Seattle Mama Doc 101

All Articles in the Category ‘Seattle Mama Doc 101’

Whooping Cough Shot: Does It Last?

A study published today in The New England Journal of Medicine evaluated the duration of protection against whooping cough after children get the DTaP shot.  Researchers wanted to find out how long the shot lasts. DTaP shots are given to infants, toddlers, and kindergarteners (schedule below) to protect them from three infections (Diptheria, Tetanus, and Pertussis –whooping cough). After these childhood vaccines, we give a “booster” shot at age 11. Because we know that many babies who get whooping cough are infected by teens and adults, all teens and adults are now recommended to get a Tdap shot to protect themselves and those vulnerable against whooping cough.

As researchers seek to understand the recent epidemics of whooping cough in the US, they have found more and more that the causes of these epidemics are multifactorial. Not only is it unvaccinated populations that allow epidemics, it may be waning immunity from shots given previously and waning immunity to natural infection, as well. Previously, it’s been estimated that our immunity to whooping cough wanes anywhere between 4 and 20 years after we get whooping cough, and that it may wane 4 to 12 years after the shot.

A little history: back in the 1990’s we switched from using the “whole cell pertussis” shot to using a vaccine that is “acellular.” Some health officials have had concerns that this “acellular vaccine” may not protect children as long. Although it does a great job protecting infants and toddlers, it may not last as long as previous immunizations. Some have wondered how long the kindergarten shot protects our children…

Physicians at Kaiser Permanente reviewed information about children in California during the 2010 whooping cough outbreak. What they found may have significant effects on how to protect our children going forward: Read full post »

Swim Lessons Before School

New data around the world has found that early swim lessons (between age 1 and 4) may confer added protection against drowning. Maybe a new rule should be swim lessons before the start of school?

Many parents tell me in clinic that they are terrified about their children drowning. If you’re one of those, arm yourself with information: read some of the links (below) and consider signing up for lessons. However, don’t use swim lessons as an excuse to decrease vigilance around the pool or lake or riverside. Young children between age 1 and 4 years of age drown the most. Drowning happens quickly, and sometimes it’s very quiet or even silent.

Information, Myths, Truths, And Opinion About Swimming Lessons And Water Safety

  • Never let an infant or toddler out of arm’s reach when swimming or playing in water. There is good data stemming from an article published in March of 2009 to suggest swimming lessons may prove to be protective against drowning. Drowning is the second most common cause of death from injury in kids less 14 or younger.
  • 6 myths about water safety  Read full post »

Surviving Tantrums: The Anger Trap

We survived one of the biggest tantrums of all time in June. At the Oakland, California airport check-in of all places. Did you happen to hear about it? I literally had to physically hold and restrain my son from running off into moving traffic. The tantrum caused for lots of staring and avoidance. It does feel like judgment sometimes, which only makes us feel worse. In a low moment, I explained to my 3 year-old that he was acting like an animal. I got progressively more and more embarrassed and progressively more and more frustrated. It was one of those moments we never expect and have a hard time forgetting. The forgiving, that comes easy. Have you read the book, How Do Dinosaurs Say I Love You? That helps, too.

Same thing happened this weekend. I missed a meeting when I got stuck in a tornado-like tantrum and spent a big part of the weekend trying to optimize ways to support my son to avoid tantrums. When it comes to tantrums, we all know we’re supposed to calm down, but it’s difficult to say the least. Our children find all of our hidden buttons and can escalate rapidly. You can’t avoid every tantrum, but some ideas to help you survive them more gracefully:

8 Tips To Survive A Tantrum

  • Giving your child enough attention and “catch them being good.” Provide specific praise in successful moments. However, don’t feel that if one child tantrums more than another that you aren’t providing enough attention. Personality is infused in behaviors, including tantrums.
  • During a tantrum give your child control over little things (offer small, directed choices with options rather than Yes/No questions). Read full post »

Why Broad Spectrum Sunscreen?

I’ve written about sunscreen before (Protecting Children From The Sun, 10 Tips on Tanning, & the video on Protecting Infants included below). More important and than any granular, scientific detail about a sunscreen ingredient, UVA/UVB radiation, or it’s vehicle– a spray or a lotion or an ointment–is how you use it. The best sunscreen is the one that is used early and often on children. No sunscreen is waterproof and no sunscreen is play proof. For infants and toddlers, I’ve found the best trick for easy application is to put it on while they are strapped into the car seat on your way to the beach! There’s no controversy that it’s best to apply sunscreen 20 minutes before sun exposure and repeat the application head to toe every 1-2 hours during active play/swim.

