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Greatest Hits & Greatest Inspirations 2013

Maui rainbow, December 28th

Maui rainbow, December 28th

I’m so thankful and humbled by all of the comments and dialogue here on Seattle Mama Doc. Since the inception of the blog in 2009, we’ve had more than 1 million different readers. For that I remain somewhat amazed and also astonishingly grateful. I really love detailing what I learn about caring for children and hold dear the opportunity to share what science holds. Writing about health care while wedding evidence with anecdotes remains a huge focus for me. I am so thankful to be a mother and doctor, practicing and writing, today. I am so grateful for all of your help.

I started 2013 blogging about my experience of being diagnosed with malignant melanoma, the process of renewal, and my hopes for 2013. I set out goals for the year:


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Greatest Hits 2012

Screen Shot 2012-12-31 at 10.47.01 AM

I give thanks every day for friends, mentors, teachers, collaborators, and family like you. It’s been a sincere privilege to share thoughts here. I’m always amazed at the depth of reflection that washes over me as the year comes to a close. However pre-conceived this day seems for reflection, today has me in its grip. The end of 2012 is filled with far more information about being a parent, being a patient, and being a pediatrician than the beginning held for me. More on that tomorrow, but for today I just want to say thank you for reading.

Here’s a list of the “greatest hits” of 2012. The list is based on the number of views and shares but also the impact these posts had on discussions about pediatric health and parenting. One post is included primarily on the number of people who went out of their way in person to discuss it with me. Please accept my sincere thank you for your insights, reflections, contests, partnership, and loyalty to learning and growing into parenting and pediatrics with me.

May you welcome in a beautiful, healthy 2013 tonight.

2012 Mama Doc Greatest Hits

  • TIME Magazine And The Mommy Middle Road This is a reaction/reflection to the TIME Magazine cover with a preschooler actively (potentially) breast feeding while standing on a stool. It’s about motherhood, finding confidence in our choices and knowing that yes, of course, you’re Mom Enough.
  • 4 Reasons Toddlers Wake Up At Night A list of reasons toddlers awaken their parents at night and 100+ comments/explanations for parents seeking the solace of a good night’s sleep. Read full post »

Toddler Sleep: 4 Reasons Toddlers Wake Up At Night

There is a lot of writing online about how to get your baby to sleep through the night during infancy but not as much expertise to help those of us with toddlers and preschoolers who wake a number of times. Between age 2 and 3 when O was released from crib jail and moved to a big bed, he’d come to find me a couple of times a night. I’d often awake (and startle) to find him standing next to my bed! I tried many things to improve his opportunity for a full night’s sleep yet for those kids who never quite figure out that sleeping through the night starts around 7 or 8pm and ends with the sun coming up around 7am, we want to help. Recent data shows that 1 in 5 infants who have trouble sleeping may continue to have challenges during the toddler years. Clearly challenges with sleep that span multiple years affect many of us.

I turned to a pediatric sleep expert for help. Dr. Craig Canapari is a doctor I met on Twitter (of all places) who answered questions surrounding sleep challenges for toddlers. Dr Canapari is a father to 2, a pediatric pulmonologist & sleep expert, and is thinking of starting a blog! He told me that when he was a kid he, “definitely did have problems falling asleep sometimes,” so not only is he an expert, he’s experienced! Check out his responses here and leave comments and questions — I’ll get him back on the blog to respond as needed.

Why does my toddler wake up at night?

Every parents has experienced the dreaded 2 AM call. You hear your little one stirring on the monitor. Either you wait, fingers crossed, to see if they go back to sleep and they don’t, or you run in there as fast as you can to stuff the pacifier in their mouth before they really wake up. Most babies are capable of sustained sleep (6-8 hours in a row) at night by age six months. If you are nursing your child, it may take them a bit longer to achieve this. I think that it is reasonable that every child should sleep through the night most nights by 9-12 months of age. Now, every child wakes up sometimes at night. I view the awakenings as a problem if they are more than a few minutes in duration, occurring multiple times at night, or resulting in significant daytime irritability for either the child or the parents.

