my dear friend, Susannah Fox who updates her work list publicly, on her blog monthly. I recorded an ad lib take on the podcast (embedded below).

Tell me what you think, share ideas, offer advice or partner with our digital health team if you can!

Power on, People. Thank goodness, here comes February!! Maybe some sunnier days? Think weather and think metaphor, too.

Widespread Influenza in US: Ways To Protect Your Family

It’s flu season, no doubt about it, with widespread influenza infections all over the United States (see the CDC updated maps with high-levels of ILI [Influenza-like illness]). Influenza is a virus (there are many types or “strains”) that cause terrible fever, cough, respiratory distress, pneumonia, ear infections, and sometimes hospitalization and death. As you’ve likely heard from the media blitz the last week or so, it’s shaping up to be a pretty nasty year – and some public health workers are concerned not only about this surge or “peak” of flu season coming early, but that it may be bigger and more dangerous than we expected. Washington is still bracing (we have lower levels) but many areas are inundated and hospitals and ERs are full. Any Google search on “flu” will give you headlines like this: Hospitals Face a War Zone, Flu Season is Bad But Might Get Worse (which is true, it might), and this with the data update this week: Flu Season Has Killed 30 Children (which is also true and dreadful).

5 Simple Things To Do During Flu Season To Help Your Family

Read full post »

How To Treat Lice And When To Ask for A Prescription

This is a follow up post to my recent post on treating head lice. It’s all just a major inconvenience. And worse than having lice is having lice again and again. And even worse than your child getting re-infested may be treating lice with an ineffective therapy. Enter…..”super lice.” Ewwwww. Although please know that their name exceeds their actual scariness. These lice are only different (aka “super”) in that some lice may have developed gene mutations that indicate they are developing resistance to a common class of over-the-counter (OTC) treatments (permethrin).

A 2016 study in The Journal of Entomology that got a bunch of media coverage found resistant lice all over the United States. Lice were sampled from 48 states at well over 100 different centers to evaluate their patterns of mutations that may render them resistant to OTC medications. Do note that the study was funded in part by the pharmaceutical company that makes one of the prescriptions, but nonetheless did find that lice are becoming harder to treat, coast to coast.

Do you have a super lice? It may be hard to know. If you’ve treated your child several times exactly according to directions and aren’t having success, you should explore prescription medications that may work better. But REMEMBER though, that sometimes you child is just getting re-infested from someone at school.  It is sometimes hard to decipher if the OTC medication is ineffective, or if your child has been re-exposed. Working with your school and with others where your child may have been exposed is always a part of this when a child continues to have lice after a treatment. There are some medicines (see section below) that may help if the OTC meds are not working. The chart below shows where the resistant bugs were detected (red is fully resistant, orange shows intermediate resistance, and green showed no resistance to OTC meds). Read full post »

How To Treat Head Lice

As parents, many of us have been there. You’re going about your day and BAM…fear and anxiety start creeping in as soon as you read the email, that perhaps again, there’s an outbreak of lice. Someone in your child’s school has lice and your child may have been exposed…blah, blah, blah. Nothing about this ever feels benign, even though it always is. Lice just feels a gross inconvenience. This post details the lice life cycle, the ways lice spread, and ways you can treat lice with both OTC or prescription medicines.

Lice infestation is common for US children and has nothing to do with cleanliness. The Centers For Disease Control (CDC) estimate 6-12 million lice infestations a year in the United States, but something you cross your fingers doesn’t make its way into your home or hair.

How Lice Live And How Lice Spread

Head lice feed on tiny amounts of blood from the scalp and if they are not on a person’s scalp, they can usually only survive about a day. This is good news for remembering that lice won’t crawl around your home for days — ever. They just can’t. Lice lay their eggs close to the scalp and when on the head can live about 28 days. They can multiply quickly, laying up to 10 eggs a day. It only takes about 12 days for newly hatched eggs to reach adulthood. This cycle can repeat itself every 3 weeks if head lice are left untreated.

Remember that head lice usually only survive for less than 1 day away from the scalp at room temperature. Their eggs cannot hatch at room temperature lower than that near the scalp. So once they fall off a child’s head, lice pose very little threat. You don’t have to vacuum the carpet, sterilize the toys, wash the house top to bottom after your child has lice. I mean you can, but don’t do it for the lice :-).

Lice is typically passed through close person-to-person contact.  Lice crawl, they can’t hop or fly (phew!). Lice mainly move from head-to-head and less commonly move from one person to another on a hairbrush or hat or costume.

Lice At School – Why Kids Don’t Get Sent Home Anymore

The American Academy of Pediatrics and CDC have fought hard against “no nit” policies in schools, in the interest of reducing the school absence associated with head lice. When recurrent infestations occur this can be frustrating but no child really ever needs to miss school for lice. Schools are increasingly unlikely to exclude children for nits, but still, in some schools, the policies persist. The rationale for not sending kids home:

  • Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as ‘casings’.
  • Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
  • The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice.
  • Misdiagnosis of nits is very common during nit checks conducted by non-medical personnel.

 

Over The Counter Lice Products


Most of the time the very best bet for lice are OTC, easy-to-use treatments. The FDA has approved over-the-counter (OTC) lice products as safe and effective when used according to the Drug Facts label instructions. There are 3 main ingredients used to treat lice: Permethrin, most commonly found in the OTC product Nix or Piperonyl Butoxide and Pyrethrum Extract, most commonly found in Pronto or Rid. Each product has different and specific treatment instructions, like if hair needs to be shampooed first or if dry hair is needed, the age a child has to be for these products to be used on their scalp and if and when a second treatment is recommended. If the thought of dealing with lice makes you light-headed, there are lice-removal services available. They’re not cheap (starting around $100 in the Seattle area), but some parents may find the expense well worth the piece of mind of getting rid of lice manually by professionals. Read full post »

MLK Day, The New Year And Tiny Habits

I’m quieted today by the profound example of Martin Luther King Jr. and one of his many enduring proclamations,

“Life’s most persistent and urgent question is, ‘What are you doing for others?”

The answer I often feel is “not enough.” While most of us spend portions of our everyday caring for or enriching the lives of others, the enough-ness and potency of feeling we’re doing enough, or giving back in satisfactory ways, can yo-yo.

There’s not a better moment than now to augment who you are and what you do with your days.

We’re halfway through the first month of 2018 and perhaps today is a beautiful moment to pause on what we do each day routinely and how we contribute. Even in the tiniest ways. Resolution season is dying down so I suggest we think less resolutions and more intentional habit formation. More intention for you and your life I believe will likely translate to more for others.

BJ Fogg, a behavioral psychologist and founder and director of the Stanford Persuasive Technology Lab, created a behavior model (see the graph below) that when dissected and simplified, details that making change in your life and forming a lasting habit is a blend of how much motivation you have for the change, the challenge of actually doing the behavior and the need for a triggering event to get the desired change habitualized. In some senses, if you have high motivation for a new habit or change, even if something is hard to do, you’ll do it with a proper trigger. If you have low motivation for the new habit, even if something is easy to do, you may not. But triggers and other barriers and thresholds can throw this all off. He recommends implementing “tiny habits” to drive change in your life by following 3 steps.

1. Start small. Make it teeny tiny. Read full post »