Author Archive

Pale4Prom: Indoor Tanning And A Hashtag

Image courtesy: @mdub686 (Original source found here)

Image courtesy: Melissa Walling (Original source found here)

It’s prom season and we all know it’s the season where teens feel pressure (and sometimes giddy delight) to prepare to look entirely fabulous for the night. Full of pressure or full of glee, this is without a doubt the time of year when teens I see in clinic talk most about tanning.

A 2014 JAMA study found 19% of teens (under the age of 19) have used a tanning bed, with 18% of them stating that they’ve used one in the last year. That’s in every teenagers still feeling that “bronzed is better” and a thing of youthful beauty regardless of the known consequences. We have to do a better job, both as parents and as doctors and health educators, explaining the unnecessary risks teens take on when changing the color of their skin. Recently, a hashtag surfaced on social media encouraging teens to be “#pale4prom.” Thoughtful critics have raised concerns about the racial implications this campaign could ignite, I do feel this campaign can do good for those teens exploring indoor tanning. We all want to feel beautiful in skin that is protected from the sun. In my mind, the easiest word to market the idea of skin without sun is pale. I’ve urged teens to enjoy the beauty of pale skin (sometimes unsuccessfully, in clinic and in my personal life) and hope the shift from bronze to pale is a trend that continues to grow as years unfold. There’s no question we can do a better job valuing what beautiful skin really is. 5 reasons why: Read full post »

Maybe This: “I Wish My Mommy And Daddy Knew”

I’ve watchedWish Mommy Knew the viral #Iwishmyteacherknew campaign with earnest intrigue. If you haven’t read about it or followed along this past week, know that the campaign started when Denver 3rd-grade teacher, Kyle Schwartz, honed listening and asked students directly what they wished she knew about them. They wrote out responses and she started to post them on social media with the above hashtag when she realized the goldmine she’d discovered. In my mind this has captured the nation’s attention because of the empathy we feel reading about perceived (and real) short-comings in children’s lives and because the raw power that third-grade words provide in understanding inequities for US children. As a previous inner-city middle and junior high school teacher I think this teacher’s tactic and insight-seeking is profound. Reminds me so much of Momastery’s post last year about a teacher who finished each week in the classroom asking children to write down who they’d like to sit next to in school. She asked not to stir up the seating chart, but to determine immediately which children were being left out. She honed listening to facilitate and build connection for children who may be silently struggling.

I’ve been snagged a number of times this past week thinking about the #Iwishmyteacherknew, thinking on asking my own children the same question. What do they wish I knew? Would they journal something they wouldn’t say? Would invited words, written out in silence on paper, protect our children from the inevitable judgment/worry/concern/disorganization they may feel in answering a question like this in real-time when something dear is at stake? Something as dear as the bond they feel?

I surveyed a couple of parents and friends in the last few days if I should do it and if they would ask their own children. Most parents I discussed it with had a similar feeling to my own. Immediately our faces wince. We cringe when we think of it, unsure we’re ready to face the reality of where our children may feel we’ve fallen short in listening or unsure we’re steady enough to not just tolerate what we hear but also change things in life to improve the circumstances.

Would you do it? You ready to ask your school-age children or even your teen what they wish you knew about them and allow them time and space and paper to write it down?

Pill Swallowing Sooner Than You Think

4-20 pill tongueAs adults, many of us take or swallow pills out of necessity to manage or prevent a chronic health condition. From a vitamin to even a life-sustaining medicine, you probably don’t hesitate or panic when swallowing the pill, even the biggies. But knowing how to swallow medicine isn’t something that just happens, often it’s a learned skill that may vary widely in regards to timing. During my education I was trained to think that once children hit double digits (age 10 years) it’s appropriate to think of them as “capable” of swallowing pills. But new findings published in Pediatrics cite research demonstrating that learning how to swallow a pill may be easier for younger children to master before they’re facing anxiety that can come from having to swallow something whole. Bottom line in the research: although many children struggle with swallowing pills, five studies reviewed find various techniques to support children with pills really do work! Mastery is possible here, but anxiousness about pill-taking spans childhood for some. Unease about pill taking can be a real barrier in treatment adherence both for children and teens with chronic health conditions.

Pill-swallowing may not come “naturally” to your child. A 2008 survey found more than 50% of children, by parental report (children from birth to age 26), were unable to swallow a standard size pill at some point. This complexity in pill-swallowing or refusal of medicines can be a once-in-a-while battle or a daily barrier at home. Many important medications are taken orally and the illness experience for parent and child is much more stressful when this challenge pops up.

