Podcast

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Reducing Back To School Stress In 12 Minutes

I find the back-to-school time period to be a little bit stressful (hellowwww, understatement) and perhaps even anxiety inducing. Even good transitions rack up stress. As we brace for the holiday weekend and expect the onslaught of school in earnest while September unfolds, I suggest we can decrease the stress with a bit of info. Here’s my 12-minute podcast to support you as you send your kids back to school and set them up for an awesome start. We’re all hoping for a healthy, safe fall. Take a listen…it won’t take long and you may find yourself a little more relaxed and ready for the chaos. Immunizations, sleep, anxiety and tips for transitions!

Tips For Getting Sleep Schedules Ready For School:

  • Timing: Shift slowly and get started now. If bedtime has migrated to 10pm, for example, and you’re hoping to have your kids sleeping by 8pm for school, start now. Move bedtime forward about 30 minutes every 3 to 4 days.
  • Screens (this isn’t new, I know): Screens, using them and exposing ourselves to the light they emit, impairs our natural sleep hormone melatonin from rising and helping our brain drift off to sleep. Have all screens, tablets, phones, and laptops transition back to sleeping in the kitchen (not at the bedside). In minimum, turn off screens at least 1 hour before desired bedtime!
  • Sleep As Health: getting sufficient sleep contributes to improved attention, safer driving, less health risks, and a more steady mood. We’re nicer when we sleep! It also contributes to how we think on life and even how we remember events; when we don’t sleep we tend to remember things in more somber light. Getting enough sleep supports a healthier life and I would suggest an even happier one. Quick reminder: school-aged children need 9 to 11 hours of sleep and teens need 8 1/2 to 9 1/2 hours. Really!

 

6 Ways To Help An Anxious Child

No question it’s tough to keep our cool when our children are unraveling. It’s especially a challenge when our children are rattled and over-run with anxiety. I partner with parents on a weekly basis who feel their children are anxious. All of us want support in knowing just what TO DO in helping our children thrive while also not letting them suffer.

I partnered with Dr. Kathy Melman on the podcast to review tips and strategies for parenting when children are anxious or when our children suffer from anxiety. Dr. Melman is wonderfully steady and clear in knowing what we can do when we find ourselves amid a sea of anxiety. Dr. Melman explains how to improve the environment for our children, what we can do for ourselves as parents to protect our children, and how to help our children not only cope but thrive in the face of anxiety, disruption, fear, and challenge. Listen in and read her 6 tips below. Number four is a BIGGIE…

6 ways to Help Your Anxious Child:

  1. Modeling Matters: If a parent struggles with anxiety—get evidence based cognitive behavioral therapy (CBT) treatment with an adult anxiety specialist. Caring for your own anxiety will limit how your child models undesired behaviors.
  2. Intervene early and effectively! If your child shows signs of anxiety that is causing distress and/or interfering with functioning, seek CBT treatment with a child anxiety specialist. Don’t wait years for help because untreated anxiety can lead to problems including possible school refusal, lack of friends and opportunities to develop social skills, limited development of independence, healthy sleep patterns, lack of involvement in activities outside of the home, substance use and depression as one’s life shrinks with loneliness, low self esteem (“I can’t handle this”) and lack of building mastery. Anxious children often don’t get the help they need and when they do, they have often already suffered for years, other problems have developed, and they often don’t get the most effective, evidence based behavioral treatment.
  3. Acceptance and Empathy: Accept if your child is “wired together” to have more anxiety and be empathic, rather than invalidating, of their experience. Taking the moment to accept their feelings (even when they seem outlandish!) will allow you to both acknowledge and then support your child more effectively.
  4. Don’t Permit Avoidance: It is really hard to see your child suffer and parents often, meaning well, allow their child to escape and avoid anxiety provoking situations. As a parent, it is important to learn to tolerate this distress, remain calm and know that permitting escape and avoidance and providing excessive reassurance only strengthens anxiety, reinforces your child’s thoughts that the world is a scary place and the belief that they aren’t capable of coping effectively. This is an important dance parents often do with their anxious children and it is critical to change this pattern.
  5. Reward Brave Behavior: Instead of paying attention to anxious behavior, reward use of anxiety management skills (recognizing when anxious, which situations trigger anxiety, what happens in your body, what are your thoughts, calming your body, challenging unrealistic, catastrophic thinking with checking the facts to develop more realistic thinking along with coping and calming thoughts, and approach feared situations in a gradual, manageable, step by step fashion). We are asking our children to do what terrifies them so provide them with empathy, support, skills and coaching so they overcome anxiety by facing their fears and learning that they can, in fact, do this, nothing terrible will happen, and they can live a full life that is not limited by anxiety. Rewarding use of skills and facing fears (known as exposure) helps your child do what is challenging. Exposure is the most important ingredient in effective treatment of anxiety.
  6. Be Involved in your Child’s CBT Anxiety Treatment: Parental involvement is critical for many reasons including learning about anxiety disorders and their treatment, learning which parenting strategies increase and which decrease child anxiety, learning to coach your child in use of anxiety management skills in challenging moments, not permitting the dance of avoidance, modeling use of skills and brave behavior, learning to tolerate when your child is experiencing distress and responding with empathy and approach, providing many opportunities for exposures and rewarding brave behavior. Parents can also use their understanding of anxiety disorders and their effective treatment to communicate important information with schools, coaches, grandparents and other involved caregivers and settings.

