Toddler

All Articles in the Category ‘Toddler’

Measles At The Super Bowl

Like the makings of a Hollywood movie, I learned this week that there were an estimated 200,000 people in Super Bowl Village this past weekend in Indiana. Amongst them on February 4th, was one (or maybe two) child with infectious measles. Fortunately, the child didn’t attend the game. Yet, measles is highly contagious. The period of infectivity starts before symptoms in some cases and usually 4-5 days before the typical rash, when many think they have just a bad cold. Measles is spread by the respiratory droplets infected people share when breathing, coughing, or sneezing. And the virus can survive for about 2 hours on surfaces or in the air after a person leaves the room. Measles has a wild history and although most children/adults do well after recovering from the illness, measles can result in severe complications like pneumonia or encephalitis. Fortunately, the majority of those in attendance last weekend who may have walked by or been near the infected person were protected by the measles vaccine.

The incubation period (the time it takes to get sick after being exposed) is about 10 days with measles. So if unprotected people contracted measles last weekend, they may get sick this weekend or early next week. Hopefully, we’ll hear of no one.

Measles spreads easily. There are reports of measles infecting every single unvaccinated person at a picnic. The public health department, even here in Seattle, sent an advisory email last night with instructions for what we doctors should do if we suspect measles in someone who was in Indiana last weekend.

But this is a global thing not just a US national sport thing. Starting in 2009, the number of cases of measles rose sharply in Europe. In 2010 for example, there were over 30,000 cases of confirmed, reported measles and in 2011 (through October), there were over 25,000 cases, with over 14,000 cases in France alone. Fifty percent of those with reported measles were children, less than 14 years of age. Immunization rates for measles have declined in Europe and public health officials point to waning vaccination as one reason for the surge. Read full post »

An App For That?

Stop what you’re doing to read this The New England Journal of Medicine perspective by Dr Doug Diekema. It’s about vaccines, opportunities for health, and physician obligation. Written for physicians, it also speaks loudly to parents and includes a few very essential points. The whole time I read the article, my thoughts kept leaping to our imminent opportunities. Today, in 2012, we can harness the tools of social media and technology to solve many of these problems. It’s time. HPV vaccine? Varicella vaccine? Remember your yearly flu shot?  I really think there could an app for that.

Let me explain.

Dr Diekema opens describing a scene very typical in Seattle.

Recently, the mother of a young child confessed to me that she didn’t know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she’d like to follow an alternative schedule, the physician had simply acquiesced, leading her to assume that the recommended schedule had no advantage over the one she suggested.

Yes, the physician obliged her desired schedule for many reasons, I suspect: time restraints/desiring a partnership/a hope for future opportunities to provide education and update immunizations for the child. In a state (Washington) that leads the nation in vaccine exemptions, we encounter patients daily who prefer a delayed or personal schedule. I’ve written about parents and alternative schedules and physicians’ conditional comfort with alternative vaccine schedules. But when Dr Diekema mentions this family, he highlights what many pediatricians and family physicians realize: families may be clustered together in vaccine-hesitancy. Friends of friends instruct each about vaccine schedules and share beliefs about safety. We know that 40% of parents who use an alternative schedule create it themselves.

Family members persuade my patients not to get immunized. Even in the midst of a pertussis outbreak in the county in which I practice, grandparents and relatives of newborns refuse the Tdap vaccine. My patients are bombarded with advice and naysayers. Who we love (friends and family) and who we trust (friends and family) certainly affect what we do. My patients get confused. And most of health (care) conversations happen outside the exam room. Therefore, hesitancy clusters in neighborhoods naturally and poses regional risk. What if we had real time information about our schools? About our neighborhood? What if Google mapped our rates of protection from vaccinations? What if we had a smart phone app that provided us yearly data on school immunization/exemption rates when we selected a kindergarten? Why not an app for that? Read full post »

Carpooling Reduces Booster Seat Use

Survey results published this week found that the majority of parents report carpooling with their 4 to 8 year-old children. About three-quarters (76%) of those carpooling parents reported that their child used a booster seat when riding in the family car. But when carpooling–the seats were used far less often. For example, the survey found 1 out of 5 parents do not always ask other drivers to use a booster seat for their child. And only half of parents always have their child use a booster seat when riding with friends who do not have boosters. So what your friends do really may change what you do.

