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Car Seats and Booster Seats And Your Precious Cargo While Carpooling

A friend pulled me aside last week urging me to write about car seat and seatbelt safety. His family had been involved in a rollover accident on the way home from school — literally, just turning in an intersection, as I understand it, they were plowed into by another car which caused their car to flip. No one was seriously injured, thank goodness, but the children were left dangling upside down, hanging by seat belts, until the medics arrived. Clearly they were shaken…and reminded how precious our time is on this planet — and how the most dangerous thing most of us do everyday is drive. All the children had seat belts on and all the children were in the back seat. Phew!

Thing is, just after this dad urged me to write this, I mean literally, just minutes later, we pulled away from a group of parents at pick-up and I watched an 11 year-old get into the front seat of her family’s car and drive away. My stomach dropped. Children under age 13 shouldn’t be in the front seat and goodness gracious, the irony of the timing just got me in the gut. Hard to message and write about something that I feel parents don’t want to know more about. Something about a laxity here for many people remains…seems this is advice many already feel they know (and don’t want to take).

3 reasons children shouldn’t sit it front seat until age 13 years: 1) It’s always safer to ride in the backseat (it’s also illegal to ride in front under age 13 years in WA state), 2) children under age 13 years are at increased risk for injury from airbags (designed for a 140 lb male), and 3) children’s bone development at the hips and breastbone is immature leading to increased risk of more serious injury in front seat

When it comes to infants and little children, maybe it’s different — I feel like parents are more interested in the data and reminders. Research out last week confirms what pediatricians have been recommending for years: rear-facing car seats to keep children safer in rear impact collisions. “We found that the rear-facing car seats protected the crash test dummy well when exposed to a typical rear impact,” said lead study author Julie Mansfield. If you’re hit from behind or the side or the front, we want children under 2 years of age rear-facing!

I talked to Dr. Beth Ebel, a Seattle Children’s pediatrician who also researches injury prevention and cares for children at Harborview Medical Center. Dr. Ebel is an expert on teen and child injuries and is especially knowledgeable about injuries related to vehicle crashes. Dr. Ebel came on my podcast to share how parents can help protect their children in their car and in the cars of others who drive their precious cargo around. Her points are emotional and inspiring to me.

5 Tips On Rear-Facing Until At Least 2 Years Old

  • The American Academy of Pediatrics recommends children travel in a rear-facing car seat until they are at least 2 years of age. If the seat allows for longer (based on size), there is NO rush to turn your precious cargo forward.
  • The worst crashes are when a car hits something from the front. Rear-facing seats protect the child’s head, spread out the force of a crash evenly across the seat, and significantly reduce the risk of injury.
  • Consider buying a larger car seat which accommodates your child through the toddler period, and THEN can be turned front-facing when your child is at least 2 years old and has reached the weight limit recommended by the car seat manufacturer. You’ll save money in the long run since you won’t need to buy a new car seat for years.
  • Use the easy “latch and tether” method to securely attach the car seat where possible. If you must attach the seat using a seat belt, make sure the seat belt is tight (i.e. the seat belt has no slack and won’t loosen).
  • Some parents worry they can’t see the child. There are mirrors for rear-facing seats if you must briefly check at a stop light. But keep in mind that you AND your child are safest when you concentrate on driving with your eyes on the road.

Booster Seats Until 4 Feet 9 Inches Tall

  • DO THIS NOW: put a mark on the wall at 4 foot nine inches from the ground. Tell your children to come and ask about getting out of a booster only when they are taller than the mark.
  • Children should stay in harness-type (“5-point”)seats until they outgrow the manufacturer’s recommendations. Most kids outgrow their harness seats between 4 and 6 years of age, and are then ready for a booster seat.
  • The booster seat is critically important because it helps the seat belt (and your child!) stay in position during a crash so that the car can do its job to protect the occupants. Seat belts are only designed for adults and don’t fit properly until a child is around 4 feet 9 inches tall – most kids will reach this height sometime between 9 and 11 years of age. I also like to remind kids that when in a booster they are up higher and can see better out the windows.
  • Some parents mistakenly put kids into the seat belt when they aren’t big enough. Dr. Ebel sees these older kids admitted to Harborview or Seattle Children’s with serious abdominal injuries, spinal fractures and head injuries because the seat belt doesn’t hold their torso in a crash.
  • Don’t negotiate on car safety. She and I both keep extra inexpensive booster seats and ask that every kid traveling in our car use one and provide it to others driving our children. (By the way, it is the law and the driver is liable).