If your child is having problematic nocturnal awakenings, there are a few possible causes: Read full post »

What Does TV Do To My Kid’s Brain?

If you want to understand more about the effects of television on the brain, you need to watch this TEDx talk by Dr Dimitri Christakis…the science around television and its effect on children and concentration astound me. Not because any of it is counter-intuitive, but because television is as powerful as it is. Television is a [large] part of most children’s lives here in the US and this presentation of fact and observations may change what you do at home. Although it seems like there is no controversy here, last week I stumbled upon one mom proclaiming the benefits for TV at bedtime from infancy up.

We gotta get the word out.

A few take-aways on media and early learning:

  • Early experiences condition the mind. Connections between brain cells change based on experiences our children have while their brain triples in size between birth and age 3.
  • Initiation of television viewing is now (on average) 4 months of age.
  • Prolonged exposure to rapid image changes (like on a TV show designed for an infant) during critical periods of brain development may precondition the mind to expect high levels of stimulation. This may then make the pace of real life less able to sustain our children’s attention. The more hours a child views rapid-fire television, the more likely they will have attention challenges later in life.
  • Cognitive stimulation (reading books or going to a museum) reduces the likelihood for attention challenges later in life.
  • What content your child watches on TV matters: the more frenetic or violent the TV show, the more likely your child will have attention challenges later in life. Television shows that move at a typical pace may be far better for our children.
  • New studies (using mice) may demonstrate that learning suffers with excess TV viewing.
  • We need more real time play for children. (Get out the blocks or get outside!)

I’d suggest the 15 minutes or so it takes to view this video might profoundly change your thinking about TV. Direct from the mouth of a father, pediatrician, and researcher, Dr. Dimitri Christakis explains how the brain develops, what television may do, and theorizes why ample time in front of the TV as an infant and/or toddler may reorganize how a children thinks and solves problems. More than anything, watching this made me want to reverse time and go back to do even more for my little boys and their developing brains. If only the daily museum trip was plausible…

Enjoy, leave any comments or questions, and I’ll wrangle up Dr. Christakis for specific answers, as needed.

2011 Greatest Hits

I continue to feel privileged to share my thoughts here. Blogging has become a huge and stable part of my life. When I celebrated my 2-year blogging birthday back in November, I realized sharing insight online is a pillar in my job as a physician. I suspect providing insight and expertise will be more and more a part of the job of my peers as time unfolds. And I remain convinced that as long as patients are online, I must be, too. Reality is, I have more time online with some of my patients than I do in the exam room. I believe this experience is a peephole into the future of elegant, efficient health care. And I trust this is just the beginning. 268 posts and counting…

Here’s a line up of the “greatest hits” from 2011. I must admit I was somewhat surprised by the list, but these are the 10 posts that resonated most (as indicated by number of times viewed) over the calendar year although not all of them were written in 2011. Some recent posts were nearly in contention for the top 10 but just haven’t had the shelf life as those from early in 2011. From the Tsunami in Japan to the adventures in potty training to one incredible, heart felt guest post!

Thank you to all of you for joining me here and for teaching me so much. I am constantly and forever indebted to you…

Seattle Mama Doc 2011 Top 10 “Greatest Hits”