Interventions Do Help

Five interventions were reviewed in the research and all of them proved beneficial for children: Read full post »

Mindfulness In A High Stakes Job

4-17 mexicoWe’re just back this week from a vacation with our children. The 6 days we had together, the variant pace at which we were able to live for the week, and the challenges that bubbled up offered some reminders but also some fears for me. We’re always on quicksand while raising children. Parenting demands exceptional grace but also exquisite flexibility and immediate rapid-fire insight. Our job descriptions, as parents, are ever-evolving; we’re asked to shift what we know as we step from stone to stone and into something new as quickly as our children do. The minute we feel we’ve figured something out — whammo — a new challenge arises we never even thought to consider.

The stakes are high. Of anything that unites us all as parents it’s knowing that truth. Along the way we will fail, fail, fail and have wondrous little successes too, thank goodness. Yet the tasks involved in raising a child will never look just like they did last month. I loved a This American Life (#553) segment I listened to this past week where a mom discussed some of the complexities in the requisite shifts she faced raising a principled little 7 year-old boy named Elias who is vegetarian and very emotional about animal-eaters. He finds himself living amid a family who explores an occasional pepperoni pizza and turkey sandwich. As his parents upend the way they eat at home (they end up banning all meat at home because of their son’s feelings) narrator Ira Glass states,

“If you’re hearing all this and you are feeling judgey about these parents and I know you are, because that is a national pastime — judging other people’s parenting – I just want to say I totally felt that way until I heard Elias….just like she says. Hearing Elias made me realize ‘oh, right, she actually is in a really tough situation. Where she has these two kids and those both have really strong feelings about this and she doesn’t want to crush either one of them.’”

Judging others’ parenting is often just the malaise of parental insecurity. We all have our own shakiness at times, especially as we’re asked to rise to new heights each new day. It’s of course so easy to judge, and so much harder to elevate and emulate others. In my mind, the best we can do while parenting (failing or succeeding) is tease out others’ profound moments. Learn from them but also copy and try those things out ourselves and see how we can make them work in our own lives. Read full post »

When Recess Is The Favorite Subject

4-13 recessMost parents cringe in the office or at the park when their child reports to me that recess is their favorite subject. Thing is, I think they may want to celebrate. Some of our best thinking, our most inventive or creative solution generation, happens when moving around outside. Research has validated the merits of play and movement for learning during the past decade and educators and pediatricians have risen up to exalt the time our children spend twirling around between math and social studies. It’s time to get excited about recess before we lose focus that it’s not just healthy weight we’re fighting for — this is about promoting healthy minds, bountiful creativity, and skills for connection too.

Tips To Advocate For Protected Recess & Play

  • White Space: I think of recess as a part of the white space we serve up for our children in life. That time and space to dream, elaborate, and enjoy whimsy in our minds. We cannot forget the value that reflection and exercise has on the creative process. When talking with your school educators and when designing a day with children make sure there are “pockets of stillness” (see #4 here on Brain Pickers) but also white space for loud iteration. No question in my mind that movement aids learning. Think of all the things you discover while going for a walk, a run or even the epiphanies you discover while taking a shower.
  • Join Forces: PTA/Lunch & Recess Matter Group. Band together with like-minded parents and educators. In the Puget Sound area, for example, only the Tacoma School District mandates a certain amount of time for recess and play. Join forces with Lunch & Recess Matter Group to re-prioritize this play and learning if it’s not happening at your school.
  • Social and emotional well-being matter (more on this later this week): Although we all want our children to have an education that affords endless opportunity (we want our children ready to be brain surgeons, artists, stay at home parents, educators, or entrepreneurs), we must remember how the time spent while playing and relating with peers may be most essential to creating pluripotent opportunity.

 Data On Recess And Play

Read full post »

How To Safely Dispose Medications & One Thing NOT To Throw Away

3-27 OTC medicine disposal

Getting rid of unused medications is something all of us do at some point or another. How to do it safely, though, is another story. Typical parenting moment: you reach into the medicine cabinet for vitamins or you’re hunting for ibuprofen or acetaminophen for a child’s fever and you grab a bottle of medication that, on closer examination, has an expiration date from several years ago. You realize you won’t use it. Before you toss that bottle in the trash, there are some safety precautions you can take to ensure the medication doesn’t end up in your sewer water, water source, or worse, in the hands of a curious toddler looking for treasure in the garbage can. The FDA provides detailed instructions on how to properly dispose of medications, but for the busy parent in all of us, there are three key takeaways:

1. MIX the medicines with things that bind

Take a bag of coffee grounds or kitty litter and dump the medication into it. The medication will bind with grounds or litter and be less likely to leak or spill out of the garbage once disposed. This method also discourages those curious little fingers (and hungry pets) from ingesting or getting into the medication!