Keep Your Children Safe In The Car

  • The biggest tragedy is when a child isn’t buckled in the right seat, or worse, isn’t buckled at all. Even a very low-speed crash can cause life-threatening injury, ejection from the vehicle, or worse.
  • Buckle up every trip. Every time. Even when you drive five blocks to grocery shop. Most crashes happen close to home. And children remember consistency – “we always buckle up in the car”.
  • Install a car seat in every vehicle in which your child regularly travels. Buy an inexpensive seat for grandma, dad, or your regular child care provider and leave it with them. Make it easy for them and explicitly spell out your expectation that your child must ALWAYS be in the right car seat.
  • Dr. Ebel’s trick for carpools: “Thanks so much for taking Elena; we really appreciate it. Do you have a booster seat for her or shall I leave one for you?”
  • Keep your child in the back seat until they are at least 13 years old. Make it a clear rule and don’t cave. It’s harder to transition them back to the back seats than it is to never allow them the “treat” of sitting shotgun.
  • There’s no reason to progress your child out of a booster seat before they are 4’9″. Every time you transition them you decrease their level of safety.

For a list of car seats and booster seats that meet Federal Motor Vehicle Safety Standard 213, view the American Academy of Pediatrics (AAP) Car Seat Product Listing. This list includes rear-facing car seats, convertible seats, 3-in-1 seats, combination seats, belt-positioning booster seats and travel vests.

Source: https://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety-Seats-Information-for-Families.aspx

Make the Most of Your Car Time

Remember that kids pay attention to what you do, not what you say. So set an example. Buckle up, put down your phone. Ask that kids also put down their electronics in the car. Driving time is a great chance to catch up in our busy lives; use it to listen, chat, sing or enjoy a shared sound track or radio station. Putting away your phone and redirecting attention to your child proclaims, “You are the most important person to me.”

What’s The Right Age For A Smartphone?

What’s the right age to get your child a cell or a smartphone? I wish I had a concrete, data-driven, definitive answer for you. I think the answer is a balance between what’s right for your family and when you think your child is responsible enough to manage the risk that comes with opening up an entire new world online and the risk that comes with losing something expensive. Research from Pew Research Center out this month (Feb 2018) finds that when it comes to adults, nearly all of us (95%) have a cell phone and 77% of us have a smartphone. But when it comes to parents specifically, we’re different– we’re all in it seems, 95% of parents with children under age 8 have a smartphone (not just a cell).  What we’re modeling in our own lives with our phones makes this even harder. If we are addicted to our phones what does it mean for our child? When it comes to having a child get a cell or smartphone of their own, Techcrunch reported in 2016 that children, on average, get a cellphone in the US at age 10.3 years. You may have strong reactions to that number.

The biggest reality IMO is that the biggest issue may not be the age of initiation for a phone or device but rather how we help our children use it, follow rules, and sincerely work to avoid “addiction” to it in life. We just don’t want to have our children (or ourselves!) pulled away from life in meaningful ways…this being alive thing is just too precious.

Half of teens feel addicted to their mobile devices, and the majority of parents (60%) feel their kids are addicted, according to a 2016 Common Sense report on tech addiction. A recent study (somewhat contested) of eighth-graders by Jean Twenge, author of iGen, found that heavy users are 56% more likely to say they are unhappy; 27% more likely to be depressed; and 35% more likely to have a risk factor for suicide.

