Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

A mom, a pediatrician, and her insights about keeping your kids healthy.

Head Lice, School, And OTC Treatment

Raise your hand if you never had head lice before going to college. Your hand isn’t in the air, is it? Turns out, lice is common. And no question, it’s wildly unsettling for us all. It’s a new world when it comes to prevention and treatment though — more choice, less stigma and less school disruption. Twentieth-century lice care is no more.

Back in 2010 the American Academy of Pediatrics (AAP) updated its recommendations on lice. Basically, schools are no longer encouraged to send children home with lice or keep them away from school. Lice spreads from child to child but it’s certainly nothing like measles. Sending children home from school for a “non-health issue” doesn’t make sense. Further, lice can be living on your child’s head for up to 30 days without hatching (horrifying I know) and can be around for weeks before causing itching the first time around so an urgent send-the-lice-infested-kid-home policy just doesn’t make a lot of sense. Thing is, this changes the game. We all want to get rid of lice on our child’s head immediately, but we’re dependent on all the other families in school doing the same so we don’t get it AGAIN…

In the midst of a lice “crisis,” don’t beat yourself up. This has nothing to do with hygiene. It has more to do with bad luck.

“Head lice are not a health hazard or a sign of poor hygiene and, in contrast to body lice, are not responsible for the spread of any disease.” American Academy of Pediatrics

KYOTC Lice 1New 2015 guidelines from the AAP offer some tips for getting your family lice-free as quickly as possible. Lots of over-the-counter (OTC) ways to deal with it. OTC treatments are safe and effective. However, lice are tricky and have been found to have resistance patterns that aren’t entirely understood at this point (the prevalence is unknown)– so rarely a parent needs to switch treatments. That means sometimes we do all the right things and even with the BEST routine and adherence and lice possibly remain. If you suspect you’re not getting rid of lice at home despite great treatment routines, involve your pediatrician. Often ongoing lice is simply that your child is getting re-infested at school or sports. Or they weren’t gone in the first place.

Follow instructions on the bottle — many treatments need to be repeated about 7-10 days after first application.

Sometimes it may be that you need to swap treatments. It’s RARE that you need a prescription treatment. Your child’s clinician can help recommend a transition to prescription medications. The prescription meds are expensive and often unnecessary but one does have the benefit of requiring only a one-time treatment and no combing.

If the thought of chemicals of any kind on your family’s skin is unappealing, manual removal by “wet-combing” or suffocation through hair is acceptable and can sometimes be effective (things like mayonnaise, butter, oils) yet there is no real hard data about effectiveness. It’s important to note that wet-combing should be repeated once a week for at least three weeks if you do this to ensure all lice and nits are removed as you must comb through entire scalp and hair fastidiously.

Discovering lice is clearly in the no-fun parenting category, but it’s also NO BIG DEAL. From experience (x 2) I can say best thing we can do is calm down, head to the drug store, comb away, wash the linens and move on.

What Parents Need To Know

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Flu Season, Pregnant Moms, And The GOP Debate


A selfie with Dr. Tom Frieden, Director of Centers for Disease Control (CDC)

It’s been a whirlwind this past week. Last week I flew to Washington D.C. as an invited speaker at the NFID Influenza News Conference at the National Press Club in Washington D.C. I joined thoughtful experts: Drs. Tom Frieden, Kathy Neuzil and Bill Schaffner to present the 2015/16 flu season recommendations and explain rationale for every-year flu vaccine. It’s an essential vaccine for children, especially as young children are at elevated risk for more serious or even deadly influenza infections. Timing auspiciously peaked interest in the news as the press conference was in the morning immediately after the presidential candidate debate where wild myths were shared on stage about vaccine science and safety. I was able to also share my refute of Trump’s false statements here on NBC Nightly News.

I got my flu vaccine at the event in front of the cameras. Thanks to the new jet-injected vaccines (truly a needleless “shot”) it didn’t even hurt! As expected, I was sore in my arm for a day or two thereafter.

