All Articles in the Category ‘Toddler’

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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Avoiding Antibiotics Whenever Possible: Less Is More

I work hard (as do most doctors) to avoid prescribing antibiotics when unnecessary. The reason? I’m concerned about both the short term effects (diarrhea, rash, allergies) and long term effects (drug resistance, altered normal bacteria and microbes on our bodies) of antibiotic use in children. As we learn more about health and about the role of “good” bacteria in wellness preservation, I suspect we will feel more and more compelled to avoid antibiotics in children. Less is often more.

There are certain medical conditions that benefit greatly from antibiotics (Strep throat, pneumonia from bacteria, kidney infections, some severe skin infections, for example). Hands down, antibiotics save lives and prevent terrible infections when bacteria are to blame. But antibiotics are not without risk. And, we know that antibiotics do no good for children when viruses are the cause of the infection. The use of antibiotics when unnecessary, contributes to “unnecessary [health care] costs, avoidable adverse events, and the development of antibiotic-resistant infections” a study published today reminds.

The hard part for parents (and pediatricians) is knowing when bacteria are to blame and when they are not. Read full post »

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.



Halloween: Wicked Scary Tantrums

I like Halloween far more as an adult than I ever did as a child. At least that is how it feels now. Witnessing the excitement this year around casa Swanson has been a hoot. Not all easy though. Like I have mentioned before, holidays come with all sorts of novel stresses that our children experience differently. Then mix in a whole bunch of costumes and candy and…imagine.

On Friday, our little O had a mega-tantrum at the preschool parade. So loud, so ornery, so insistent that he never donned the costume and never got near walking in the parade. The tantrum ended only after arriving at home. I was feeling entirely terrible already as I was out of town and unable to make it to the parade, but when the husband called me at the airport and told me it was better that I wasn’t there after all, I felt even worse. The Mama-ache reached new heights. Although I mentioned that day one of preschool was a heroic moment, days 2 through 25 have been (typically) different.

Tantrums are wicked-scary-terribleness sometimes. The public grimaces, and then points and whispers and stares and judges. Our children’s friends and peers run the other way. And we parents look like out-of-control-bats. Tantrums can be very Halloween, actually. A post on the New York Times Motherlode blog yesterday couldn’t have come at a better time. Read full post »

How Much Milk? Seattle Mama Doc 101

We don’t need cows to survive but their milk sure does provide us with a convenient source of calcium. The amount of milk our children need varies with age. I outline needs in the video but know this, as your child ages from a preschooler to a school-age child to a teenager, their calcium needs increase. Of course, if your child doesn’t like milk or is allergic to milk products, you have plenty of ways to get them the calcium they need from other foods rich in calcium to fortified juices to calcium supplements and calcium-fortified bars.

Getting The Calcium Our Children Need:

  • Lowfat milk is an easy and affordable source of calcium, but it certainly isn’t the only one. Other calcium rich foods include soybeans (edamame), tofu, broccoli, spinach, and almonds. Click on that link for a comparison of how much calcium each food contains compared to a cup of lowfat milk.
  • Calcium needs increase by age. Here’s a chart that breaks it down by the milligrams of calcium kids need each day. If you’re not into counting milligrams of calcium, think of calcium needs by the glasses of milk need daily: about 2 cups for 2 to 3 year olds, 2 1/2 cups for 4 to 8 year olds, and 3 cups for rapid-growing 9 to 18 year olds.
  • You don’t need whole milk for proper nutrition after age 2. “Whole” only refers to the amount of dairy fats, not the amount of vitamins or protein. US Studies find that almost 1/3 of families still serve their older children whole milk. I recommend switching to lowfat milk once your child turns 2.
  • Fewer than 1 in 10 girls gets the calcium they need between the age of 9 and 13 years. Fewer than 1 in 4 boys in the same age gets what they need. I’m perplexed by the sex difference, but suspect it has to do with calorie restriction (read: dieting), cultural norms, and the vast array of alternative beverages marketed to teens. When I searched for an explanation, I found data on fur seals. If you know the answer, please leave a comment!
  • If you are concerned your child is lactose-intolerant (very rare prior to age 5 years) consider getting milk products that are lactose-free or getting pills from the doctor that help children digest the lactose (milk sugar).
  • If your child isn’t a milk-hound, consider finding ways to keep calcium-rich snacks within reach. For easy snacks consider a handful of almonds or a piece of low-fat string cheese. Leave them out and in arm’s reach after school.
  • And remember, the only two things your toddler to teen needs to drink on planet earth are milk & water. Everything else is an extra.

