Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

5 Things You Should Know About Concussions

This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd). Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them.


Soccer is the highest risk sport for school-age girls.

Soccer is the highest risk sport for school-age girls.

What Happens During A Concussion?

A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain, resulting in a mismatch where the brain needs more energy but receives decreased blood flow to the brain temporarily. This mismatch in blood flow is believed to last up to 10 days following an injury and helps explain the symptoms associated with a time-limited injury such as a concussion.

Unfortunately this also explains why diagnosing and managing concussions can be vexing. Unlike a broken bone, we do not have validated imagining or blood tests that enable definitive diagnosis. The best practice of diagnosing concussion currently relies on obtaining a detailed history and physical following an injury. Depending on the severity of the injury and initial presentation, a sideline assessment should performed to look for common post-concussive symptoms. If the initial injury is more severe one may need to be evaluated in the emergency department and imaging may be obtained to help rule out a more severe injury. Each traumatic brain injury is unique, and should be treated with respect. There is nothing more heart breaking than a traumatic injury being improperly respected and identified, leading to a delay in care and permanent deficits.

 It can be challenging to determine which concussions are mild, severe and which may progress. Ultimately the goal is to prevent injuries, screen for potential head injuries when appropriate and diagnose and treat injuries in a timely fashion to limit their severity.

How To Prevent Head Injuries

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The Seriousness Of Concussions

J. Forrest Bennett, ARNP, Rehabilitation

J. Forrest Bennett, ARNP, Rehabilitation

This is a guest post from J. Forrest Bennett, an ARNP at Seattle Children’s and Dr Samuel Browd (@DrBrowd) a neurosurgeon who, together with their team, care for children after concussions. Clearly, we’ve all heard more about concussion these past few years. Not just because of pro-football tragedies and lawsuits but also because of the increasing expertise the medical community is acquiring around how to care for children and young adults after getting hit in the head. We’re also learning how to prevent head injuries in the first place. Forrest and I first started discussing this last spring when I began to see his passion in getting great information out to families. He’s convinced the more we parents (and community physicians) know about what to do with head injuries the less children suffer. In some cases what we do in minute 1 or day 1 after an injury can really change how a child recovers. Take a peek at this awesome post and please post comments/questions if you have them. More content will also be published later this week.


There is an ongoing debate about how we should best assess, manage and prevent head injuries in sports. Given the complexity of the injury and the effects that a concussion can have on an individual there is no room for the outdated and dismissive terms such as “getting your bell rung” or a “ding to the head.” Being dismissive of head injuries can lead to premature return to play and can end tragically. These injuries really matter.

This isn’t to say that kids shouldn’t play sports of course. Sports promote cardiovascular health and play a crucial role in the character development of children and adolescents. Parents must balance the risk with the benefits of sports to promote healthy decision-making. I like to talk about an active risk-reduction lifestyle. Through outreach and education we can prevent debilitating injuries, identify concussions early, and provide care plans that stem from evidence to limit the impact injuries have on kids.

What Every Parent Should Know About Concussions

  • Helmets do NOT protect against all concussions
    • Helmets provide crucial protection against skull fractures and more severe brain injuries but you can still suffer a concussion even with all of the proper protective equipment.
  •  There is a right way to play sports
    • Teach your kids safe ways to play sports and adhere to the rules of the game. For example: no tackling in soccer and no head tohead contact in football. HEADS UP trained coaches teach actively safe participation in sports.
    • The majority of sport rules are intended to maintain a level playing field and enjoyable experience. Head to head contact in football is just one example of improper and unsafe play that has recently drawn national attention in increasing ones risk for injury.

Because injuries happen, a group of experts developed the Standardized Concussion Assessment tool- 3rd edition (SCAT 3). This tool can help guide trained coaching staff, athletic trainers and medical providers in the initial assessment, triaging, and monitoring of these injuries. Many concussions can be handled through the expertise of your pediatrician or primary care provider. Concussions with prolonged symptoms (lasting weeks to months) and\or more severe injuries frequently benefit from a team approach. Read full post »

Whoops: Over-The-Counter Dosing Errors Common

OTC revised infoIt’s that time of year again. The season of snot and mucus and colds….if you’re a parent you may even call this “sick season.” Typical cold viruses are getting readily exchanged as recirculated air in crowded malls, classrooms and daycares facilitate exchange of the germs. It’s more than inevitable that one of your kids will come down with something. Those 6-10 colds that children get on average, every year, have arrived which means there’s a good chance you’ll be up late one night with a feverish or coughing child reaching for an over-the-counter (OTC) medicine . Data proves we’re all at risk for making a dosing error. Remarkable how easy it is to do. As a pediatrician I always have to check (and double check) the label when I’m home dosing my kids. The bottles and doses are all so different.

