Seattle Mama Doc 101

All Articles in the Category ‘Seattle Mama Doc 101’

PG-13 Movies


PG-13 movies now have more gun violence than R-rated ones.

I was in fourth grade when Red Dawn debuted as the first PG-13 rated movie back in 1985. At the time Red Dawn was released, it was considered one of the most violent films by The National Coalition on Television Violence, with a rate of 134 acts of violence per hour, or 2.23 per minute. And although not every PG-13 movie has had significant violence (think Pretty in Pink) it turns out PG-13 and gun violence have become close bedfellows over the last 28 years.

New research out today in Pediatrics finds that gun violence is becoming a more common thread in the movies. Researchers sampled 945 films (all from the top 30 grossing films annually) since 1950, coding and evaluating 5-minute violent sequences in those films. The results proved unsurprising but unsettling: overall gun-violent sequences more than doubled in the sixty years from 1950 to 2012. When looking specifically at PG-13 movies researchers saw a tripling in gun violence since the rating was created in 1985. The trend for violence in these PG-13 movies has grown so rapidly it’s created a new reality. Over the past 30 years, R-rated movies have shown no change in the amount of gun violence sequences while PG-13 have soared making gun violence more prominent in PG-13 movies than in R-rated movies. Stunning when you think of it — gun imagery densely populating the movies targeting our teens. Yes, violence sells.

Read full post »

Numbers For You On Flu

>

It’s time for flu shots. Winter respiratory season is on its way and, “The single best way to protect against flu is to be vaccinated every year.” Ideally your child (and you) will have had the flu shot at least 2 weeks prior to any exposure to the virus. If your infant, child, or teen hasn’t yet had their flu shot call today for an appointment. Waiting provides no added benefit and only increases the time a child is more susceptible to getting influenza this season.

Listen to the video for information on quadrivalent versus trivalent flu shots, options for nasal flu spray (NO POKES!), and new viruses included in this year’s flu shot.

Information For Parents Online: Protection from Flu Shots

Undervaccination

There isn’t a lot of research on children’s safety when a child is on an alternative vaccine schedule. While we clearly know that the longer you wait to immunize a child for vaccine-preventable illnesses, the longer the window of time a child is left susceptible, there isn’t a huge data set on children who are late to get shots or who are considered “undervaccinated.” Although it’s intuitive to think that a child who is not getting immunizations on time is at higher risk for infections (particularly during times of epidemics), it’s helpful when the science backs up our instinct and thinking.

This is likely something you already knew but there’s new research to compound our understanding.

Children Late On Shots Are At Risk For Whooping Cough

Recent pediatric research found that when it comes to whooping cough, children who were late on getting their shots are more prone to infection. In fact the more doses of the DTaP shot that a child misses, the more likely it is that they could be diagnosed with whooping cough.

A JAMA Pediatrics study published online in September 2013 evaluated children between 3 months to 36 months of age. During the first three years of life children are recommended to have 4 doses of the DTaP (Diphtheria, Tetanus, and Pertussis) shot starting at 2 months of age. In the JAMA matched case-control study children who were late on 3 doses of DTaP were 18 times as likely be diagnosed with whooping cough compared to children who were up to date on their shots. Children unvaccinated (missing 4 doses of DTaP) were 28 times more likely to be diagnosed with whooping cough when compared with fully vaccinated children.

The takeaway reminder? When you start a series of immunizations for your children, make sure you complete all shots in the series. Most experts believe children aren’t fully protected from whooping cough until they’ve received 4 doses of DTaP (at 15 months of age if on-schedule).

We have to finish what we start — another reason to get in on-time for well-care visits during the first few years of a your child’s life. And as a final note, the value of well-child care extends well past immunization.

Texting And Driving Again


The research published about texting and driving never seem to add up to my in-real-life experience. In a typical day driving in Seattle I see countless people with their phones out, many with it wedged at the steering wheel, stuck between their right hand and the right turn signal post. Like all of us have come to observe, it’s the unusual or unexpected driving patterns that alert me to look into their car window and confirm my suspicion.

I hate feeling like an old lady, angry at those few reckless decision-makers who compromise my family’s safety on the road. I also hate feeling powerless amidst the problem. After a few feeble and failed attempts to influence others’ decisions on the road (waving my hands, pointing my finger or honking my horn and screaming in my fury), it’s clear to me that we citizens can’t police the issue. Further, trying to change others’ behavior from our own driver seat is an entirely imperfect solution – yet another distraction. I can’t help but ranting that I remain angry about this significant human frailty–the inability to follow the law and put down the devices and drive. Read full post »

Why You Should Make Sure The Helmet Fits


Buying the bike helmet isn’t enough, of course. We have to make sure our children actually wear them. We’ve gone through phases at our house (loathing to loving the helmet). The challenge isn’t often buying the helmet, it’s getting that helmet on every time and fitting it properly. I’ve learned the hard way– -after I pinched the skin on O’s chin a few times, I wasn’t even allowed to be the one helping him get it on!

