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No Nasal Flu Vaccine This Year: Flu Shot For All Over 6 Months

 

Summer vacation has just started and it feels like the mild 2015-2016 flu season just ended. Here we are already hearing about new recommendations for the 2016-2017 season. Big news in the media today about flu vaccine: recommendations to only offer the shot (and no nasal flu spray) to improve children’s and public protection from the vaccine. Hundreds of children in the US die each year from influenza. We know the best way to protect against complications from influenza is to have families immunized. Flu vaccine is an every-year, essential vaccine as the strains included in the vaccine shift each year based on the types of flu predicted to spread across North America.

Recommendations For Pediatricians And Family Practitioners: Only Flu Shot For Families

Yesterday The American Academy of Pediatrics (AAP) endorsed the Advisory Committee on Immunization Practices (ACIP) recommendations to AVOID use of flu mist vaccine this coming flu season.  The Centers for Disease Control (CDC) will review the recommendations shortly; if CDC accepts the recommendation it will become official US policy.

We all want choice with vaccines and the nasal spray was a great option and a safe one. It was particularly effective during the 2009 H1N1 pandemic flu season and has been safe and very well received (no poke!) by families ever since for children over the age of 2. However, data from the past three years have found that it has been less effective in protecting children and their families from the most common strains of flu circulating (more below).

The nasal flu spray vaccine is still licensed and still safe. Because of recent data, this year to improve protection, ACIP is recommending only using the injected flu shot because it is far more effective at protecting against the strains of flu expected to arrive in the US.

That means a needle and quick poke for our kids. I talked to the TODAY Show about the recommendations this morning. I also talked with influenza and vaccine experts.

This decision was made to protect children against flu because no one wants to give a vaccine that is not as good as another vaccine. There are no safety concerns-just effectiveness concerns.” ~Janet Englund, Seattle Children’s Hospital Infectious Disease expert

Flu vaccines are different from most other vaccines because influenza virus shifts and drifts from one strain to the next each year. The vaccine is prepared annually to improve the likelihood of it working to protect the type of flu that eventually arrives and causes infection. Because it’s prepared annually and the strains shift and change, flu vaccine effectiveness varies from year to year. While vaccines aren’t 100% effective in all who get them (influenza vaccine typically has a vaccine effectiveness between 50 and 60%) and the science behind them is always changing, they are our best bet at protection against influenza.

What To Know About Nasal Flu Vaccine

  • Accounts for roughly 1/3 of all flu vaccines given to children in recent years.
  • Uses a live but weakened strains of flu virus to stimulate the immune system to protect.
  • Effectiveness has varied. Last year for example, the 2015-2016 nasal flu vaccine is estimated to have been only 3% effective protecting against any strain of flu (versus an estimated 63% vaccine effectiveness for the injected flu shot).

Influenza and complications from the infection are hardest on infants and young children, pregnant women, the elderly and those with underlying health conditions that make it harder to deal with the infection (diabetes, asthma, neurologic conditions and problems with the immune system). Depending on the season, influenza causes anywhere between 4,000 and 50,000 deaths a year in the US. Thankfully, each year only a couple hundred of those deaths are children. The flu vaccine is recommended for ALL infants and children ages 6 months & up to protect them from the infection, their community, and severe complications.

Talking To Kids About Shots

  • Don’t promise no-needle visits! Pediatricians will also work hard from today forward to not promise the opportunity to always offer a nasal flu vaccine option. We’ll likely get to offer it in upcoming seasons, but this year, we’re back to the shot.
  • Remember that needle phobia is real. Treat the anxiety with respect and work with your pediatrician and care team to minimize anxiety with shots.
  • Teach the “cough trick”. It’s a distraction technique (a child or teen coughs, just as the needle goes in). Ask your child to cough as the shot is being administered and studies have shown that kids feel less pain.
  • Children watch their parent’s experience with shots. Know that your reactions and comments of calm and trust go a long way. Here are some additional tips to help get your children through shots.
  • Treats (ice cream, special snack, time at a special park or restaurant) after shot visits are AWESOME incentives!