Do You Have An Anxious Child?

No question, hands down, I get more requests from friends, family, and acquaintances for help finding support and and advice parenting anxious children than any other pediatric issue in the school years. So it’s my sincere DELIGHT to introduce and partner with Dr. Kathy Melman on my podcast. Dr Melman runs the outpatient psychiatry and behavioral health clinic and has decades of experience advising families and supporting anxious children. She helps translate the facts around what causes anxiety, how to discern anxious behavior from clinical anxiety, and helps parents understand just what we know and what we don’t. Her tips and advice below!

Where Does Anxiety Come From?

1. Anxiety is a normal emotion and a natural part of life. Fear exists in all of us and there are typical fears that are seen at different developmental stages such as Stranger Anxiety (clinging and crying) at 7-9 months of age. This happens as the child goes through developmental changes such as the stronger ability to differentiate familiar faces from those that are unfamiliar. Anxiety is a normal and important emotion that is adaptive and protective. For example, anxiety helps us stay away from dangerous situations such as leaving or not entering a building when we see smoke or fire or smell something burning. Imagine living at a time or in a place without grocery stores or restaurants for securing food, without homes with locking windows and doors. Imagine that we instead have to venture out to hunt and gather food with concern about dangerous animals or people lurking behind a bush. In this situation, concern about safety is warranted and being vigilant, scanning the environment to pick up on danger cues would help someone survive. The rush of adrenaline that occurs when highly anxious is called the “fight or flight” response and it helps someone escape or avoid dangerous situations.

2. Environmental Stress: Anxiety increases in more stressful situations. This can includes fear of safety, homelessness, instability with frequent moves or other important life changes, loss or death of caregivers or other important people, war, hearing or seeing disturbing news, economic difficulties, abuse, sexual assault, bullying at school, high pressure, expectations and demands in school, home and/or activities. Even in healthy, safe environments, all children experience some anxiety. For example, occasional or short lived worries occur when a child is faced with an especially stressful or new, unfamiliar situation. These are real issues with all that is going on in the world right now.

3. Environmental Learning: Dr. Melman reminds, “Children Learn What Children Live.” Modeling matters. Listen to what Dr. Melman shares in the podcast about overprotection and the risks of being over-involved.

4. Avoidance. Anxiety is maintained and strengthened by avoidance. Through avoidance, you don’t get to see that your worst fears will not happen and that you can, in fact, do it! Let’s look at an example of a child invited for a sleepover at a friend’s house. Perhaps this child is not experienced with sleeping away from home and struggles with sleeping in his own room and bed at home. The idea of a sleepover sounds fun and then reality hits as the time to go to sleep approaches. The child becomes panicked, maybe with physical symptoms such as heart racing and pounding and stomach aches. He has thoughts that he won’t be able to fall asleep or that something bad will happen like a robber breaking in, and calls his parents to pick him up which they do. The child starts to feel relieved and no longer anxious as soon as they learn that they can escape this feared situation by going home. The child’s fear and desire to escape and avoid is strengthened because of the strong relief is experienced when rescued and by the fact that parents agreed that there was a need to come home rather than an ability to cope, ride out this wave of distress, stay the night and see that nothing bad happened and that he could, in fact, be courageous!