Prepping for the press conference, I was a little underwhelmed to learn that only roughly 50% of pregnant women get the flu vaccine. If you’re expecting, here’s what you need to know about the flu vaccine. Quick 1-minute video below. SPOILER: it’s an essential and safe vaccine to get at any point of your pregnancy. Read full post »

Using Melatonin To Help Children Fall Asleep

Melatonin Boy SleepingWhen I recently shared this article on my Mama Doc Facebook about a “magic” children’s bedtime story promising to make the going-to-sleep process easier, many parents inquired about melatonin.

No question that supplemental melatonin has a role in children’s sleep dysfunction but also no question that parents are turning to melatonin out of a need for convenience. I’ve had COUNTLESS curbside consults from parents asking me if melatonin is safe to use in the short-term but also for years on end. The short answer is we don’t entirely know because studies just haven’t been done. Often when I get the story of how families are using melatonin, I end up advising changes in the sleep schedule more than a need for meds. What we do know: melatonin can help children fall asleep with sleep dysfunction, sleep dysfunction and inadequate sleep have serious health consequences, and although melatonin only helps with sleep initiation (falling asleep) it can be hugely beneficial for children who lie awake at night for hours at bedtime. The other thing we know: melatonin is not regulated like medicines (it’s overseen as a food supplement) that has been studied in very few pediatric populations so it’s difficult to generalize safety for children everywhere. Lots of definitions, dosing info, and pediatric sleep expertise below.

If your child can fall asleep in about 30 minutes after the lights are out (especially when you have made sure no screen time for 1-2 hours prior, no caffeine in afternoon) then melatonin is unnecessary.

If it were my child I’d use melatonin if sleep dysfunction at bedtime was getting in the way of necessary sleep, but I’d also do everything I could to get them off of it as soon as I could. Many children respond to the hypnotic effect of higher doses of melatonin, but many children are also given it for family convenience, too. In my experience, sometimes families use it to treat anxiety (those kids whose mind spins and spins and spins and worries) at bedtime. Although sometimes melatonin helps kids fall asleep, it’s just a band-aid.

Children are sleeping less than ever before and there are mounting impediments to a good night’s sleep (screens, early school start times, stimulants in the food source, busy school days and activities keeping kids up late). However inconvenient, I think sleep hygiene (routine bed time, no screens before bed, bed used only for sleeping) and consistency with what we do as parents may be the only magic wand to wave for sleep throughout childhood. Awakenings typically rise from all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically. When it comes to challenges falling asleep, sometimes melatonin can really help, especially in children with underlying autism spectrum disorder, attention deficit disorders, or children with shifted sleep schedules.

Only a few long-term studies have looked at prolonged use and associated effects, but most sleep specialists consider melatonin safe, particularly for occasional short-term use. The bigger question is why parents feel the need to give their child melatonin.  –Dr. Maida Chen

What is Melatonin?

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Another 20 Questions, Another School Year

last gasp of summerTime is so slippery. As we get older we feel the slip of time differently, having children pulls these time-space continuums to extremes. Nothing slower than a night with an infant who won’ t sleep and nothing seems faster than a school-age child flying through grade levels. As we prep for the beginning of the school year again this year I cannot help mentioning that it is clearly a delight to see our little humans head back into the classroom. But a little part of me whimpers inside, too. Tomorrow school really is supposed to start.

When O got up this morning and joined us at the breakfast table his first muttering was, “Why is it so dark?” I know some have been back in school for weeks but in the Seattle area many of us are just getting back to it.