Don’t be fooled– sunscreens marketed for children may not provide any increased safety or protection. You’ll see and hear conflicting reports on ingredient safety, particularly as differing groups discuss concerns about chemical ingredients versus physical/mineral ingredients. Trouble is, groups now warn about the physical/mineral ingredients (previously felt to be the safest) due to their particle size. And although the FDA warns against using spray sunscreen with children (concerns about inhalation of the fumes) most families love the convenience. Here’s a comprehensive, current review on ingredients & safety.

Good thing is, most everyone agrees that the ingredients in sunscreen are less risky than any significant sun exposure or burn in childhood.

The video above explains the need for broad spectrum protection. You’ll need to look for a sunscreen that has 2 or 3 ingredients to cover all the range of UVA and UVB rays that damage our skin. Here’s the American Academy of Dermatology’s tips.

A Little Science About UVA/UVB Light & Sunscreen:

  • UVA radiation causes Aging and deeper skin damage. To protect against the entire spectrum of UVA rays, you’ll likely need two ingredients in the sunscreen–most commonly you will see oxybenzone or avobenzone coupled with another (zinc oxide, titanium dioxide, for example) to cover the entire UVA spectrum of light. Although some people report concerns about oxybenzone’s irritation to sensitive skin, recent research finds when it’s only at typical 1-6% concentrations, skin reactions are unlikely. If using a sunscreen for the first time, apply a small patch of sunscreen to your child’s leg as a test before using it elsewhere. UVA radiation is constant throughout the year, regardless of season or heat index. Read full post »

Your Friend’s Pool: Drowning Risk

New research shows that there is a 6-fold increased risk for drowning when at the pool of a friend or relative.* Something about being at the home of a friend or relative may change the way we supervise our children. In the Florida study, 79% of patients that were seen in an ER for drowning accidents were at a home pool.

We also know that young children under age 5 drown more in home swimming pools than anywhere else. Anyone can drown in any body of water. But more than anything else I can say, know that children are more vulnerable to drowning due to their size, maturity level, insatiable curiosity, swimming skill level, familiarity with water, and communication skills. Babies and children can drown in any collection of water over 2 inches deep. The Florida research also shows that where we are and who we’re around while swimming may change levels of supervision and distraction.

Plan Ahead When Children Swim in Pools:

  1. Never let anyone swim alone.
  2. When swimming, young children need constant eyes-on, non-distracted supervision. Put down the book, put down the cell phone, and put down the alcohol. As best you can, focus only on your children. There are too many tragic stories of quick phone calls and book chapters that have left children unprotected. If you’re at a party, designate one adult to provide constant supervision.
  3. Know about safety equipment present at the pool, watch for risks from entrapment around drains, pool covers and pool equipment, and have a phone nearby. Call 911 immediately if you’re concerned about a potential drowning accident — seconds matter.
  4. Enroll your children in swimming lessons and update their skills every single year. However, never trust swimming lessons to be protective for drowning. Your supervision is paramount. I’ll post more on this next week.

Drowning injuries and deaths are preventable but often silent and quick. Young children under age 5 drown more than any other group, but nearly 1000 children die annually from drowning.

 Resources on Drowning Prevention

*When I say “drowning victims” in the video, I didn’t mean to imply all those patients in the study died. Of the 100 study subjects with drowning accidents, only 10% had life-ending drowning accidents. Fortunately, 90% of the patients that presented to the ER after a drowning accident survived and had full neurologic recovery.

Understanding Risks For SIDS

New research helps clarify ways we can reduce risks for Sudden Infant Death Syndrome (SIDS) or Sudden Unexplained Death in infancy. A recent Pediatrics study found that the convergence of risks (see diagram below & listen to video) for infants is meaningful–reducing number of risks may reduce SIDS deaths. Avoiding multiple and simultaneous SIDS risks may help– especially for babies who are vulnerable due to family history, genetics, prematurity or prenatal exposures. Further, research published the same month in The American Journal of Public Health (April 2012) confirms that sleep environment hazards (co-sleeping, soft sleeping surfaces, shared sleep surfaces with people or animals) contribute to SIDS. 70% of infants who died from SIDS were sleeping in a surface not intended for infant sleep (adult bed, couch, chair) and 64% of infants who died were sharing a sleep surface, with half sharing with an adult. We can decrease SIDS risk by controlling our baby’s environment, knowing their vulnerabilities, and sharing what we know. Put babies on their backs without soft bedding (bumpers/pillows/blankets) in their own crib until 1 year of age.