Parent Sleep Matters

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Sleep is tied to our outlook, our mood, our performance, our safety, and our sense of stress/anxiety. We’re nicer people after we sleep and I often say that after a good night of sleep I get to be more of the mom & parent I earnestly want to be. Sleep is magical that way.

Thing is, sleep has a profound effect on our perspectives and attitudes about life. In fact research has found that sleep loss causes bias in our memory — the less sleep we have the more we focus on negative events and the more our memory builds space for memories of the negative details in our life. In addition, the less we sleep, the less we think our children do. Huge opportunity to improve things when we not only prioritize our children’s sleep but our own.

For more listen to the podcast and read this and this where I talk with sleep expert, Dr. Maida Chen and discuss 5 ways to improve our own sleep and our family’s wellbeing.

Each Hour Matters: How Much Children Should Sleep

The American Academy of Pediatrics (AAP) has issued a Statement of Endorsement supporting the American Academy of Sleep Medicine (AASM) guidelines outlining recommended sleep duration for children from infants to teens. Not exactly “news” but great reminders because of their import. The statement is pretty clear about it’s importance and perhaps this is why it will make headlines:

Sleeping the number of recommended hours on a regular basis is associated with better health outcomes
including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and
mental and physical health. ~Journal of Clinical Sleep Medicine

Melatonin Boy SleepingHard to beat the benefit. Nothing quite as powerful as this besides, in my mind, a feeling of belonging and getting outside and moving/exercising every day! I’m in full support of the guidelines. Bottom line, even with the phase shifting we’re doing with summer because of the glorious evening light we get, and with release of the noose of tight schedules during the school year, there’s no question each night of sleep is something worth preserving and protecting. If we think about sleep like we think about what we feed our families and how much we move and exercise, we’ll be keeping our wellness in check.

Little deficiencies in sleep matter. Sure, if you’re a great sleeper and get the recommended amounts of sleep nearly every night, one night here and there with a bit less sleep is tolerable. But children who consistently don’t get recommended sleep accumulate sleep deficiencies into an earnest sleep DEBT. That sleep debt has consequences like decreased attention, increased risk for challenges with weight, dangerous driving, bad mood (YUCK!), injuries, hypertension, diabetes and decreased performance at school. In teens insufficient sleep is associated with increased risk of suicidal thoughts, suicide attempts and self-harm. This is all real deal, powerful and important stuff. The National Sleep Foundation has found that 85% of teens don’t get adequate sleep leading researchers to call this The Great Sleep Recession. Badness for all of us. Knowing bad sleep habits can start early, we can address this actively and consistently.

Sleep Recommendations For Children, Even In Summer

For optimal health, children should keep a consistent bedtime — helps with school days, attention and actually getting the sleep they need! Even if you shift bedtimes to later times this summer (Yeah!) keep thinking on these goals in hours.

sleep needed by age

In addition to these recommendations, the American Academy of Pediatrics suggests that all screens be turned off somewhere between 30 minutes and 1 to 2 hours before bedtime so as not to interfere with falling asleep. Data has found small screens (smartphones) are more disruptive to sleep that even TVs. And another thing pediatricians recommend (because we have the data to back it up) is that parents make sure no TV, computers, tablets or other screens be allowed in children’s bedrooms.

For infants and young children, establishing a bedtime routine is important to ensuring children get adequate sleep each night. Even if it’s about to shift, keeping it consistent from one night to the next can be the magic stuff of good dreams.

Teen Vaping Leads To Cigarette Use


Big news published today in Pediatrics; a new study reports that adolescents who vape are 6 TIMES more likely to smoke cigarettes in early adulthood. Researchers studied 11th and 12th graders during the transition from being US minors to legal adults when they have the right to buy traditional cigarettes (age 18 years) to see the effect using e-cigs had on smoking traditional, combustible tobacco cigarettes. It’s known that if you’re friends use e-cigs you’re more likely to use and it’s known that rates of e-cig experimentation are on a rocket ride for teens across the US. Because we know that more than 80% of all adult smokers begin smoking before the age of 18; and more than 90% do so before leaving their teens, when and why people get addicted to nicotine matters.