Common Sense Media launched a new campaign to protect young minds from the potential of digital manipulation and addiction. The campaign, called Truth About Tech, aims not just to help us as parents but also to influence the tech industry in making products less intrusive and less addictive.

In my family, I’ve told my boys we can talk about a cell phone at age 12. But we do let them use an iPod and an iPad and holy moly, it’s not easy….nor perfectly executed. When and how you introduce devices to your children will always be a personal decision — for you and your family — and it will always demand your longstanding attention and follow-along. The good news in the overwhelm, you can always change up the rules as you go, especially if the ones you make aren’t followed! The AAP Family Media Plan is a great tool to start the conversation together as a family and allows you to print it out and put it up in the house as an easy reminder of what was agreed upon.

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What I’m Doing Now – January 2018

It’s still (barely) January of 2018 and I’m doing my best to try to new things, take breaks from old things, be more strategic, practice tiny habits, and spend time with my sweet boys and family. I’ve even committed to a weekly early morning swim with a dear friend to just ritualize something beautiful for the year.

(added 2/1/18: Check out this palliative care physician’s twitter status update [read the whole thread — amazing] for any reminder for why we should just be with our babies when we can and why we should tell more stories, read more books, and perhaps, eat more ice cream!)

Many of you are familiar with my Seattle Mama Doc podcast which typically features parenting advice and pediatric experts sharing ideas for particular health topics. But I’m often asked about all the different hats I wear: mom, doctor, Chief of Digital Innovation at Seattle Children’s Hospital, Chief Medical Officer at Before Brands, reporter at KING5 News and more. So, this is my first attempt at detailing what I’m working on each month — the juggle — why I’m doing it and how it all feels. It was an idea inspired by my dear friend, Susannah Fox who updates her work list publicly, on her blog monthly. I recorded an ad lib take on the podcast (embedded below).

Tell me what you think, share ideas, offer advice or partner with our digital health team if you can!

Power on, People. Thank goodness, here comes February!! Maybe some sunnier days? Think weather and think metaphor, too.

How To Treat Lice And When To Ask for A Prescription

This is a follow up post to my recent post on treating head lice. It’s all just a major inconvenience. And worse than having lice is having lice again and again. And even worse than your child getting re-infested may be treating lice with an ineffective therapy. Enter…..”super lice.” Ewwwww. Although please know that their name exceeds their actual scariness. These lice are only different (aka “super”) in that some lice may have developed gene mutations that indicate they are developing resistance to a common class of over-the-counter (OTC) treatments (permethrin).

A 2016 study in The Journal of Entomology that got a bunch of media coverage found resistant lice all over the United States. Lice were sampled from 48 states at well over 100 different centers to evaluate their patterns of mutations that may render them resistant to OTC medications. Do note that the study was funded in part by the pharmaceutical company that makes one of the prescriptions, but nonetheless did find that lice are becoming harder to treat, coast to coast.

Do you have a super lice? It may be hard to know. If you’ve treated your child several times exactly according to directions and aren’t having success, you should explore prescription medications that may work better. But REMEMBER though, that sometimes you child is just getting re-infested from someone at school.  It is sometimes hard to decipher if the OTC medication is ineffective, or if your child has been re-exposed. Working with your school and with others where your child may have been exposed is always a part of this when a child continues to have lice after a treatment. There are some medicines (see section below) that may help if the OTC meds are not working. The chart below shows where the resistant bugs were detected (red is fully resistant, orange shows intermediate resistance, and green showed no resistance to OTC meds). Read full post »

MLK Day, The New Year And Tiny Habits

I’m quieted today by the profound example of Martin Luther King Jr. and one of his many enduring proclamations,

“Life’s most persistent and urgent question is, ‘What are you doing for others?”

The answer I often feel is “not enough.” While most of us spend portions of our everyday caring for or enriching the lives of others, the enough-ness and potency of feeling we’re doing enough, or giving back in satisfactory ways, can yo-yo.