What Is The Tdap Shot? Seattle Mama Doc 101

Tdap is a shot necessary for all adults and children starting at age 11 that protects against infections caused by Tetanus, Diptheria, and Pertussis (Whooping Cough). Because of increasing reports of Whooping Cough and increased infant deaths in the last 2 years, we are working hard to protect infants, children, adolescents and adults from Whooping Cough (caused by Pertussis). Most importantly we want to protect our newborn babies from being exposed or contracting whooping cough. Whooping cough is most dangerous and most devastating (occasionally fatal) for newborn babies (under 2 months of age) and infants under the age of 6 months. If you are around a newborn baby it’s essential you’ve had a Tdap shot at least once as an adult. Watch the video for more.

Keep in mind, even fully vaccinated adults can get pertussis. If you are caring for infants or young children, check with your health care provider about what’s best for your situation.

What is Whooping Cough & How is it Treated (Link)?

WHEN TO CALL THE PEDIATRICIAN: Pertussis infection starts out acting like a cold. You should consider the possibility of whooping cough if the following conditions are present:

  • The child is a very young infant who has not been fully immunized and/or has had exposure to someone with a chronic cough or the disease.
  • The child’s cough becomes more severe and frequent, or her lips and fingertips become dark or blue.
  • She becomes exhausted after coughing episodes, eats poorly, vomits after coughing, and/or looks “sick.”

How To Protect Your Family From Whooping Cough

  • The best way to prevent Pertussis (Whooping Cough) is to get vaccinated.
  • Children 7 to 10 years old who did not have their full DTP/DTaP series (2,4,6, and 15 months shots) need a Tdap shot.
  • Children with either an unknown or incomplete shot record/history before age 7 years of age need a Tdap shot.
  • All adolescents with an up-to-date record need the Tdap shot at the 11 year old well child check-up/visit.
  • Anyone over age 11 who has not previously received Tdap – when indicated.
  • There’s no minimum interval between Td and Tdap vaccines. Meaning, if you for some reason had a Td (“tetanus booster”) in the last few years, you still need a Tdap now to protect against whooping cough(Pertussis). No 5-10 year interval is required between the shot.
  • Vaccine protection for pertussis, tetanus and diphtheria fades with time, so adults need a booster shot. Experts recommend adults receive a Td booster every 10 years and substitute a Tdap vaccine for one of the boosters.
  • Getting vaccinated with Tdap is especially important for adults who are around infants – new parents, grandparents, babysitters, nannies, and health care providers.

AAP Policy Statement on Using Tdap to prevent Pertussis

CDC: Protecting your family from whooping cough (Pertussis)

Limited Time At Well Baby Checks: Seattle Mama Doc 101

A recent study confirmed that there is limited time with pediatricians for well baby care. The Pediatrics study surveyed parents retrospectively about their well-baby visits with pediatricians; 1/3 of parents reported having less than 10 minutes with the doctor! I say this can still be a great place for partnership, reassurance, diagnosis, and care even if time is limited. As a parent, you have to be a pro, too. Plan ahead, prioritize questions for the doctor, and help set the agenda for the visit when the pediatrician walks in the room. It’s always okay to ask (anything) and it’s always okay to return for follow-up visit, too.

Maximizing Time With Your Baby’s Pediatrician:

  • Set an agenda. The minute the pediatrician walks in the room, tell them what you want to learn during the visit and what worries or stumps you most about your baby or your parenting. If you help shape the agenda, you’ll avoid those painful “door-handle” conversations where the doc tries to leave (because there are other patients waiting and there is no more time) and you feel rushed and dejected. No one likes those conversations. If your doctor isn’t good at agenda-setting, you can be. Remember this is a partnership, not a dictatorship…
  • Because time is unfortunately always limited, prioritize your questions. You may have 15 questions, but list them out in order of concern/preference. As your pediatrician asks their own questions and completes a comprehensive physical exam of your baby, it’s possible to ask others and you may find yourself surprised that they addressed concerns you had without prompting. But prioritize so you don’t forget the last (and possibly most important) question of all.
  • It’s always okay to ask. ANYTHING. Don’t shy away from questions because your doc has limited time. If necessary come back a week or month later if you’re still wondering about something you need to clarify.
  • It’s okay to schedule a follow-up visit. One of the pitfalls in well baby care is that many parent want to squeeze 2 or 3 visits into one. During a well baby visit, there is a lot to accomplish (some studies find that docs are supposed to cover over 50 topics). So if you are also concerned about an acute or new illness/behavior problem, consider scheduling a separate visit. You’ll likely all be more satisfied with how you can get what you need and how you can partner to protect and prevent illness and injury for your baby or child.
  • Don’t leave empty handed! Ask the doctor what websites or online references you should read for more information after the visit.