Over the last decade there has been great progress in helping teens stay away from tobacco cigarettes but the new vaping trend, e-cigs, hookahs, and chew-able tobacco is unfortunately changing the game and changing risk. Last week the CDC published new data,”Cigarette smoking among high school students dropped to the lowest levels since the National Youth Risk Behavior Survey (YRBS) began in 1991, but the use of electronic vapor products, including e-cigarettes, among students poses new challenges according to the 2015 survey results.” Read full post »

Seattle Mama Doc Podcast Is Live

Audio is having a moment and I’m hooked. I am so thrilled to announce the launch of my Seattle Mama Doc podcast! It’s a weekly, quick, 5-15 minute show to help guide you through the joys and the complications of parenting. I’ll share what I’ve learned throughout my career in pediatrics and years of parenting my own 2 children, but also really hope to get super smart people to share what they know out to the world! The podcasts will air each week and will include interviews with pediatric experts, researchers, and peers across the country who are committed to preventing illness and injury while raising children — but this will also be a show sharing wisdom into how to enjoy the immense and privileged task of raising our babies into adults. The goal here is to breakdown all the guilt we have, doubts we share, and give us a boost in knowing what we’re doing well. Parenting is high-stakes but we really do have this.

You can listen to a couple of the first few episodes below and you can download episodes on SoundCloud, iTunesGoogle Play Music & Stitcher. Please subscribe and let me know what you think!

I recorded several episodes on sleep with my good friend and the Director of the Seattle Children’s Pediatric Sleep Disorders Center, Dr. Maida Chen. She’s a mom to 3, pediatric pulmonologist and sleep science guru. She’s also just uber-articulate. Here’s a blog post we did together a few years about with more on why and when children dream.  More podcasts arriving weekly on Tuesdays.

Maida Recording

Self-care And Parenting, Sleep And Loneliness

My passion in work and the focus of my career is centered around improving the health and well-being of children. It always will be. I can get SO wrapped up in the opportunities to leverage every tool I’ve got to clarify, learn, relieve suffering, and contribute to pediatric health. I feel lucky to have the tools I do to translate/partner with patients and families and I feel humbled by the ongoing challenges in reducing pediatric illness and injury…earnestly it can leave me feeling very obliged to do more and more and more. There is just so much we can do to leave this planet better than how we found it. Most of us feel this way, of course. One of the thrills in working in a clinic and a hospital, a TV news station, and online with all of you is that I am bolstered and surrounded by cohorts of people who invest huge amounts of time in improving the lives of others.

Engagement In Parenting, Work, And Self Care

Many of us feel deeply engaged in raising our children while also feeling wholly committed to improving our community as we slide into these years where we’re really ready. We have completed our education, we’re more senior in our roles at work, and we’re now trusted by others to contribute. In this privilege of simply being engaged in these ways we can sometimes over-focus on being productive, vigilant  and present in our work while also being loyal friends, parents and partners. We do this to the point that we earnestly de-prioritize ourselves. Some people can juggle all of these investments elegantly. Most of us are still a work in progress.

There’s a lot out there telling us how to do this being alive thing better; the self-help sections of the internet are pretty heavy up there in the clouds. I don’t hold a singular, gold nugget of data in my mind that says when we care for ourselves data proves our children are healthier, happier. But I know it like I know the hue of blue in the sky.

I like this Atlantic piece, The Internet Wants To Help You Take Care of Yourself and if you’re looking for content on self-care, check out these TED talks, too (if you haven’t yet seen Brown’s talk on the power of vulnerability cancel the rest of your day if need be to find the 20 minutes to watch it). When thinking about self-care I don’t just think about vitamin D and exercise, sleep and vegetables. I think about the foundations of our belonging and our connection to others. Amid all the people we’re supporting, all the work, all the love of our children and families and all of our activities, do we feel we belong? Is it possible amid all these people, these tasks and responsibilities, and all this love that we might feel a bit alone?