There’s not a better moment than now to augment who you are and what you do with your days.

We’re halfway through the first month of 2018 and perhaps today is a beautiful moment to pause on what we do each day routinely and how we contribute. Even in the tiniest ways. Resolution season is dying down so I suggest we think less resolutions and more intentional habit formation. More intention for you and your life I believe will likely translate to more for others.

BJ Fogg, a behavioral psychologist and founder and director of the Stanford Persuasive Technology Lab, created a behavior model (see the graph below) that when dissected and simplified, details that making change in your life and forming a lasting habit is a blend of how much motivation you have for the change, the challenge of actually doing the behavior and the need for a triggering event to get the desired change habitualized. In some senses, if you have high motivation for a new habit or change, even if something is hard to do, you’ll do it with a proper trigger. If you have low motivation for the new habit, even if something is easy to do, you may not. But triggers and other barriers and thresholds can throw this all off. He recommends implementing “tiny habits” to drive change in your life by following 3 steps.

1. Start small. Make it teeny tiny. Read full post »

How To Help Your Gassy Baby

Things to give to new parents: smart books. Awesome things to give to new parents: books about how babies eat and poop. What and how babies eat and how they fart and poop (and sleep) are basically all new parents think about. I’m not exaggerating — of course the most emotional part of new parenthood is the love and overwhelm that takes us over. But second to it is what the baby eats and how they poop. Period.

I’m standing on my chair clapping as I tell you that Dr. Bryan Vartabedian recently published a new book: Looking Out for Number Two. A candidly written, humorous, scientifically-backed poo bible. It’s an illuminating look into every parent’s secret obsession – their baby’s poop. I am thankful, both as a mom and pediatrician for his sound advice and expertise. Poop is a big topic in almost every well baby exam and I’ve written about it several times (see below). But I haven’t dedicated a post to something so many parents worry about and search for remedies: gas.

Most babies are naturally gassy, but it can be quite painful (obviously) and lead to lots of screaming and thrashing about. Signs that your baby has gas are: crying, pulling their legs into their bellies, wiggling & hard belly.

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I’m Not Eating Meat Raised With Antibiotics Anymore

A lot of people don’t eat meat for all sorts of reasons. You know why: their health, the environment, they don’t want to eat animals, just doin’ the right thing for the planet. I’ve gone through times in my life where I didn’t eat meat. Now I do again. The more I learn about health care, the more certain I am that as I go forward eating meat and preparing it for my family, I can use science to guide me to do it in smarter ways.

Being smarter about how we eat meat makes sense. This includes not consuming nitrates (cancer risk) and preservatives when we don’t have to, but also choosing meat raised without unnecessary antibiotics. Smarter meat-eating involves creating a demand for meat that’s safer for us and the population. Antibiotics used to raise animals for meat production aren’t always in our best interest, health-wise.

Animal agriculture uses 4x the amount of antibiotics as human medicine, so buying meat not raised with antibiotics is without a doubt a way towards a safer world where antibiotics can be reserved for use in helping us. Antibiotics aren’t used when raising farm animals to make the meat on your kitchen counter safer — raw or undercooked meat is still a biohazard, even if raised with lots of antibiotics — you can still get an infection from meat raised with antibiotics. Antibiotics are often used to raise animals in crowded or less ideal conditions to help prevent them from getting infections. The more antibiotics we use anywhere, the the more we’ll see resistant bacteria everywhere. So reducing demand for meat/animals raised in conditions demanding more antibiotics is a good thing. Moving forward, I’m raising my hand to eat meat (whenever possible) not raised with unnecessary antibiotics.*

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6 Tips To Help A Child With Autism Eat Better

There are ways to support picky eaters and children who refuse new foods. I’m back with Dr. Dolezal further discussing feeding challenges for children with Autism Spectrum Disorders (ASD). The first post explored why children with Autism have challenges with eating (almost 90% do). I often say that a typically developing child will not starve with a full refrigerator, but this advice just doesn’t hold up with ASD children. I love Ellyn Satter’s advice and mission in helping adults and children be joyful and confident with eating. Her resource and guidance inspires a “division of responsibility” that basically a parent’s role is most simply to provide great healthy food and a child’s job is to choose what and how much of it to eat. But we have to acknowledge that parents to children with ASD need more information about challenges and often far more support. Here are Dr. Dolezal’s 6 tips to help a child with autism, or any child who choses to eat only a few, certain foods, eat better.