How To Stop A Nosebleed: Seattle Mama Doc 101

Nosebleeds are a common frustration during childhood. Although finger-nose-picking is a common cause, other climate changes (dry), medication use (nasal sprays), and other medical problems (rarely) can be the cause. The best advice? Don’t panic. And do your best to help prevent nosebleeds: stop the picking (GOOD LUCK), use humidifiers in children’s rooms, nasal saline spray, or Vaseline. And, keep a towel handy. One of the best ways to calm down when the blood is gushing is to sop it all up.

My quick tips:

Don’t Panic.

Don’t stick anything up your child’s nose to stop the bleeding.

Don’t have your child lean back, rather apply pressure to the nose for 10 complete minutes while your child is tipped slightly forwards.

Healthy Children’s Tips on Stopping nosebleeds

Nosebleeds, See A Doctor If:

  • Bleeding does not stop in 20 minutes, after you’ve applied pressure.
  • If you think your child may have put something in their nose or something is stuck there (like a bead).
  • Your child has more than 3 nosebleeds in 24 hours
  • Your child gets frequent (weekly or even monthly), heavy or hard-to-stop nosebleeds
  • The nosebleed is a result of a blow to the head or serious fall
  • If your child is dizzy or is weak with the nosebleed

First Day of Preschool

He exceeded expectations. Our little boys do that, it seems. And like every parent, I glow and gleam and glitter when they do. Today little O exceeded. Today was O’s first day of school. And although I am the one who housed the separation anxiety this morning, I expected him to miss us at some point. Pick his head up and look for  me. Or look back over his shoulder. Or ask where we were. Or wonder about his role in the room. Or go looking for his brother.

Turns out, no. The note from the head teacher described a “duck to water” and “no moments of upset.” No accidents. No crying. No trouble. She ended the email with “watching him smile all over the place was a joy.” Are you kidding me? Yes, that’s my boy. My Our boy.

This is no guarantee for tomorrow, and I get that and I expect the tantrums and the imperfect moments, too. But this is a day to celebrate. 3 years ago today I was on bed rest. Wondering, worrying, wishing, and hoping for health. Today my little boy started school. It is jaw-dropping-roof-blow-off-mesmerizing moment for me. What these children can do. For themselves and for those of us privileged enough to witness their lives. Independence is an incredible gift.

O marched into his role as a preschool-student triumphantly. The only one in tears was me. And then his brother, at the end of the day. Sometimes this little boy lays out his scientific method for strength. Like a Marine, he’s always happy to be the first one through the door.

It’s love. I feel

Most Parents Avoid Alternative Vaccination Schedules

I see this as a glass half-full, glass half-empty issue. Yesterday, a study was published in Pediatrics detailing research conducted in May of 2010 about parents’ preferences to use alternative vaccination schedules versus following the recommended CDC vaccination schedule. The majority of the media coverage focused on the finding that over 10% of parents followed a schedule other than the one recommended by the CDC. Not perfect and not ideal from a public health stand point. Yet, of course, the other way to see this is that nearly 90% of parents did follow the physician-recommended schedule. That’s a pretty good success rate for doctors.

As a pediatrician practicing in Washington State, I saw this study half-full. As I read through the methods, results, and discussion, I took notes on the cover page. I actually made that little doodle. I couldn’t help but think about the nearly 90% of families (87%) who followed the recommended schedule to protect their children and their communities. Clearly 87% is not 100% (I get that) and it leaves our communities and our children at risk, but I believe we can continue to improve trust with ongoing education.

Focusing on the group that does vaccinate their children on the schedule may be a good strategy to understanding where we can improve our communication about the benefits of vaccination. We often focus on the group that doesn’t vaccinate but we miss insight from those of us who do immunize our children on the schedule.

Details: The study was conducted on over 2000 respondents, where 771 families qualified by reporting having a child between 6 months and 6 years of age. They were asked if they followed the CDC schedule and then if they didn’t, they were asked to answer a series of closed-ended questions regarding the nitty gritty of the schedule they used. Parents’ age, gender, race/ethnicity, and level of education and family insurance were collected.

Glass Half Full Findings: Read full post »