This makes sense. I guess. It’s clear people get tired of recommendations. Today, for example, when I sent out a link to the Washington State Booster Seat Law, someone replied on Twitter, “Oh come ON!” 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.

Learning To Lose?


We spent a fair bit of our time on vacation last week playing two games with the boys: UNO and Spot It. Our son F is wholly competitive; he likes to know all the answers and he likes to win. He really likes to play and giggles when things go his way or when throwing a SKIP or DRAW 4. But he is also beginning to show how much he hates to lose. It turns out he’s rarely wrong about things, so not having things go his way isn’t really a part of his evolving schema. Thing is, he is also really polite. So when his behavior disappoints us, he takes things seriously.

After losing at both UNO and Spot It Thursday afternoon he began collapsing in the chair, throwing his excess remaining (losing) cards onto the table (or the floor) in frustration. After a second dramatic display, I’d had it. I told him he must sit out a game the next time we all got to play. I used the rationale, “Your friends won’t want to play games with you if you can’t celebrate when they win.” And, “Everyone playing the game is aiming for the same goal, we all want to win. Sometimes it just won’t be in the ‘cards’ for you.”

The next game he got to play was UNO and his grandmother won. He said, “Congratulations, Grandma. Well done.” He held onto his cards. He smiled. It was verbatim to how I’d instructed him. And I must admit, something about it didn’t seem quite right.

About 2 hours later the husband read a passage out loud to me from The New Yorker about Peter Thiel and his desire to win, stemming back to his math prowess as a child and his inclination for chess.

He became a math prodigy and a national ranked chess player. His chess kit was decorated with a sticker carrying the motto “born to win.” On the rare occasions when he lost in college, he swept the pieces off the board; he would say, “Show me a good loser and I’ll show you a loser.”

And there you are. A parenting perplexity. The question really is, do you want to create an obstinate-genius-winner or a good loser? I must admit, part of me really doesn’t know. But I’m certain there is something in between…

Preschoolers: Movers And Shakers

The most amazing thing about vacation is how much time you get to spend outside and how much time you get to move. We’ve just returned from a week away where the boys spent the far majority of their days without a ceiling. Delicious.

Sure, it’s easy to live outside when you’re on vacation. The challenge is in our “normal” lives–the ones where we go to work, school, and complete activities. It turns out our parental efforts for safety and our need to cultivate “learners” may be getting the way of our children’s health. Sometimes we may be over-thinking things.

We’ve been touring preschoolers and kindergartens these past few weeks. I’ve been thinking a lot about the 3 dimensions in which our boys spend their days. So a qualitative study on preschool centers and physical activity published by the Academy of Pediatrics last week caught my eye.

Three-quarters of all preschoolers between the age of 3 and 5 years are in child care and more than half of them are in either preschooler, day care, or nursery school center. Most children spend the majority of their waking hours, after age 3, outside of their home. Many children spend very long days at school, leaving around 6pm to head home. After 6pm, there is little time for outdoor play. Read full post »

Preventing Scald Burns: Mama Doc 101

Scald burns are common injuries for young children that arise when our skin or our mouths and mucus membranes have contact with burning hot liquids or steam. Children under age 5 account for nearly 1 in every 5 burn victims each year in the United States. The bathroom and kitchen are the typical danger zones. Many burns come from liquids heated in the microwave but children are also commonly burned from scalding liquids or water heated on the stove or in the shower or tub. The video details ways to protect your children (and family) from a terrible burn. Fortunately, you can improve your child’s safety in a matter of seconds: today, turn your water heater down to 120 degrees Fahrenheit.