A new study in Pediatrics found that every eight minutes a child under the age of 6 experiences a medication error (outside the doctor’s office or hospital). Over the course of ten years (2002-2012) 696,937 children experienced medication errors. Young children (under age 1) had the highest rate of errors making up more than 25% of the total number. For parents these may be easy mistakes to make as containers and dosing devices aren’t always clear (nor are they consistent) even after FDA rule changes were made a few years back.

It’s important to note that the study referencing dosing errors (above) found dosing errors from cough & cold medicine are thankfully going down while dosing errors around other meds are actually rising. It’s also of import to say that most pediatricians don’t recommend OTC cough and cold meds for children under age 6 anyway as they provide little benefit and put children at risk for side effects and dosing errors. Read full post »

Is Overuse Of Antibiotics The New Global Warming?

Desinfecting.JH

Antibiotic resistance is like global warming; it feels like it’s someone else’s problem to solve and much bigger than all of us. Yet the simple choices we make – whether or not to use antibiotics and which ones we pick – do affect us and our community. ~Dr Matthew Kronman

This week is Get SMART About Antibiotics Week, aimed at raising awareness of antibiotic resistance and the importance of appropriate use. Dr Kronman’s “inconvenient truth” reminder serves up the importance of our choices; what we do everyday with our food and our medicines changes not only our own health but also the health of others now and in the future. Antibiotics in food, water, and our clinics and hospitals change our environment. Each dose of antibiotics given to our children, ourselves, or the animals we eat change our community’s health in general. The more we use antibiotics that kill off susceptible bacteria, the more we select bacteria for survival that are resistant to known treatments. The consequence over time for us all is that there are more resistant bacteria or “superbugs” around causing harder to treat infections.

 4 Things You Can Do Today To Avoid Excess Antibiotics

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Has Your Babysitter Had The Whooping Cough Shot?

Mama Doc w baby girlA Seattle high school recently announced a minor outbreak of whooping cough: 13 students were diagnosed with laboratory-confirmed pertussis. None of the teens are contagious as of today, but it poses an interesting question about protecting our children and communities. A health advocate and friend on twitter suggested a savvy reminder: we can help teenage babysitters get up to date to protect young babies and children. Yes! Is it our parental responsibility to make sure babysitters, nannies or even sweet grandmas are properly vaccinated? Should it be the question we ask before we inquire if they’ve completed CPR training? Perhaps.

It’s hard enough to ask grandparents and friends to vaccinate or “cocoon” to protect our youngest and most vulnerable. It may be a challenge with the neighbor babysitter as well. I’d suggest just saying, “Hey, did you get your 11 year-old shots and your flu vaccine this year?” Thing is, one hurdle may be that your 15 year-old sitter may not know if they’ve had their teen pertussis shot. As a reminder, all children are given immunizations for whooping cough (DTaP) at 2, 4, 6, and 15 months. They then receive another dose at age 4. Then a tween booster dose (the Tdap shot) at age 11 years.

Many children prepare for the big job of babysitting by taking classes. At Children’s our next Better Babysitters class is November 22nd. I’m working to ensure that instructors make sure they help teens determine if they’re up-to-date on immunizations during the course!

What Is Whooping Cough?

  • Highly contagious bacterial infection (pertussis) of the nose and throat causes “whooping cough.”
  • Easily spread by coughing and sneezing. Symptoms appear 7-10 days after exposure (on average)
    • Symptoms differ by age, babies & young children may have severe coughing spells or even pauses in breathing. We worry most about newborns, young infants under 2 months of age but also consider babies under 6 months of age “high-risk.”
    • Adults and older children could have fever, runny nose and bad cough that progresses into coughing fits, “whooping” sounds with cough, or even a cough that lasts over 100 days (even if treated). Treatment prevents spread, not the cough.

Is Whooping Cough Serious?