  1. Science Of The Soft Spot — Science of the soft spot in babies (anterior fontanelle) including a 3D CT scan reconstruction of an infant skull.
  2.  If It Were My Child, No Tylenol Before Shots — Some data behind why I believe there is no good reason to pre-medicate with acetaminophen prior to shots.
  3. Colic, Crying And The Period of PURPLE Crying — An overview of “colic” and baby crying in first few months as well as a link to a Good Morning America Health interview I did.
  4. Japan Tsunami: Reminder To Prepare — How to prepare your home and family for an unexpected catastrophic event.
  5. Fast Paced Media And Four Year-Olds: Cartoons On The Brain — A post about new research exploring the effects of fast-paced cartoons over slower ones on the executive function of 4 year-olds.
  6. If It Were My Child, No Baby Food Before 4 Months — Research finds early introduction of solid foods may increase risk of obesity.
  7. Four Hours On A School Bus — A guest blog from an incredible friend about the “food allergy tax” & how parents go well out of their way to protect their children with severe food allergies, over and over again.
  8. Radiation Disasters: No Potassium Iodide — After the horrific tragedy in Japan, many families worried about effects of radiation moving over the West Coast of the US. This is an overview of the risks of radiation and why I didn’t recommend using potassium iodide (KI) in children.
  9. Pull Ups & Potty Training — An overview (and video) on how and why to ditch the diapers at night as soon as you can…
  10. Treating Ear Infections With Antibiotics — New research (Jan 2011) on using antibiotics for ear infections. A reminder of how less really can be more.

So that was 2011. The blog has had a big spike in readership this last month and we’ve welcomed many new visitors. So I wonder, what do you want to hear about in 2012? I have a series of posts I have been working on about the HPV vaccine, another on sudden cardiac death screening, and one post brewing about IQ testing in children. But what else are you waiting for? Tell me and I’ll do my best to heed the call.


What Is A Foreskin? Mama Doc 101

Caring for your son’s foreskin is pretty much a hands-off job. But knowing what is normal and how your son’s foreskin develops and changes over time is essential for every parent to a boy with an uncircumcised penis.

In the beginning, during infancy, your son’s uncircumcised penis needs no special care. The foreskin is a piece of skin overlying the outside of your son’s penis. You never need to pull the foreskin back or detach it in any way. You clean it just like any other skin surface on his body.

Over the first 5 + years of your son’s life, the foreskin will gradually “retract” or pull away from the head of his penis. This happens without intervention as the connective tissue bonding the foreskin to the head of his penis dissolves on its own. As this happens, you can teach your son to wash the end of his penis with soap and water and rinse it well. Some boys will be able to fully retract or pull back their foreskin by the time they start Kindergarten while others may not fully retract it until puberty. Both are okay. Read full post »

Four Hours On A School Bus

A good friend wrote a “secret, imaginary blog post” and sent it my way. I realized instantly it was a real blog post. But to protect her son and allow the imaginary (blog) to become real, she called upon her childhood and the beloved author Judy Blume, for help. She chose the pen name Veronica:

Then Nancy decided we should all have secret sensational names such as Alexandra, Veronica, Kimberly, and Mavis. Nancy got to be Alexandra. I was Mavis.
Are You There God? It’s Me, Margaret by Judy Blume

Veronica is an awesome friend, a passionate researcher, and mom to two. Like all of us she has stumbled upon unexpected challenges in protecting her children from harm. In particular, protecting her son with severe food allergies. Her post helped me see more clearly what it is like to love and to care for and to support a child with severe and life-threatening food allergies. What it is like to wave good-bye for a day of school…and house worry. And really, what it is like to have no choice but to go well out of the way.

Enjoy her post. Tell us what you think. Share what you do to protect and support your own children with food allergies. If you’re looking for online information about food allergies, Veronica likes going to Food or Kids With Food Allergies:

Four Hours On A School Bus: Parenting & Severe Food Allergies

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How To Dose Acetaminophen or Ibuprofen

Earlier this year, the FDA recommended the discontinuation of infant acetaminophen drops. The goal was to minimize confusion by only making acetaminophen (aka Tylenol) in one universal liquid strength for both babies and older children. However, because the FDA provided a recommendation and not a mandate, there are currently two different liquid acetaminophen preparations on the shelves marketed for babies. And another liquid marketed for older children. Ultimately, it may be more confusing than ever. Thank goodness I just got a little help from my friends…

The pharmacists at Seattle Children’s Hospital created the below handouts designed to clarify dosing for infant and children’s over-the-counter (OTC) fever reducers/pain relievers. Print them out and put it in your medicine cabinet. Review it with Grandma or the sitter or your partner. And remember, the most important way to avoid a dosing error is to keep the original dosing device with the actual OTC medication. Resist the urge to grab a kitchen spoon!