5. Expecting Bad Things to Happen: Anxious thinking also plays a role in where anxiety comes from.

6. Genes: Anxiety Disorders runs in families. What can we do if our child has a genetic loading for anxiety disorders? While we can’t change genes, we can aim to reduce stress in our lives and change our own modeling and reactions. We can learn to understand and accept our child’s temperament/wiring and empathize with our child’s feelings while also teaching our children how to think more realistically about the world, to expect less danger in situations, and encourage our child to approach in a gradual and consistent manner the situations that he or she fears. We can give our children skills to cope more effectively with challenging situations.

How To Talk To Boys & Girls About Sex

I haven’t felt like a pro in knowing how to talk about sex with my boys. No matter that I was a middle school science teacher, I’m now a pediatrician and an ever-evolving mom of two. It’s a tough topic even for me as a “talker.” So it was a TRUE JOY and huge relief (let’s be honest) to podcast with two international pros in talking-to-girls-and-boys-in-building-up-esteem-and-confidence-and-knowledge around puberty and sex…

This past month I spoke with Great Conversations co-founders, Julie Metzger and Dr. Rob Lehman. They share their profound expertise and compassion in talking to boys and girls about sex and sexuality and supporting children growing into adults. We broke these podcasts up by age — what to say to a 9-year-old versus what to say to 12 year-olds and what we can say to our teens. I learned so very much from these courageous, kind, and amazingly brave experts — about our connection to the success for our children — and how we meet soul-to-soul with our children in conversations as they traverse life and sex and growing up.

4 Quick Tips For Talking About Sex With Boys and Girls:

Here’s a few takeaways but really, it’s better if you listen to Julie and Rob explain in the podcasts. Really.

  1. “Don’t over speak!” advises Julie Metzger. It only takes 1 minute of courage! Our kids and teens don’t want long-winded, hour-long conversations when questions come up. Keep it short and simple and don’t freak out. Julie teaches girls to plant questions when there isn’t even time for a big response so we adults can get ourselves together to respond. And she reminds: swift, authentic answers when children ask questions are likely best. Phew… one minute of courage. I can do that.
  2. Happenstance helps: Some of the best conversations happen because of what is happening in the world (dogs mating, Janet Jackson’s top falling off, buying tampons and children asking about it). And this is a series of a bazillion conversations throughout a child’s lifetime, not one BIG SEX TALK. Let the nuance and randomness of life support your conversations over time about sex, sexuality, their bodies, and their opportunities.
  3. Everybody wants this to go so well: So many people want puberty and “the sex talk” to go well but even more so, everybody wants a child to do well in their teen years as they grow up. These children are literally flanked by those who want the best for them. From teachers, to parents, to coaches and pediatricians, relatives and neighbors. You have a network of people who want to help and support your child/teen through this time period — remind your teen.
  4. Lead with the positives and avoid conversations that involve “don’t.” You can express your values without closing doors. Opening lines for sharing your beliefs without shutting things down for your child: “What we hope for you is……” or “in our family we believe….” And the other thing — if and when the puberty talk comes up or the sex talk floats in the air, talk about the great things in puberty first (getting taller, gaining independence, more feelings of love and crushes and lust for others) before delving into the tough stuff that may seem a bit unsavory.

Helpful Resources

Infants Turning Blue And Other Scary Things

EVERY new parent worries about their newborn from how much they are eating, sleeping, peeing and pooping to ensuring they hit developmental milestones. We also worry about how they breathe and how they sound. It’s a stressful time period and most aren’t running on tons of sleep themselves — so we’re more emotional baseline. Occasionally, a terrifying thing happens where your infant turns bright red, or even blue or pauses their breathing. They may arch in a funny way or get stiff in their arms or legs. We may wonder if something serious is going on. If your infant (under 12 months of age) has an episode where they have pauses in breathing for less than 1 minute, they turn blue and then recover to normal…chances are…it’s normal. Normal? Turning pale or blue doesn’t seem normal nor does having your baby get stiff, nor does a second where they pause their breathing, but it can be, and there’s a name for it: Brief Resolved Unexplained Event (BRUE).