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An Unfair Advantage

MIL photoI recently listened to an interview on This American Life that stuck with me. The show was entitled “It’s Not The Product, It’s The Person” and went through a series of examples uncovering the reality that great business (or great work) is more a product of the who than the what. Who people are, how much grit, tenacity, raw or natural talent, passion, or skill really matters when doing whatever it is that that they do. Far more perhaps than what they actually create, sell or even perform. And although this isn’t the point I mean to make (you’ll see) it’s worth noting that the show opens with details of a young entrepreneur, like really young (age 11 years) and demonstrates how her talents, bravado, and finesse allow her to sell things and attract attention that others can’t. The show rounds out as the narrator showcases the varying pitfalls in his own quest for success as an ex-NPR radio producer turned start-up entrepreneur. The story was somewhat lighthearted, of course, but one point stuck. As he was gleaning information from an established, successful venture capital investor he was asked a potent question. The investor was interrogating how this fledgling entrepreneur could get funding; assisting him in creating his “pitch” for the money people. He asked, “What’s your unfair advantage?”

Think about it, what’s your unfair advantage?

It stuck with me because it was so relevant for success in an often random, senseless world of building ideas and companies but also in parenting “like a pro.” An unfair advantage sometimes facilitates success and I would suggest nearly all of us have something in our pocket that we know makes it work. You can think of this unfair advantage in terms of celebrity or early success for some (Kate Hudson’s mom is Goldie Hawn after all, and it certainly seems easier to get a bedroom in The White House if your last name is Bush or Kennedy or Clinton for that matter). Yet we all also know that success isn’t only built of “unfair advantages,” that it does take advantage wed to sheer passion, purpose or intent. But clearly those unfair advantages help people get their ideas and skills discovered.

It was only recently that I realized my unfair advantage this past decade or so. Read full post »

If It Were My Child: A Turkey Without Antibiotics

turkey photoMy coffee arrived in a red cup today so I know the holidays are officially upon us; Thanksgiving will be here before you know it.  If you’re ordering a turkey (and/or you’re incredibly organized) you’ll likely be picking out your bird in the next few days. Who are you people? For you prepared and pre-paid types and even those of us who wait until the Thanksgiving week, we have some decisions to make and a great opportunity. What turkey we buy matters.

This year I’ll be making the choice to purchase a turkey raised without antibiotics –when you choose this type of turkey it doesn’t mean “organic” (even some organic meats come from animals fed antibiotics). Antibiotic resistance is a growing problem and I’m taking a new step to keep my kids away from excess antibiotics, like those found in many Thanksgiving turkeys. This is new for me and hasn’t been a priority until the last few years as I’ve tuned into information about the human microbiome and ways that antibiotics in our land, food, water and pharmacies really change our own habitat and potentially our family’s health.

The Problem With Unnecessary Antibiotics

I’ve written several posts on avoiding antibiotics when unnecessary, but here’s the cliff notes version: When you (or your child) take an antibiotic, most of the susceptible bacteria exposed to the drug will die. “Good bacteria” (naturally living on our skin or in your throat or GI tract) and “bad bacteria” (the ones causing the infection) will fail to survive. However, some bacteria will possess genes that allow survival amid the presence of antibiotics. Over time and without competition from other organisms, these bacteria can even thrive. This set-up creates different colonies of bacteria where some will be resistant ‘superbugs’ and changing the bacteria in our environment and our own bodies. Some of these colonies will eventually cause infections that are hard to treat. The more antibiotics are used anywhere, the more possibilities for these ‘superbugs’ to replicate with resistance over time. In fact 97% of doctors are extremely or fairly concerned about the growing problem of antibiotic resistant infections. Most parents are worried, too.

The Case For Antibiotic-Free Turkeys

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More Data That Laundry “Pods” Carry Risk

pod photo croppedLaundry detergent pods continue to cause trouble — increasing convenience yet posing risks to young children. New data out today confirms what we’ve seen since their introduction. These cute, colorful and entirely convenient laundry packets (typically called “pods”) were introduced in the U.S. in 2012 and quickly made measuring out laundry detergent a thing of the past. Unfortunately we’ve also seen that these pods grab the attention of young children. Beautiful design gone wrong. As you’ve likely heard, or witnessed yourself, young children can be drawn to the pods (often these packets of detergent look like a preschooler’s toy or a piece of candy) and because of young children’s unique method of exploration (infants/toddlers/preschools use their mouths as much as their eyes & hands to explore) they may be at risk for injuries if the detergent pods are in arm’s reach. New research out today from Pediatrics documents an ongoing onslaught of children exposed to laundry pods, more than 17,000 children in less than two years. Some in the media have translated the volume of calls to poison control — a call every hour in this country — secondary to exposures to these packets of concentrated detergent.

