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Super Basic Reminders For Summer

Summer is upon us and we all want to do our best to keep our families safe and healthy. Some of the summer reminders can seem obvious. You’ve likely even heard the reports out last week warning against using a blanket to shade a baby in a stroller (those enclosed spaces can heat up like greenhouses). Heat waves, sun, vacation, time away from routine, summer is a time of typical increasing adventure and exploration. The product of exploration are bumps and bruises and scrapes and sometimes, even burns. Quick reminders here for why to use effective prevention medicines and how. Pretty obvious advice, but here’s 3 items you should have readily available all the time: sunscreen, insect repellent and maybe even antibiotic ointment — although bandages are a start. You can reach for the ointment once you get home!

  1. Protecting Children From The Sun

    1. Use broad spectrum sunscreen that covers UVA and UVB rays with an SPF over 30. As a reminder UVA are rays that cause aging to the skin and UVB rays cause burns. Both are bad news, especially during childhood.
    2. Sunscreen isn’t the BEST protector for our skin– shade is. But being outdoors in the sunshine is the essesnce of childhood. Consider sun protective clothing like rash guards, hats and sunglasses – always better to use things that can’t be absorbed in the skin! And plan activities in direct sun to avoid the most intense sunshine of the day (between 10am and 4pm) when you can.
    3. Choose an SPF over 30 (SPF refers to the amount of protection the sunscreen provides against UVB rays), anything over that doesn’t make much difference. More than what kind of sunscreen is how you use it. Apply 20 minutes prior to sun and every 1-2 hours while in the water or high activity.
    4. Look for sunscreens that include zinc or titanium and avobenzone — these are physical barriers rather than chemical ones — that are less likely to be absorbed in the skin.
  2. Preventing Insect Bites

    1. Summer brings out bugs including mosquitoes, wasps and flies. No question we’ve all been thinking more about mosquitoes than ever before with Zika in the news. Here’s a clear and easy-to-read resource on what repellents to use if you live in an area with Zika transmission.
    2. Children should wear long-sleeved shirts and long pants if in areas with lots of insects as that will help protect from bites more than anything else. On areas exposed outside the clothes, you can use repellent.
    3. Use Environmental Protection Agency repellents. All EPA-registered insect repellents are evaluated for safety and effectiveness.Reapply insect repellent every few hours as directed on the bottle
    4. Do not spray repellent on the skin under clothing and don’t use products that are a sunscreen and insect repellent mixed together — dosing intervals are different and areas they are needed often are, too. If you need both products, apply sunscreen first and then insect repellent over it.
    5. It is safe to use EPA–registered insect repellents if pregnant and/or nursing!

Bug repellent for babies and children:

    1. Do not use insect repellent on babies younger than 2 months of age (protect them with clothing or avoid the deep woods!).
    2. Dress your child in clothing that covers arms and legs, especially at times when insects love to irritate (evening hours) and use netting to avoid bites when possible for sleeping or in a stroller.
    3. Do not apply insect repellent onto a child’s hands, eyes, mouth, and cut or irritated skin.
    4. Spray insect repellent onto your hands first and then apply to a child’s face — don’t ever spray directly on a child’s face.

3. Caring For Cuts And Scrapes

    1. Clean cuts and scrapes immediately with water. Rather than soaking, do your best to keep your child still (distraction, think distraction!) while you let water run over and through a cut or abrasion.
    2. There’s no need to use hydrogen peroxide, iodine or an iodine-containing cleanser, which can be irritating to tissue already injured. Water is a safer bet for cleaning out the wound. Tap water is safe (you don’t need sterile water!) and the pressure from a faucet can sometimes really help irrigate a cut or abrasion very well. Consider irrigating the cut or scrape for a number of minutes if you can get your child to cooperate.
    3. After the cut/scrape is clean, cover up with topical antibiotic ointment and repeat the application of the ointment about 2 or 3 times daily with a loose bandage for a few days.
    4. Also: a reminder that the scars created from injuries are healing skin and more sensitive to the darkening in the sun. If you want to improve the way a scar heals, work to keep it out of the sun where UVA radiation hits. Best to keep healing scars out of the sun for the first year to prevent long-lasting scar formation. Hats (if scars on the face) and sunscreen go a long way in year one to improve wound healing!

 

5-13 know your OTCs

This post was written in partnership with KnowYourOTCs.org. In exchange for our ongoing partnership helping families understand how to use OTC (over-the-counter) meds safely they have made a contribution to Digital Health at Seattle Children’s for our work in innovation. I adore the OTC Safety tagline, “Treat yourself and your family with care all year long.” Follow @KnowYourOTCs  #KnowYourOTCs for more info on health and wellness.

The Penis Podcast

This is a podcast episode about one thing…the penis. Guest on the podcast Dr. Rob Lehman, the co-founder of Great Conversations and leader of the For Boys Only classes at Seattle Children’s hospital joins me to discuss what’s “normal”  and all the examples of “normal but different.” We dive into what parents need to know about care of uncircumcised/circumcised penis, thoughts on erections (they begin in utero!), boys with their hands down their pants, appropriate touching and ways to help boys deal with a culture focus on size. I often say that when I’m in clinic, I get the most attention from parents when I’m talking to them about their child’s genitals and many families are nervous to ask about concerns. It’s something everyone wants to know about, but a lot of people are shy or embarrassed to bring it up — do hope this podcast helps. Don’t hesitate to ask concerns you have from the very beginning — most often you’ll likely get A LOT of reassurance.

I am a mom to two boys and like every other mom I know was surprised from the beginning with the amount of “hands down the pants” moments that start even in infancy. A treat to have Dr. Lehman provides great tips to normalize and set appropriate boundaries for touching and clear up ideas for better understandings of normal development.