There’s heartache and anxiety that comes with day one of school because the day is so emblematic for a year of what is to come. First day is packed of a blend of hopes and dreams, worries and insecurities, and pure unbridled excitement. For the last few years I’ve been asking the boys 20 standard questions just before they start. Here’s what they said this year:

20 Questions At School Start:

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More Teens Getting HPV Vaccine: Boys And Girls

The vaccine schedule is the same schedule for boys and for girls. The path to today’s human papilloma virus (HPV) vaccine has not been entirely straightforward for parents as recommendations have changed over time. Know this: the clear and simple message is that HPV vaccine is safe and effective for boys and girls. We know it works best when given earlier in the tween/teen years and we know the immunity it produces in our bodies is durable and lasting. HPV vaccines is an anti-cancer vaccine that works best when given to boys and girls at age 11. For me it’s a no-brainer to recommend this vaccine enthusiastically before children head off to 6th grade.

Earnestly, it’s not a “new” vaccine as pediatricians began giving the vaccine back in 2007 and it’s been given well over 50 million times. In the U.S. we starting giving the vaccine to girls first yet because human papilloma virus can infect boys and girls, men and women, HPV vaccine is also recommended for boys age 11 and older. Uptake by boys has been fast and steady since recommendations included them. Three different HPV vaccines are now available: a 2-HPV strain (protects against the viral strains that cause 70% of cervical cancer) or a 4-HPV strain vaccine (same 2 strains plus two more that protect against HPV strains causing warts) and now a 9-strain vaccine (expansion of strains causing warts), upping the number of different viruses that the vaccine protects teens against. The new options improve protection against HPV viruses that cause genital warts and also HPV viruses that can cause cancers of the cervix, mouth, throat, vagina and rarely, the penis.

HPV Vaccine Protecting Teens

Although we haven’t reached vaccination rates of countries like Australia (they vaccinate at school which certainly makes the vaccine convenient) our rates of completed HPV vaccine series are up (see graph below). In Australia where the majority of teens have been immunized they have seen remarkable progress:

  • A 77% reduction in HPV types responsible for almost 75% of cervical cancer
  • An almost 50% reduction in the incidence of high-grade cervical abnormalities in Victorian girls under 18 years of age
  • A 90% reduction in genital warts in heterosexual men and women under 21 years of age.

Boys and girls getting the vaccine protect themselves but they also help protect future partners.

Why Does Avoiding HPV Matter?

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How To Read OTC Medication Labels

reading labels 1Reading and familiarizing yourself with the drug facts label is perhaps more important than it seems before you administer an over-the-counter (OTC) medicine to your children. I think we may get more hands-off at times than is ideal. And I think caregivers who casually help us with our children (grandparents, babysitters, nannies, neighbors) can too. Although it’s inconvenient to fill out forms for medicine administration in daycare, preschool and school, these locations seem to be the environments with the most safety around OTC medicine delivery. Those forms help remind us how important this stuff can be.

With little ones and children all heading back to school, as parents we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the inevitable fall, wintery illnesses resume, it’s a great time to set aside some time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, etc. In some ways it’s combination medicines that make me worry the most.  Read full post »

4 Things To Know If Your Son Is Off To College

male college prepYou may have already read yesterday’s blog on preparing your daughter for college. Much of my advice for girls, of course, also pertains to boys (and vice versa). I’m writing two separate posts only for the purpose of getting people to read this content, not to differentiate. I added one section here for boys (on alcohol and risks) not because it’s an issue for boys only. In fact, we know that 1 out of every 5 high school girls binge drinks (see below).

If you have a boy heading off to college this fall there are a few things to know to help improve his safety and success this year. Of anything I know from my experience being a previous school teacher, and now pediatrician and mom to boys (still 10 years away from college!) the transition from HS to college-age is one steeped in emotion for all. In addition to the tips I’ve provided for girls, alcohol and the HPV vaccine are topics to discuss to ensure it’s a better and safer year for your son (or daughter) this year.