2. SEAL the mixture in a container

Make sure your kitty litter/medication mixture is properly sealed in a sealed plastic sandwich bag or a take-out food container with a sealed lid before throwing in the trash.

3. THROW the mixture away

Now you’re okay to throw the medication (and binder) into the trash safely. Don’t flush medications in the toilet or dump them into a body of water of any kind.

The One Thing You Shouldn’t Toss:

Read full post »

Balance And Bad Parenting, Maybe

3-27 jumpingLast night four Swansons sat in row 6 of a little commuter airplane on the way to visit family, all plugged in. Four people who love each other with four separate devices hardly communicating for the two hours or so that we sped through the air. At first glance it can look like an utter failure — you can hear the criticism ringing in your ears — this family must not be connected, or these working parents, pounding out emails and prepping presentations while their children watch videos and play apps, really must have their priorities off, right? Right.

Maybe.

On that flight I read a beautiful blog post from tenacious pediatric researcher Dr Jenny Radesky that questions the new world in which children are being reared. The one where their parents are plugged-in, distracted, perhaps less attentive and less available while raising infants and young toddlers. It’s the same world today, where preteen digital natives may be connecting more by text than by talking. She cites data that found, “if you take away preteens’ mobile devices and make them hang out with their peers in the country for one week, they get better at reading other people’s facial expressions.” Perhaps these children and teens are swapping thumb skills for interpersonal ones. Radesky is the researcher behind the observations out last year evaluating parents’ use of mobile phones at dinner that alarmingly demonstrated children’s near need to act out to get their parents’ attention.  Are our parent-child connections forever changed because of the profound brilliance that digital devices have in capturing our attention? Radesky brings up the zone of proximal development (I’d not previously heard of it) and its profound value. She says,

In order to effectively teach children how to regulate their behavior, we need to interact with them in what psychologist Lev Vygotsky termed the child’s “Zone of Proximal Development (ZPD).”  This means  knowing their cognitive and emotional sweet spots: what they can do on their own, what they can’t do, and what they can do and learn with an adult’s help.  You can’t fit the puzzle pieces in yet?  Let me guide your hand a little bit until you figure it out by yourself. You can’t calm down when you’re frustrated yet. Let me help you identify what emotion you’re feeling and then show you some options for calming your body down. And I’ll slowly take my support away until you can do this skill on your own.

Oh yes, we certainly do need to be in this space and be available, eyes connected, body engaged, actively listening to the loves of our life (children). In championing this reality we can easily finger-wag that how things used to be (without smart phones and wild virtual connection to data and community) is better. Slow down, unplug, unwind, and CHECK BACK IN, right? Common Sense Media even has a new PSA campaign, that I happen to love, tagged #realtime guiding us back to life with a series of delicious, tight videos reminding us how we mess up. Read full post »

E-Cigs And A Free App To Help Quit Smoking

Last week a proposal was introduced that would give Washington State the toughest e-cigarette laws in the country. If passed, House Bill 1645 would significantly raise the taxes on e-cigarettes, ban the sale of flavored vaping liquids, ban online sales to Washington residents and require producers to list ingredients on labels. And while opponents of the bill argue that e-cigarettes are “healthier” than tobacco, there’s no denying the dangers of having such a highly addictive substance in arm’s reach to children and teens in an unregulated manner. Washington isn’t the only state taking action. This week California released a campaign calling out marketers of e-cigs for targeting teens. Teens are using e-cigs more and more with 1 in 5 high school sophomores here reporting having used them in the last month. E-cigarettes and e-hookahs may carry an illusion of safety they don’t warrant.

What House Bill 1645 Proposes

  • Instill a 95% tax on vaping products similar to tobacco product taxes
    • Right now only North Carolina and Minnesota have imposed taxes on E-cigarettes
  • Make it illegal to sell flavored liquid nicotine or other vaping fluids
  • Ban internet sales to Washington residents
  • Require ingredients list on all labels

Curbing An Urge To Smoke: An App For That

Supporters of e-cigarettes and those fighting against regulation often claim the devices are helpful in helping tobacco users quit, so-called harm reduction. I certainly won’t and can’t argue with anecdotes that this is useful for those wanting to quit. While this concept hasn’t been entirely disproved or entirely proven, there is still a lot we don’t know about vaping and the effects of liquid nicotine. If you or someone you know wants to quit tobacco, there are some new digital resources available to help you kick the habit. The good news is we can be hopeful that dual-pronged approaches may help those wanting to quit earnestly succeed. Download this app?