Preventing Scald Burns in Children

Be protective of young children around hot liquids from day one. Never carry hot tea or coffee while holding your baby. Insist on the same from anyone who has the privilege of holding your baby.  I’ve taken care of infants with severe burns and plenty of older children. Severe burns are not only extremely painful and onerously traumatic, they can lead to serious health complications and lasting disfigurement. Now is the time to protect your child.

Why Burn Doctors Hate Instant Soup

Safe Kids Fact Sheet

Home Safety Council Handout

Pee, Patience, And Parenting At 35,000 Feet

Recently while on the plane, O wet his pants. Lovely really. He’d refused to pee prior to getting on the plane. Refused to pee at home. Essentially, O refused to pee “on command.” No surprise for a strong-willed-spirited just turned 3 year-old. And after he wet his pants, he then proceeded to have about 14 accidents (yes, I’m exaggerating) later that same day as we traveled to his grandparents’ home. Instead of being patient, supportive, and perfect, the husband and I realized we were just plain-old disappointed. And full of judgment.

Potty training takes patience, perseverance and a positive attitude. Many days we don’t have all three, all at once.

O had mastered his potty-trained world well over the last month or so and the wetting accidents weren’t on our to-do list. He’d been dry all day for a number of weeks. The frequency he was wetting on that particular Wednesday coupled with the inconvenience of it being a travel day just wasn’t my pleasure. Although he’d delayed pooping in the potty for a few months (also totally normal but uber-frustrating, too), that had all resolved some months back. The accidents felt like an inconvenience. And although as a pediatrician, I know how to lend advice in this area, it’s the taking advice part that is more of a challenge.

After age 3, when a child shows resistance to using the potty the “right” thing to do, is to carry on with a smile, stop providing reminders for your child, show that you’re unflappable and continue to praise success. Ignore potty failures, praise potty success.

But it is a seriously difficult task at 35,000 feet when surrounded by pee. Consequently, we spent part of the holiday nudging each other about how terrible we were and how we needed to move from D&J (disappointed and judging) to P&C (patient and compassionate).

Read full post »

7 Truths About The “Stomach Flu”

As we hit hour 40, heading into day 2 of vomitorium here at our house (O has been sick), I will suggest a couple of things I know as a mom and pediatrician about gastroenteritis or the “stomach flu”:

  1.  Hand-washing and keeping things clean is your best defense from getting ill with a stomach bug. Not surprisingly, this is particularly true after touching or supporting your child and when preparing food and/or eating. Some viruses will survive on surfaces for days. And some viruses can even survive hand-sanitizer. But even with ridiculous meticulous detail to hygiene, every parent knows that when the vomit if flying it’s hard to lasso every single errant particle. So simply commit to do you best. Change the sheets and clean up areas of vomit immediately after supporting your child. Soapy warm water is your friend. Wash surfaces immediately, use hot water for the wash, and use high heat in the dryer.
  2. 24 Hours (or so) In general most pediatricians will tell you that vomiting doesn’t exceed 24 hours with typical gastroenteritis. But really, it can. Many kids don’t follow the rules. Once a virus that causes gastroenteritis takes hold of a child, vomiting starts. Children tend to vomit more than adults but I’ve never read or learned why this is. With most viruses that cause the “stomach flu,” as the infection moves through the stomach and intestines, vomiting stops after about 24 hours. But not always. If you advance liquids too quickly, or a child eats more solids than they are ready for, even after the first meal 1-2 days into eating again, they may have a vomit encore. If you have one of those, start back where you started (sips of clear liquids) and go very very slow advancing their diet. If vomiting is accelerating at 24 hours, it is time to check in with your child’s doctor.
  3. Disgusting & Terrifying It’s creepy-eepy to take care of a child with vomiting. Read full post »

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 »