Check out a video I made last year about common OTC medication dosing problems. The numbers will surprise you (hint: nearly all pediatric OTC meds in the US had inconsistencies, superfluous, or confusing dosing instructions). Dosing medications for our children can be more complicated than we’d like. So let me know what else you want to know about dosing acetaminophen or ibuprofen.



Fast-Paced Media And 4 Year-Olds: Cartoons On The Brain

A new study, along with an incredible editorial, was published today in Pediatrics about the effects of watching fast-paced cartoons on the attention and working memory of 4 year-olds. It’s basically a Spongebob versus Crayola versus Caillou show-down. At least it feels that way in the media summaries today. And thus, it’s bound to hit the front pages of every parent’s windshield. First and foremost, it’s a genius study for getting the word out and attracting media attention–media love to talk about media. Especially when it comes to the effects on children; all forms of media are looking for a viable option for longevity. There is just so much competition now.

Also, the study is interesting. Plain and simple, I couldn’t wait to read it. We watch Caillou around here and my husband and I like to dissect and ridicule it (in private)–everything from the outfits to the color scheme to the lessons. As a parent, it’s kind of painful to watch–its just so utterly wholesome and slow. On the flip side because of this goodness in the the content and pace, we feel less “guilty” letting the boys watch it. The result has been a win-win: the boys looooooove it–I mean, love it–and we pat ourselves on the back for the choice. Good media is far better than bad media, we think. Fortunately, the data backs up our instinct. And this helps with our mommy-daddy-guilt. We’re a really low media viewing house, but not the lowest. We have friends whose children don’t see a screen for months at a time. Read full post »

Pull Ups and Potty Training

My take on Pull Ups: get out of them as soon as possible! Easier said than done, of course.
Bed wetting is a common challenge for children (and their families). If your child is wetting the bed you certainly know that may be the understatement of the week. You’re not alone in your struggle to help your child stay dry at night, even if it feels that way at times. Know this, I talk about bed wetting every single week in clinic.

Bed wetting is familial and fortunately, often improves simply with time. Watch the video for more information, but the cliff notes: although Pull Ups are convenient, at times they may hinder and prolong bed wetting. If your child is potty trained but wears a Pulls Up/diaper at night, never having tried a night without them, there may be less incentive to potty train. Achieving nighttime dryness demands connecting their brain with their bladder. If there is a diaper on, there may be less motivation to form this connection.

Of course, achieving full potty training success is a huge milestone in every child’s life. It’s a big one for most parents, too. Remember, bed wetting is seen in up to 40% of 3 year-olds, 20% of 5 year-olds and even 10% of 6 year-olds. Watch the above video for my take on Pull Ups and ways to support your child, when ready, to ditch them.

Potty Training and Pull Ups, DO:

  • Try to get out of the Pull Up from time to time. Don’t force it, but if you child is interested in giving it a try without one, do it!
  • Set your child up for success: limit fluids after bedtime, consider waking them to pee at 10 or 11pm, and light the path to the potty so they know how to get there in a hurry.
  • Tell your child it’s not their fault for wetting the bed.
  • Tell your child if one of their parents was a bed wetter. Chances are, they were! Provide them support.
  • Celebrate success whenever it happens (any dry nap, dry night, less pee than usual, getting from the bed to the potty in the middle of the night).

Potty Training and Pull Ups: DON’T:

  • Don’t punish a child for wetting the bed. Even when you’re uber frustrated cleaning the sheets for the one hundredth time, to do your best to hide disappointment when your child wets the bed. This will only increase your child’s anxiety and frustration.
  • Don’t assume your child can’t make it through the night without a Pull Up. If they are dry during the day and dry during naps, I’d certainly give it a try without them.
  • Don’t force your child out of diapers or Pull-Ups if they resist. If resistance arises, back off and try again in a few weeks or month’s time.