3-23 smartquit

Image courtesy: Washington Department of Health

Washington State residents have access, for a limited time, to a free app called SmartQuit. Sponsored by the Department of Health, the app is a tobacco cessation program that proved three times more effective than trying to quit on your own, according to a recent study from Fred Hutchinson Cancer Research Center. SmartQuit users create a personal plan to become aware of their urges to smoke, they then learn new ways of thinking about those urges to suppress the desire to smoke. The Washington Department of Health is offering the app for free to a limited number of users. Because the funding is limited, please don’t download unless you’re serious about using the app as the number of free downloads will run out. Consider it? If you or someone you know does, report back on your opinions?

Read full post »

Peanuts During Infancy To Prevent Food Allergy

Photo from Edwart Visser Flickr Creative CommonsThere’s new data out to support stronger recommendations for introducing peanuts during infancy. Like hemlines, it may seem like this data keeps changing. As time, the science and our understanding of risk unfolds we’ve seen shifts in advice about starting solids that have left many parents wondering what really is best when starting foods and wanting to decrease risk for food allergy.

Briefly, and in general, it’s best to start a variety of foods for your child during infancy, starting around 4 to 6 months of age. In fact its now believed that it may be protective to introduce things like wheat, egg, soy, fish, and peanuts even before a child takes their first step around a year of age. The 2013 recommendations (that exclude information about peanuts) are explained in this post, “When Should I start Baby Food?”

The recommendation to share diverse foods during infancy that includes fish and eggs may feel new to you. For example, when my babies were born (mid-2000’s) advice and consensus suggested that avoidance of peanuts until after a year of age was best — the thought that avoidance of peanut during critical development may be protective against severe allergy development. Now, concomitant with a doubling in food allergies, we face an utter and potentially embarrassing reality — perhaps medical advice and our work to improve allergy risk by restricting foods in  infancy did just the opposite. Perhaps avoidance was exactly the wrong thing to do. Maybe we’ve engineered part of the problem.

This kind of advice can feel intense when raising children. “Do this, don’t do that, do this now, don’t do this now!” Doing the right thing is what we all want but doing right can remain elusive, especially when recommendations shift. I remember a fellow pediatrician questioning my eating a peanut butter sandwich while I was pregnant with my second son. She couldn’t believe I’d made that choice. At the time I remember not only feeling judged but a little terrified too. Perhaps I’d not take the data seriously enough? Oh goodness, I thought, as I diligently didn’t introduce “high allergy” foods until toddlerhood for my boys. Today I realize that wasn’t all that right either. It can feel like another hemline change for sure and yikes these sure are shorter skirts!

Fast forward 7 years to 2015. A New England Journal of Medicine study out this past month systematically evaluated risk for development of peanut allergy in children who were at higher risk for developing the allergy in the first place. And they started with infancy and introduced peanuts early in some of the babies. Researchers found if infants were introduced to peanuts early in life (between 4 and 11 months of age) their risk of peanut allergy at age 5 years significantly decreased.

The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy.  ~ New England Journal Of Medicine

Read full post »

The Inconvenience Of Prepackaged Baby Food

dv2159103Feeding a toddler is hard work because of all sorts of normal shifts that happen after the first birthday. But new data out this past month (see below) reminds us how pre-packaged toddler food isn’t the best food source, despite package claims. Whole food, the food your family eats, and the fresh stuff is the way to go.

Infant hunger matches their rapid growth; we’re used to our babies ravenous and near consistent basis from day one yet as infancy progresses feedings space out and form meals. By a year of age most children go 4 hours or more between eating. Toddlerhood is a completely different story; growth slows after a year of age and toddlers start to test limits in profound ways. Food is no exception. It can be tempting to reach for whatever’s convenient that you know your kid will eat (fish crackers, anyone?) but in the long run making good nutritional choices for whole food regularly will exceed the nutritional detriments of pre-packaged “toddler” food.  In fact, a new policy statement released by the AAP this month is urging parents (and schools, daycares etc.) to take a “whole diet” approach to kids’ nutrition, namely focusing on a mix of foods from the five food groups and avoiding highly processed foods. Read more about the policy here from my friend Dr Claire McCarthy. These “fresh is best” ideas aren’t new to you I suspect but the data about food being marketed to us (and our children) is: Read full post »