Single-Dose Detergent Concerns

The first warnings about the dangers of laundry pods came out in May of 2012.  The American Association of Poison Control Centers (AAPCC) started getting calls about children getting in to the capsules and ABC news did a subsequent story warning parents about the risks. Several factors make the pods a serious risk for young children: they’re appealing to the eye (look how fun and colorful the Tide pods look in the photo above) and small in size.  They also have a thin membrane (built to dissolve quickly in the wash) and are full of highly concentrated soap. It’s unclear exactly why this concentrated liquid causing so many new symptoms (vomiting, coughing, or rarely severe breathing problems and severe symptoms like changes in level of alertness or seizures). Dr. Suzan Mazor, an emergency physician at Seattle Children’s, adds she’s seen several eye abrasions, which happen when children accidentally squirt the pod contents in their eyes. She adds, “These ultimately heal just fine but can be painful and distressing to the children and parents.” The ingestions have been serious enough at times to send children to the ICU and need mechanical ventilation. With the beautiful curiosity of a toddler coupled to the lack of judgement, you have a recipe for this “pod” problem. Here’s a look at it by the recent study numbers:

  • 17,230 – Children under the age of 6 exposed to laundry pods (between Feb. 2012 – Dec. 2013), the majority being ingestions. The AAPCC reports that 8,915 exposures have already been reported in 2014 (data through end of September, 2014)
  • 645% -The increase in exposures to laundry packets between March 2012 – April 2013
  • 74% – The percentage of children exposed to detergent packets who are under age 3 years. Clearly toddlers are the most vulnerable group when it comes to these packets of detergent
  • 80% - The percentage of ingestion for the reported cases. This translates out that 8 of 10 children who have an exposure put these pods in their mouths. About 7% of children have injuries to their eyes, and the remaining 3% are a combination of skin injuries and damage caused by inhalation into the lungs
  • #1 – #1 household product ingested in Italy. This isn’t just a US problem. In Italy, where detergent pods have been available since 2010, the product is the number one most commonly ingested household product
  • 56% – More than 1/3 of kids vomit after an ingestion. For overall exposures, 48% percent of children exposed to pods vomited, making it the most common side effect. After vomiting comes coughing  or choking (13%), eye irritation or pain (11%), drowsiness or lethargy (7%), and eye redness (6%)

pod poison timeline

What Parents Need to Know:

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Baby Talk: How Moms And Dads May Differ

baby talk photo edited

There may be a stereotype that women talk more than men; the language environment in which we’re raised, starting at day one, may have influence on this. Whether or not women are chattier than men is due largely in part to the context of the conversation. But a new study published in Pediatrics shows when it comes to parents talking to their babies, the term “Chatty Cathy” probably rings truer than “Chatty Carl.” And this has the potential to change the game with your child as they age. It’s well founded that the number of words your baby/child hears in the first few years of life has dramatic impact on their vocabulary, school success and education for a lifetime. Parent-talk has more impact on a child’s IQ and vocabulary than their education or socioeconomic status. Who we are as talkers really changes our babies’ lives.

Gender Differences In “Baby-Talk” And “Parent-Talk”

The Pediatrics study out this week evaluated the intersection of both baby-talk (comparing preterm and term baby boys and girls vocalizations for 16 hours at a time) and parent-talk (comparing Moms’ to Dads’ vocalizations to their infants) at birth, at about a month of age (based on original due date), and at 7 months of age. More than 1500 hours of recordings (derived from little devices worn on babies’ vests) were analyzed to compare family language interactions. Babies in families with a Mom and Dad at home were included (no same-sex couples). About ½ of the babies were late preemies (note: 1/4 of all the babies studied had a stay in the NICU) and 1/3 of families were raising children in a bilingual home. I found three key takeaways: Read full post »

Teal Pumpkin Owners Deserve a Treat

teal pumpkin If you see a house with a teal pumpkin in front of it when you’re out with your kids this Halloween, give that homeowner a high-five. They’re making it a point to include kids with food allergies in on the trick-or-treating fun during this candy-filled holiday.

The Seriousness Of Food Allergies

Food allergies are a serious subject. It’s estimated more than 15 million Americans (6 million of them children) are affected by them. Dealing with food allergies can mean disruption to daily life and changing the way you celebrate holidays (so many are focused on food!).  Case in point, several of the 8 most common foods & food groups that can cause serious reactions are found in Halloween candy. Think: milk, wheat, peanuts, eggs, soy and tree nuts (also fish and crustacean shellfish, but you probably don’t have to worry about the neighbors handing out fish-sticks tonight).

What’s The Deal With The Teal Pumpkins?

The Teal Pumpkin Project is a campaign started by FARE (Food Allergy Research and Education) to promote safety, community and inclusion for children with food allergies. Read full post »