Despite my lack of popularity with the boys on helmets, I’ve maintained hard rules: if the helmet isn’t on, the bike goes away and can’t be used for another 24 hours. I see helmets without buckled straps or hanging off the back of children’s heads everywhere I go. It wasn’t until I wrote a blog post about helmets when my oldest started to bike a few years back I learned to fit one properly.

Wearing a helmet reduces injury from bike & bike-motor vehicle accidents over 80% of the time. If the helmet isn’t snug and fit properly, it is far less likely to reduce injury. Hundreds of children and adults die annually in the US on their bicycles (primarily when struck by a car). Because 3/4 of all deaths on bicycles come from head injuries, wearing a properly fitting bike helmet can be a huge win. I hear over and over from children and parents in clinic that even though there is a helmet in the house their child isn’t always wearing it.

Further, when I review how important it is that the helmet fits, children and teens will often tell me they aren’t likely wearing it correctly.

Fitting A Bike Helmet

correct helmet fitYou want to ensure the helmet fits properly in 3 locations: above the eye, around the ear, and under the chin.

Eye: The helmet needs to be level on your child’s head (not back on their head like a baseball cap or yamaka) and needs to be positioned squarely on the forehead. Check with your fingers that the helmet is just 1-2 fingers above the eyebrow line.

Ear: The helmet straps should lie flat against their head (no twists!) and should form a “Y” shape just under the ear.

Chin: This is likely the point of most contention with children! The strap needs to be snug. Your child can help do the buckling (to avoid the dreaded pinched skin) but you make sure they are adjusted to the correct length. It should be snug enough to allow only a finger between the strap and chin with their mouth closed. When your child opens their mouth up wide, it should cause the helmet to move down on their head (see the video).

Read full post »

Teens Girls And Pelvic Exams

Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.

About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. The American College of of Obstetricians and Gynecologists (ACOG) published a statement in 2012 outlining rationale for speculum exams and guidelines that support waiting until age 21 years in the absence of a health problem.

Some teens will need a visit with the gynecologist during their teen years because of health concerns, symptoms, or a desire for a long-acting reversible birth control like an IUD (intrauterine device) or implant. IUDs and implants are considered first-line birth control for teens now. The experts say these implantable devices methods are “top-tier contraceptives based on effectiveness, with pregnancy rates of less than 1% per year for perfect use and typical use. These contraceptives have the highest rates of satisfaction and continuation of all reversible contraceptives. Adolescents are at high risk of unintended pregnancy and may benefit from increased access to these methods.” Some IUD devices use hormones, some do not. Intrauterine devices can be inserted for up to 5-10 years depending on which type a teen chooses. In general, teens will need to see a gynecologist for an IUD placement.

The National Center For Health Statistics reported a near 50% decrease in teen pregnancy over the last 2 decades.

For routine care, teens should see their pediatrician every year for regular, routine well-teen care, teen vaccinations (including the HPV vaccine), and to obtain annual screening for sexually transmitted infections. Sexually active teen girls will need annual urine tests for gonorrhea and chlamydia and blood tests for HIV. We really want to grant teens access to private counseling, support, education, family planning, and well care during high school and don’t want them to erroneously worry about routinely having a pelvic exam. Read full post »

Love The Sun, Protect Your Skin

Sun protection is essential in childhood. Here’s 3 golden rules, backed by science, for you to use when purchasing, applying/re-applying sunscreen, and protecting children from the sun. Remember, more important than any ingredient or any particular SPF number or brand is the way you use a sunscreen: the best sunscreen is one used early and often.

Sun-protective clothing (those UV shirts, shorts, and hats) is an awesome, affordable, and easy way to protect children from sun without the hassle of sunscreen. Risks for skin cancer increase with sun exposure, family history, and sunburns in particular. Protecting your children from excessive sun exposure and sunburn is an anti-cancer move. That’s power.

3 Rules For Protecting Children From Sun Exposure

  1. Respect the brilliant sun; know your local risk. Enjoy the sun but be smarter. After surviving melanoma, I’ve been forced to change the way my family lives with the sun to decrease our risks. I’ve learned a ton about letting the UV index guide me. UV index is a measure of the radiation you are exposed to when outside. Radiation from the sun increases cancer risk, increases skin aging (wrinkles!), while it decreases eye and immune health. UV index varies with the time of year, the type of weather, the latitude, and the time of day. Check out your UV index today (by zipcode) and download the free app (search “UV index” in your smartphone). Make a habit to check the UV index every day to get a sense of your family’s exposure–I guarantee it will surprise you. Even on cloudy days, the UV index midday can rise to levels that will encourage you to protect your skin. Don’t be scared of the sun, just be smarter. Read full post »

You Can Help Prevent Shaken Babies

Babies get shaken most after periods of inconsolable crying. Since April is Child Abuse Prevention month, here’s some information on abusive head trauma (previously know as “shaken baby syndrome”) and ways you can help support new parents with babies who cry.