The first TED talk in that self-care list up there grabs my attention like an alarm when Guy Winch speaks on loneliness:

Loneliness creates a deep psychological wound, one that distorts our perceptions and scrambles our thinking. It makes us believe that those around us care much less than they actually do. It makes us really afraid to reach out because why set yourself up for rejection and heartache when your heart is already aching more than you can stand.

Of course one thing that seems to ALWAYS help when overwhelmed is sleep. I often say that I’m a better parent and simply more the person I want to be everywhere when I’ve prioritized sleep for myself and for my babies. Data shows we simply are more level and more positive in our perspectives when we’ve slept. We’re safer drivers, we’re more focused at work or school. We all hear this and we all know this on some level…..that caring for ourselves is the prerequisite to caring for others. We make less mistakes. But in the midst of all of our hectic sandwich generation schedules, it’s easy to pay lip service to self-care and continue to motor on, focusing on delivering care for others. And THIS: self-care can sound fluffy and self-centered. People throw around the word “deserve” a lot. As I get older I see self-care as elemental to a meaningful and connected life. And I certainly see it as a huge challenge. When babies come into our heart it’s hard make sense of all of the marriages we have (to our families, to our work and advocacy, and to ourselves). Read full post »

Cry-It-Out Improves Sleep And Reduces Mom Stress

Parents debating sleep training can rest (literally and figuratively) easy. New data out today in Pediatrics found that letting babies cry-it-out (CIO) or self-soothe does not increase signs of stress compared with babies who don’t. The study out of Australia tested two sleep training methods: “graduated extinction” (parents leave and return at increasing intervals of time, AKA one version of CIO) and “bedtime fading” where parents shifted bedtimes based on how long it took babies and young toddlers to fall asleep. The groups of babies and their moms were compared to those in a control group of babies and moms/dads who received only sleep education. The group in total was small, some 43 infants spanning 6 months to 16 months randomized into the three groups. I was fortunate to be able to discuss the study and what it means for parents on The TODAY Show this morning. In addition, I chatted about the study design, findings, and implications with Dr. Maida Chen, the Director of the Seattle Children’s Sleep Center. We were both excited as the study evaluated baby’s sleep, tracked their sleep with actigraphs (movement monitors), evaluated sleep by parental sleep diaries, measured morning and afternoon cortisol levels (a stress hormone) and tracked time to fall asleep, number of nighttime awakenings, total sleep time, mom’s stress, mom’s mood and long-term bonding. Even though the study may have some limitations (very small sample size and parents self-selected to the study with sleep concerns therefore it may be non-representative of parents at large who AREN’T worried about sleep) the randomization to the three groups and the measures studied boost the exciting results.

6 Take-Aways From The Baby Sleep Study

Read full post »

All Dogs Bite

Baby and DogTo the owner of the two black poodles who bit my husband last Saturday early morning while running at Magnuson park, this is for you. But also for all of us as a reminder to something I know both from the medical data and from life experience too well: all dogs bite. Even when an owner assures you they don’t or won’t.

For many, having a dog isn’t just having a pet, they are clearly part of our families. We invest, we believe, we protect, and we stand behind them. I’ve written about the love my family has for our sweet dog Luna who passed away a year ago this month. Many of us love our dogs for many reasons, and they even have been shown to boost humans’ health in psychosocial but also fundamental ways. A study published in JAMA Pediatrics back in 2015 found that exposure to dogs during a baby’s first year was linked to a 13% lower risk of asthma in school age children. Having a dog also helps teach children responsibility and can boost their self-esteem. But we do have to remember, dogs are animals and they act like it when provoked, frightened or activated. All dogs will bite given the right circumstance. Coincidental to a dog bite in my family, this week is National Dog Bite Prevention Week and I’m sharing some tips from the American Academy of Pediatrics (AAP) for keeping your family and children safe from dog bites.

Each year, more than 4.5 million people in the U.S. are bitten by dogs, and of the 800,000 Americans who receive medical attention for dog bites, at least half are children. Almost 1 in 5 people bitten by dogs require medical attention. Children are, by far, the most common victims of dog bites and are far more likely to be severely injured. Most dog bites affecting young children occur during everyday activities and while interacting with familiar dogs. Remember, as most dog bites involve familiar animals, prevention starts in your home.