No question we have to trust our instincts if we think something isn’t going well for our babies and I always suggest seeing your pediatrician or family physician or nurse practitioner if you worry about your infant’s health, for reassurance. No question! Go in, get reassurance and learn. Don’t ever feel bad if everything checks out — this is why your pediatric team is there for you and your family. However, when you do go in for an evaluation from a nurse practitioner or physician,  even if your baby has unusual breathing at times, or tenses, or even has a change in color, you may not need a lot of testing. Sometimes it’s normal.

Some Information About Breathing Patterns In Infants:

  • Periodic Breathing: Newborns breath less regularly than older infants, children or adults. This is in part because of their immature brain stem (the part our brain that regulates the drive to breathe). The majority of newborns experience some periodic breathing in first couple weeks of life and most infants don’t have periodic breathing after 4 or 5 months of age. The term “periodic breathing” captures behaviors where babies breathe rapidly for a few moments, then pause for a few, then breath rapidly again. Most of the time periodic breathing happens with pauses that last no more than 10 seconds. It can appear really unusual to a new parent or relative. The Academy of Pediatrics defines it this way: “Breathing is often irregular and may stop for 5 to 10 seconds—a condition called normal periodic breathing of infancy—then start again with a burst of rapid breathing at the rate of 50 to 60 breaths a minute for 10 to 15 seconds, followed by regular breathing until the cycle repeats itself. The baby’s skin color does not change with the pauses in breathing and there is no cause for concern.”
  • Color Change: babies can change color with crying, eating, fatigue or movement. Most of the time parents notice that babies will get bright red or ruddy while other times parents worry their baby looks pale or even a bit blue. It’s true that color change can represent underlying heart or breathing problems so if ever sustained over 1-minute it needs to be evaluated promptly. However, color change in infants over 2 months of age that resolves within 1 minutes may not need any work-up after you check in with a clinician. Sometimes color change can come from things like gastroesophageal reflux, coughing or choking, too. If any concern about your baby’s color it’s worth checking in with the pediatrician for a physical exam. While in the office, a pediatrician will do a full physical exam and ask lots of questions, and they can also check a spot oximetry for oxygen levels (pulse oximetry is standardly obtained in first 24 hours after birth to check blood oxygen levels to screen for underlying heart problems), do a electrocardiogram (EKG), and have observation.
  • Noises: babies make all sorts of terrifying sounds! Gagging sounds, choking, gurgling, sneezing, and coughing. Most of these during infancy fall in the range of typical and normal if they don’t interfere with eating, breathing, and sleep. Sneezing is fairly common in the first couple months, again because of immaturity of reflexes. Some parents worry about babies who spit up and sound like they can’t breathe and want to put babies on their tummies. No evidence that is recommended and to lower risk of SIDS, we always recommend babies are put on their back in bare crib for sleep.

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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.

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.

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

All Dogs Bite


To 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:

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Join In On The Seattle Mama Doc Podcast?

Always a work in progress here — trying to think on ways to share new data, expert advice & enjoy the journey of parenthood. I’m excited to announce we’re going to pilot a Seattle Mama Doc Podcast early next month. Since this blog’s inception in 2009 we’ve covered nearly 650 standard blog posts, vlogs, guest contributors, interviews and now I’m going to test out a podcast. I am a huge fan of crowd sourcing and co-design, so will you help create the look, feel and content of the podcast alongside me? I would love to know what topics you’re interested in, which you’re tired of hearing about, who you want me to interview and frankly, anything else you’d like to share.

My hope is to interview experts and researchers here at Children’s, parents, and patients when there’s interest in sharing the experience of raising children. We’ll include the smarts of friends and peers across the country working on preventing and preventing illness while raising children. We’ll highlight all the tips and tools we learn along the way, new evidence, expert opinion and ideas to feel better about our decisions while raising our children.

I’ve recorded 3 options for the introduction of my podcast (I’m well aware of kind of bootleg smartphone audio quality for these little demos — promise to record high quality content in studio for the actual podcast).

Which resonates and makes you want to tune in?

Tell me what to cover. And also, would you want to join me on the podcast? SAY SO, PLEASE!

Option #1

 

Option #2

 

Option #3