All babies cry. But some babies cry more (see the graph in the video). Babies do follow predictable patterns in crying: most babies start crying around 2 weeks of age and their crying peaks by 2 months, then tends to resolve around 3 to 4 months of age. But there are some babies who simply cry more than others. Dr Ronald Barr has researched crying in infants for over 30 years and developed the PURPLE period of crying based off data on all types of infants. Learning about the PURPLE period so you can help reassure families that they aren’t doing ANYTHING WRONG when they have a fussy baby. It’s okay that a baby fusses and cries, particularly at peak times (around 2 months of age, in the evening), our job as parents and community members is to support parents dealing with this fussiness.

Crying is aggravating to all of us. When I spoke with Dr Ken Feldman, a pediatrician and expert in shaken baby syndrome (now called abusive head trauma), he reminded me of a startling finding. He mentioned a North Carolina study found that 20% of parents surveyed admitted to shaking a baby out of frustration at some point.

You’re not alone if you’ve felt overwhelmed while caring for a cranky baby.

Take turns soothing fussy babies. Put babies in their cribs on their backs if you get really frustrated. It’s always okay to walk away from a really cranky baby for a 10-15 minute break!

Read full post »

Why Do Babies Wake Up At Night?

Most babies wake up at night. And although some superhero babies sleep 10-12 hours straight starting around 3-4 months of age, most infants wake up during the night and cry out for their parents. There are scientific reasons and some developmental and behavioral explanations for these awakenings. I spoke with my friend Dr Maida Chen, a pediatric pulmonologist, mother to three, and director of the Pediatric Sleep Disorders Center to put a list together regarding why babies do this. Leave questions and comments below if we can explain more. I’ll author a follow-up blog on ways you can help your baby when they wake up, too.

10 Reasons Babies Wake Up At Night:

  1. Sleep Cycle: Babies wake up during the night primarily because their brain waves shift and change cycles as they move from REM (rapid eye movement) sleep to other stages of non-REM sleep. The different wave patterns our brains make during certain periods define these sleep cycles or “stages” of sleep. As babies move from one stage of sleep to another during the night, they transition. In that transition, many babies will awaken. Sometimes they call out or cry. Sometimes they wake hungry. It’s normal for babies (and adults) to wake 4-5 times a night during these times of transition. However, most adults wake up and then fall back to sleep so rapidly that we rarely remember the awakening. At 4 months of age, many parents notice awakenings after a first chunk of deeper sleep. This is normal, and often due to development of delta wave sleep (deep sleep). The trick for parents is to do less and less as each month of infancy unfolds during these awakenings; we want to help our babies self-soothe more and more independently (without our help) during these awakenings so that sleeping through the night becomes a reality.

Read full post »

What You Should Know About Energy Drinks

I think of energy drinks as the new liquid accessory for many teens. Something to hold onto with nervous hands and something to spend money on when they’re really tired or need a “boost.” Teens report drinking them because of inadequate sleep, a need for energy, and wanting to mix them with alcohol. It’s big business to market energy drinks to those in high school or college and that big business is remarkably successful. More than a 1/3 of teens (39%) say they’ve had an energy drink in the last month and “jock identity” is associated positively with a frequency of energy drink consumption.

These drinks may really make you look cool…

College students may be even more compelled to drink them; one study found 50% of students had consumed at least one to four drinks in the last month. It’s hard to remember from our vantage point, adults aren’t really the target of energy drink advertising and sponsorships. Because of that paucity of advertising, only 15% of adults say they drink them.

Trouble is, there’s nothing really good for us in these energy drinks. We don’t ever need the caffeine, guaranine, ginseng, and sugar from these concoctions. Energy drinks can have 3-4 times the amount of caffeine in a regular cup of coffee but you may never know it. The labels can be opaque and misleading. The labels aren’t regulated and the content of caffeine isn’t mandated. A can of soda can have no more than 65mg of caffeine while one energy drink (Wired X505) has 505mg. I think this should make you mad.

A recent summary came out in Pediatrics in Review to help guide teens (and their doctors) on what they need to know. But many of us are still catching up. These are not “health” drinks although some of the claims on the bottle and advertising may suggest so. Most parents would prefer their athlete drink water over energy drinks. Thing is, their athlete would do far better. Caffeine can make you anxious, have palpitations, elevate your blood pressure, cause digestive problems, and increase insomnia. The sugar in these drinks will likely just add weight, not great energy, to your athlete.

Things To Know About Energy Drinks

  • Energy drinks are not regulated by the FDA like soda is. The FDA is investigating health effects but there are no current mandates in place for manufacturers. A can of soda is limited to 65 mg of caffeine. Energy drinks don’t have those limits and often the bottles and cans don’t even list all ingredients that have stimulant-like effects. Popular energy drinks have anywhere from 150mg of caffeine per bottle to up to 505mg. For reference, a typical 6 oz cup of coffee has about 100mg caffeine. Read full post »