Children who graze are really not open to trying new things. — Dr. Dolezal

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Why Children With Autism Struggle With Eating

If you’re a parent to a child on the autism spectrum, take some comfort in knowing that up to about 90% of children with autism struggle with significant eating challenges. You are NOT alone in this. The challenges can range from picky eating to dependence upon PediaSure or g-tube for caloric intake. We know that children thrive in an expected world. But children with autism can take that to the margin where a preoccupation with sameness can drive them to eat only the same thing every day. Despite these staggering numbers, there are evidenced-based treatments and models of care that can help improve the lives of children and families from a nutritional and quality of life perspective. I had the pleasure of having Dr. Danielle Dolezal on the podcast to discuss this topic. The first podcast here is an overview of why children with Autism Spectrum disorders have these challenges with eating.

Rigidity and sameness contributes greatly to feeding picture. Eating is one of the most sensory experiences you can have.” ~Dr. Dolezal

Dr. Dolezal is the Clinical Supervisor of the Pediatric Feeding Program at Seattle Children’s Autism Center. She’s super smartypants and created the highly sought after (nearly 500 families on the wait list, unfortunately) interdisciplinary team model and program at the Autism Center. That means patients that have multiple factors contributing to feeding issues (medical, skill, motor, physiologic, and psychology) get to see a variety of team members under 1 roof. She started off her career with a masters in special education with special emphasis in early childhood and children who struggle with severe challenging behavior. She then got her PhD in child psychology with further emphasis in behavior analysis specializing in feeding disorders and severe challenging behavior. So needless to say….she knows her stuff. Her podcast is so good. Insistence on sameness is a common theme and can be horribly challenging for families who worry about their child’s nutrition.

A Few Quick Tips:

  • Try to not let your child slip into patterns of grazing, which is very common and leads to disrupted hunger/satiety patterns. This makes it difficult for them to try new foods because they graze to take the edge of the hunger all day long and are never really sitting down to eat a full meal at set meal times. They will be more apt and ready to try new foods if you keep to a set schedule. They don’t have to stay seated in a seat. They can stand up. But the food stays at the table.
  • Try celebrating and reinforce flexibility with something the child is already doing. So if they are eating dry/crunchy textures, try branching out to ANY type of cracker. Go from white cheddar Cheez-It to regular Cheez-It. Celebrate that as a new learning experience and new demonstration of flexibility.

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Avoiding Shame When Talking About Weight With Your Teen

Figuring out what to say to a child or teen about being overweight can be perplexing. We want out children to love to eat. We want our children to love their bodies. We want our children to be of healthy weight. We want to avoid ever making our children feel shameful about how and what they eat.

It can be a challenge to figure out what to say when we worry our children may be overweight or at risk for being overweight. How do we talk with them about eating well without making them feel any frustration/shame/overwhelm about their body? There are roughly 7 million children and teens younger than 19 years old in the US that are of unhealthy weight or obese. In Washington, 23% of 10th graders (15 to 16 years old) are overweight or obese. That’s nearly one-quarter of teens who are at one of their most vulnerable ages. So lots of parents may find themselves wanting to support different choices with eating and activity and not know quite how.

Adolescent expert Dr. Cora Breuner is a specialist who works with teens who need extra help getting to a healthy weight. She recently joined me on a podcast to discuss talking about the difficult topic with your teen. Specifically, Dr. Breuner shared tips on how to approach conversations with your teen about their weight, and common confusions and excuses for overeating.

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