Some species of dogs are more likely to bite unprovoked or when startled (Pit Bulls, Rotweillers, German Shepards, Huskies, etc). But this post really is intended to remind us that even when a sweet lamb-like doggy of ANY breed gets frightened or provoked by an unsuspecting human, toddler or child, they may bite without even THINKING of it. Some of this is just animal instinct.

7 Ways To Help Prevent Dog Bites:

Read full post »

Moms, Benefit of Part-time Work, And Breastfeeding

pumpingA new study out confirms something that almost every working mom and dad already suspected — it can be a challenge to maintain breastfeeding goals when you return to work after only a few months with your newborn, especially when asked to return to working full time. The study out this week found that moms who worked about 1/2 time (19 hours or less) were able to continue breastfeeding similarly to those women who didn’t work.

Logical: the more hours a new mom works, the tougher it is for her to continue breast feeding. The amount of time we work may be more influential than the timing of our return to work. In this study, conducted in Australia, women who worked 19 or less hours in a week were much more likely to maintain breast feeding until their baby turned 6 months old, compared to moms who had returned to full-time employment. Additionally, women who work 19 hours or less only faced a 10% chance that they quit breast feeding altogether by the time their baby turned 6 months old. Your level of work place seniority will also affect your ability to continue breast feeding at 6 months, meaning those in managerial-type roles will have more success. Other factors that made it easier? Unsurprising it’s being older, higher education, better physical and mental health and being self-employed.

If we want moms to be successful with the recommended breastfeeding guidelines through infancy we should think on how we prime them for success. And how we support them.

It’s inconvenient but potentially important to acknowledge that it’s simply harder for moms to go back to the workforce, especially those who breastfeed, than it is for dads to newborns. In the first few months of life, the time it takes to nurse a baby is equivalent to a 8-9 hour work day for most women. Most babies will drain a breast in about 12-15 minutes if they are eager and actively feeding but babies often stay on the breast for up to 20 minutes or even 30 minutes at a time. Therefore, if you sit down, feed your baby on the right, feed you baby on the left, burp the baby and then change the inevitable diaper:  poof, one hour.  And, most newborns feed up to 8-10 times daily. 1+1+1+1+1+1+1+1+1. Math is easy when you do it this way.  Breastfeeding alone is a full time job for the first few months. The time spent with a baby nursing diminishes as the months unfold but it can still be a significant number of hours spent every day.

The take home for me here is that we may be more successful, culturally, supporting moms to return to work during the 1st 6 months after a baby is born if we give them options for part-time work. Especially if breastfeeding past 6 months is a goal. Read full post »

Swaddling On Side And Tummy May Increase Risk Of SIDS

SwaddleBoth of my babies loved to be swaddled. It helped them calm down and I always experienced them happier and easier to console while snuggled & bundled. My experience isn’t unusual. Research in the past has found that swaddling rates are increasing and it can help newborns with sleep awakenings while also creating a slight reduction in crying in babies under 2 months, and may help babies have more quiet sleep. So the new study out today in Pediatrics evaluating the relationship between swaddling and Sudden Infant Death Syndrome (SIDS) therefore caught my attention. The study pooled research and data from 4 previously published studies to look at risk for babies who are swaddled. Although the data and findings in this new study don’t prove relationships, it does evaluate risks for babies who are swaddled versus risks for babies who were not.

Pediatrics Study Finds Swaddling On Side And Stomach Increases SIDS Risk 

  • Meta-analysis of 4 studies looking at relationship of swaddling with SIDS risk that spans data from babies in 2 decades and 3 diverse areas of the world: United Kingdom, Australia, and United States (Chicago).
  • Conclusion: Current pediatric advice to avoid tummy and side positions for sleep especially applies to infants who are swaddled.
  • Swaddling risk increased with age in infants. Infants who were swaddled over the age of 6 months had a double increased risk of SIDS.
  • Swaddling risk varied with position of sleeping. The risk was highest for babies swaddled and put on their tummy while also higher for babies put on their side and then those swaddled and put on their back compared with babies not swaddled.

Read full post »