Possible Allergy Protection From Thumb-Sucking And Nail-Biting

We do have to pick our battles at home. As a pediatrician I’ve never gotten too excited about advising parents to spend a lot of energy trying to rid your child of the thumb-sucking or nail biting habit. In general parents aren’t successful — peers are. Often it’s when friends or peers bring the habits up that children are motivated to stop. We can help support them by reminding them when hands are in their mouth or even having them place socks on their hands while watching television as that’s a common time for the behavior. Although many parents worry about their children sucking their thumbs and fingers, it’s a common habit, with some studies finding almost 25% of children do. Much time is spent thinking about ways to help our children quit, worrying whether germs on their hands will translate to illness and hoping it doesn’t affect their teeth. A new study today this week in Pediatrics highlights perhaps a positive effect of thumb sucking. It’s worth a mention.

Allergy Protection From Thumb-Sucking And Nail-Biting?

The study evaluated children between age 5 and 11 and their later diagnoses of hay fever, allergy skin prick testing and asthma. The premise of the study builds off the somewhat controversial concept of the hygiene hypothesis. The basic premise of the hypothesis is that germ exposure early in life can contribute to how our immune system responds as we grow and develop. We may build up tolerances and immunity that conform us into less allergic people if we have different bacteria and germs around. Basically, living in a sterile environment may not be “safer” as some believe lots of dirt, bacteria, and germs early and maybe not so many sensitivities later…

In the past theories for the hygiene hypothesis have supported a decrease risk of asthma (dirt and germs coming in from and on pets may decrease allergies or asthma later) and a small 2013 study a couple years back found those children who had parents who “cleaned” the pacifier with their own mouth may be less likely to develop allergies (theory was the bacteria transfer from mom/dad’s spit to baby changed their pattern of exposure to bacteria and possibly a tendency away from allergies and asthma later). So some researchers looked a the effects of children who have their hands in their mouths more to see if any protection comes of it — they evaluated data spanning from childhood to adulthood. Read full post »

Getting Your Children To Eat Vegetables

girl and vegetablesThis post is written in partnership with a Seattle Children’s parent, Beverly Emerson, who wanted to give back to our efforts. She’s a mom, food marketing, and R& D executive who has been thinking about how to get healthy food choices out to children for over 2 decades.

My two boys eat veggies pretty well. But that’s like saying Tuesdays are always good days. Sometimes it’s easy, sometimes it isn’t, of course because I’m raising humans on the planet and every day is something a little new. I think the reminders from Beverly may trigger some change in us. Beverly answers this:

“How can I get my child to eat two cups of vegetables a day?”

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

According to government recommendations, our kids need between 1 and 3 cups per day depending on their age. Does it feel like that is a dream? Like one of those stretch-goals that will never be hit? There are some tricks to make it easier, and none of them involve hiding vegetables, but actually encourage kids to embrace the fresh flavors and textures of vegetables in their natural state. Yes, it really is possible!

Here are three keys in getting kids to eat (and LIKE) their vegetables:

1. Start Early & Keep Going

Research shows that if a pregnant woman eats vegetables regularly in pregnancy, her infant will be more accepting of the flavors as well during the transition from milk-based diet to introduction of complementary foods. But acceptance begins to decrease as kids move into toddlerhood and preschool years. Humans are biologically wired to dislike bitter foods, and so we need to work at continuously exposing our children to the flavors.  Susan B. Roberts, a Tufts University nutritionist and co-author of the book “Feeding Your Child for Lifelong Health,” suggests putting a food on the table at least 15 times to see if a child will accept it. At our house, we use a “thank you bite” model. We insist that our children have one tiny “thank you” bite of a new food simply to expose them. I know that she won’t like it the first time, and maybe not the fifth time. But suddenly, she’s reaching for a full helping! Until that happens, you can prepare dishes that YOU will eat so you don’t feel like you’re wasting food. Read full post »

No Allergy Medication For Kids Under 2

Recent heartbreaking news reported about a baby who died due to a medication overdose by his babysitter/nanny has me reeling. And although this is a tragic, outlier type event, it can awaken us to everyday ways to improve our children’s safety with over-the-counter medicines.

The tragic story: a fussy baby was mistakenly given allergy medicine to calm him down and get him to sleep after a day of crankiness. Allegedly, the babysitter unfortunately gave an adult dose of an allergy medication. Sometimes medicine side effects can impair or stop breathing. Especially at elevated doses. The lesson from this horrific story is threefold:

  1. Medicines, even those sold over-the-counter have real effects and demand our serious attention. We need to make sure medication dose is the right one. The story of this tragedy is a nightmare to even think on, but it can remind us to make sure we are always a part of every dose our children are given of ANYTHING. Every parent should know it’s not “over-the-top” to have any caregiver review medication administration with you every time for safety.
  2. Kid medicines for kids not for the adults who care for them. Medicines should be used only when necessary and not for adult convenience. Fussiness in babies is exhausting for parents and caregivers. Read about fussiness and the period of PURPLE crying here especially in early infancy that’s considered normal. We need familial and community support for parents exhausted and overwhelmed by fussy babies. And we need back-up plans for respite for caregivers to babies, but we also need to remember that medicines given to a child for the benefit of a parent just isn’t the reason they were designed or licensed. As a pediatrician I just can’t recommend using allergy medicine to knock your kid out. Just doesn’t make sense. Proper and appropriate medication dosing is paramount but using medicines only when necessary is where you have to begin.
  3. Allergy medicines, even over-the-counter medicines are not recommended for use in babies under age 2 years.

Medication Rules For Parents Everywhere

Read full post »

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. Read full post »

Parent Sleep Matters

Podcast also available in:

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