ONE: Safe Sex & Birth Control – What Your Teen Son May Need To Know:

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3 Things To Know If Your Daughter Is Off To College

Prepping for college - female.pngIf you have a daughter getting ready to head to college this fall, holy moly I’m excited for you. In clinic it’s clear to me that the huge transition from high school to college-age brings great joy but also a remarkable sense of unrest for everyone, too. Vaccines, birth control, and suicide prevention may not top your to-do list while packing the car but there’s no question these are 3 things you can check in on to ensure it’s a better and safer year for your daughter. Not only is a brand new meningitis vaccine available to college-age girls this fall, included here are reminders with ways to support your daughter and her health as she heads off to learn even more…

ONE: Birth Control Options For Your Teen Daughter

1. Amazing Resources To Prevent Unwanted Pregnancy

The CDC confirms that as girls head off to college we know over 40% of them have had sex. And although 4 in 5 of them used a form of birth control the last time they had sex, only about 5% are using the most effective forms to prevent pregnancy. Read full post »

Window Falls: Innocence And Curiosity

Window falls are a gut-wrenching topic because they cause devastating and preventable injuries in children. This hits home for me; in just 9 years of pediatric practice I’ve had a handful of patients fall through open windows and screens. Every single fall has occurred because of innocence and curiosity — a child just wanting to see, or be involved in, something outside. So many of us don’t get our 2nd or 3rd story windows secured for children and we often just don’t expect a child to push through a screen… 

Each year in the United States 15 to 20 children under the age of 11 die, and nearly 15,000 are injured, because of falls from windows. A colleague, Dr. Lauren Wilson, is sharing her story, her perspectives while working in the hospital (Harborview Medical Center), and her ideas for preventing injuries as we close out this hot summer in our town deplete of air conditioners. We’ve included some tips on preventing falls in your home below. Don’t wait!

As a pediatrician, I was called four times last week to help care for young children with severe head injuries due to falls from windows.

Each time my pager goes off to mark a potentially devastating injury, I mourn. Not just for the family whose life is changed in that moment, but also for our city’s failure to make basic efforts to prevent these falls. I also know each time I am called that this will not be the last.

Despite reporting on these injuries, children continue to be injured at alarming rates. Since January 1 this year, Harborview Medical Center has treated 42 children with fall-related injuries in the hospital. Dozens of other fall-related injuries are cared for in primary care clinics and emergency departments. Read full post »

It’s Gotta Be Screen Time Somewhere

Illustration by David Rosenman

Illustration by David Rosenman

My boys always want it to be screen time. I don’t think that is changing anytime soon. These apps, shows, games, and devices are only getting smarter at capturing their attention.

It feels like there isn’t a giant list of new advice to share regarding “screen time.” But because of the recent media focus and deluge of content on “screen addiction,” coupled with recommendations for dealing with screens while parenting this summer, I’m here with a few responses and observations. It seems to me, parents (all of us) are looking for a couple of things in the content we read about parenting with screens: permission and hacks for simplicity. This post will perhaps offer neither. Until the end.

Most of us acknowledge that not all screens are the same, nor is all programming, nor are the stages of life where apps and screens are enjoyed (infants versus an 8 year-old). “Screen time” is an issue layered with complexity. Parenting during this explosive device development era demands simple rules and dictums for limiting their use help, but the rules by themselves limit the development of full-on zealots. No one follows the rules like religion. Parents, grandparents and caregivers aren’t devout to recommendations because we claim the rules just don’t fit into the context of our lives. Most of us figure out a way to make justifiable exceptions. It’s simply too easy to pull out your phone, especially when it delights your child the way it does, and entertain. But no question that with the rules out there stressing non-use and limits, we’re left feeling a little guilty anytime we left our children indulge. Imagine knowing that screens before bed interfere with the “sleep hormone” melatonin (the light emitted from the screen limits secretion) but even so still choosing to let your children “chill out” with a video for a 1/2 hour before bed each night. Or imagine following the no-screen-time-before-age 2 religiously for your first child but then breaking this rule routinely when you have a second one! This just happens all the time. Read Why No TV Before Bed Is Better. Read full post »