Read full post »

Surviving Separation Anxiety

Separation anxiety varies WIDELY between children. Some babies become hysterical when Mom is out of sight for a very short time, while other children seem to demonstrate ongoing anxiety at separations during infancy, toddlerhood, and preschool. I’ve got one of each in my home. The trick for surviving separation anxiety demands preparation, brisk transitions, and the evolution of time. I would suggest we parents suffer as much as our children do when we leave. Even though we are often reminded that our children stop crying within minutes of our leave-taking, how many of you have felt like you’re “doing it all wrong” when your child clings to your legs, sobs for you to stay, and mourns the parting? As a working mom, separation anxiety creates questions for me. Although it is an entirely normal behavior and a beautiful sign of a meaningful attachment, separation anxiety can be exquisitely unsettling for us all. Here are facts about separation anxiety and 6 tips to improve the transitions I’ve learned the hard way (I’ve made about every mistake). Read full post »

Picking A Summer Camp

As you construct a schema for your summer, plot vacation time, and plan for summer camps, more than anything I think you should build in some unstructured time. Carve out hours, half, or even full days each and every week with an absent itinerary. Wide-open days inspire creativity (in us all) and allow children to stumble upon a little boredom. I would suggest boredom is a helpful tool for everyone here and there, especially our children. Just think of the motivation that comes from it! Read this perspective: What Caine’s Arcade Teaches Us About Modern Parenthood.

Good thing for those of us who are less organized: unstructured time comes without difficulty as the camps fill up and we run out of options. Now (May) is the time to sign up for many camps, so get on it. The unstructured time I mention is only delightful if peppered into a summer filled with adventure and discovery. Summer camps offer a great place and space for fostering independence, building skill and esteem, and forging new friendships. Choosing a camp may feel entirely daunting if your child has special health needs, you have limited money for camp, or you’ve never separated from your child for long periods prior. Here are a few tips and resources I’ve found that may help: Read full post »

Concerns About Autism: Reasons To See The Pediatrician

When it comes to autism, we’ve all been rocked by the recent CDC data that found ongoing increases in the number of children diagnosed with autism annually; it’s estimated that 1 in 88 children has autism in the US. The rates are unfortunately higher for boys. The number is unsettling to say the least, particularly as the cause of autism is multifactorial and not entirely understood. Although we know genetics and family history plays a role, we don’t know what causes the majority of autism.

Read more about the science of autism from Autism Science Foundation.

We do know one thing: research proves the earlier you intervene to get a child additional services, the better their behavior, the better their outcome, and the better their chances for improved communication. You don’t need a diagnosis to access services for your child.

When you worry and can’t find resources online that reassure you, it’s time to check with your child’s clinician. That’s the point of a real partnership and a true pediatric home. Fight to find one if you don’t already have one. Fight to improve yours if it’s imperfect. The feedback I receive from families in my clinic allows me more leverage to make change. We’re all responsible for improved health communication…

Signs of Autism In Infants & Toddlers:

There is not one specific behavior, test, or milestone that diagnoses autism. More than any one behavior,

  • You should observe your infant demonstrating curiosity.
  • You should observe your baby expressing joy nearly every day after 4 months of age. Your child should smile when they are 2 months old, 4 months old, 6 months old and thereafter.
  • Your child should show you they know their name by 1 year of age.
  • You should see that your child tries to communicate thoughts more effectively with each month that unfolds during infancy and toddlerhood.

Here’s a list of specific Autism Warning SignsRead full post »

How Do Doctors Screen For Autism?

Pediatricians, nurse practioners, and family doctors start screening your baby or toddler for signs of developmental or communication challenges like autism from the very first visit. As a pediatrician, how your baby responds to you (and to me) during the various visits during infancy and toddlerhood guide me in their screening. In the office I get to observe how a baby giggles, how they look to their parents for reassurance, how they try to regain their mom’s attention during our conversation, how they point or wave, how they respond to their name, and even how and why they cry when I’m around. Those observations in combination with family history, health exams, and parental perspectives remain extremely valuable for me in helping identify children at risk for autism.

However, more formalized screening is recommended at both the 18 month and 24 month well child check. In most offices, clinicians use the M-CHAT, a 23-point questionare parents fill out. Often, I have to help parents answer one question in particular, (“Does your child make unusual finger movements by their face”) but other than that, most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for autism and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a toddler at risk with additional genetic, neurologic, or developmental testing.

It’s important to note that screening isn’t diagnosing. If your child has a positive screen for autism, it doesn’t mean they will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about autism, don’t be shy. Read full post »