Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

A mom, a pediatrician, and her insights about keeping your kids healthy.

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.

Easy Ways To Prepare Your Family For An Emergency

In the past I’ve hated preparing for emergencies. It made me nervous and like most people I procrastinated because I hated playing out a potential tragedy in my head. However it’s easy to say:

I am really happy I made an emergency kit about 3 years ago. I really don’t regret the time or money I spent getting it done. I do think I’m less anxious now.

September is Emergency Preparedness Month so hopefully in the nick of time we can all make preparing our family a priority. Before you read on know that pacing yourself and setting a goal for completing a full preparation can be set months out. Make a goal perhaps that by the end of 2013 you’ll have a communication plan, a 3-day emergency kit prepared, and have met with or talked with a neighbor or two about how you can work together in the event of an earthquake, tornado, other weather-related emergencies, fire, or safety threat that cuts you off from others’ help. Experts recommend you have enough supplies, first aid kits, medications, water, and some battery backup to last you for at least 3 days. If you’ve already purchased and/or assembled a kit, don’t forget to refresh it. I realized just this week that the water in our emergency kits had somehow leaked and/or partially evaporated. Time to replace it. Water does expire so instructions for “making” safe water from the Centers for Disease Control help. Read full post »

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 »

A Cab Ride In Canada

It was sunny when I landed in Toronto on Tuesday evening so I felt a bit lifted as I sat down into one of the most pleasant cab rides I can remember. The driver was 69 he said, and his claim to good health was avoiding alcohol, shunning cigarettes, and waking up each and every morning to exercise. “Just 30 minutes a day,” he said, “Changed everything in my life.” I held my tongue as he kept talking. The coincidence with the first meeting I’d have while in Toronto was startling. As Dr. Mike Evans and I talked over coffee the following morning, the serendipity of the unified voice in Canada was an unexpected delight. A patient and doctor sharing the same similar thought—one from experience, one from expertise: 30 minutes a day could change your life. If you haven’t seen the video, please watch 23 ½ hours now.

The cab driver was one of 10 children to his mother and father born in the Philippines (5 boys, 5 girls – how’s that for biology playing out) who has lived in Canada for 11 years. All of his siblings were living now in Canada or the US and he’d asked why I’d arrived in Toronto. I’d arrived to, “Share some ideas on using social tools to transform health care,” I said. Maybe it was our deeply political and nearly anthropologic conversation that charmed me. Maybe it was the story I re-read just prior to taking off in Seattle detailing the generous cab drive a man offered a dying woman. Yet Tuesday night in the cab I realized instantly, like I usually do, that although I was there to share my thoughts with a number of people, I would learn potentially much more from Canadians than I would impart. It really is so good to get out of Dodge and see how other people do things.

Read full post »

An Annual Interview: 20 Questions

new leafYesterday our 6 year-old asked if I’d snap a photo of this leaf. He suggested that it may in fact be the first orange leaf of fall. His need for the photo alerted me that autumn truly is upon us.

Last year I started a few traditions when my oldest started Kindergarten. One was asking the 20 questions below. Although last year we asked these just prior to school start, we finally got around to asking them yesterday. The four of us had a hoot reviewing the responses. Our 4 year-old got a chance this year, too. I may update the questions next year but I’m thrilled to be stacking these responses in the boys’ memory boxes. I’ve included both 2012 and 2013 responses because it’s the evolution that is so valuable. Traditions are like that, better with each repetition. I also included some responses from our 4 year-old that are just too good to leave out…

  • 20 Questions At School Start

  • What is your favorite color? “Yellow”—>2013 “Orange”
  • Favorite number? “5” —> Not surprisingly this year he said, “6” and our 4 year-old chimed in with this, “9,000… no wait, 199.”
  • Favorite food?: “Strawberries”—-> “Bananas” and to keep us honest our O said, “Cotton Candy.”
  • Favorite toy?: In 2012 he said, “This is going to be a tiny bit hard……airplanes.” —> This year just, “Airplanes” (no hesitancy).
  • What are you most happy about this summer? “I got to spend more time with Mommy and Daddy” (be still my heart). Nothing quite so romantic this year. All our 6 year-old said was “Swimming in Lake Washington.” But our 4 year-old produced this doozy: “Going to the radiology summer party with the bouncy house.”
  • Favorite memory from the summer? In 2012, “Going through the Costco carwash.” (you can’t make this stuff up). This year nothing just so comic, rather he said, “Going down the water slide in Berlin, Wisconsin.” Read full post »

It’s Time For Flu Shots

Please don’t tune me out on this one. Don’t let this post resemble Gary Larson’s The Far Side cartoon where you only hear, “Blah, blah, blah, Flu shot, blah, blah, blah, Flu shot, blah, blah, blah”

I write about flu every year because it’s one infectious disease that is not only more aggressive and dangerous for babies and young children, it’s vaccine preventable. The flu causes high fever, terrible cough, body aches, and significant discomfort. It can also potentially cause more serious infections like pneumonia. Unlike viruses that cause the common cold (rhinovirus or RSV), we have a vaccine for influenza.

I’ve had multiple patients in only 7 years of pediatric practice refuse the flu shot and subsequently get influenza. A few of my patients have required hospitalization for influenza and several have had serious infections requiring multiple visits to clinic, ER trips, and respiratory distress. Whenever this happens in an unvaccinated patient, I feel I’ve failed.

The great news with flu is that we can improve protection for our children and teens easily. The majority of the 150+ children who died last year from flu in this country were not vaccinated. And although it’s true that the vaccine doesn’t protect 100% of those who get it, it does protect most from life-threatening illness. Getting a flu shot is the #1 best way to prevent a life-threatening infection from the flu.

It’s flu shot season. You thinking, “blah, blah, blah…?”

The American Academy of Pediatrics has a new policy statement out this month. Their big message is to get all children up to date on their flu shots as early as possible. Read full post »

E-Cigarettes

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm

Ever Electronic Cigarette Use ~ National Use Tobacco Survey, 2011-2012

Grim news out today. E-cigarette use in teens has doubled in a year. The CDC reports that 1 in 10 high school students admitted to ever using an e-cigarette in 2012. The rate of use doubled for middle school students as well. Although I’m not surprised, I remember just weeks ago tweeting about my dismay with Jenny McCarthy’s new job– advertising e-cigarettes. I took flak. Some advocates for e-cigs felt I was shortsighted and not valuing the potential benefits of these electronic nicotine-laden vapor tubes. All I could think of was her image, the lure she may create for teens, and the likelihood that teens would peek in on e-cigs with greater fervor.

Just a month ago we learned that smokeless tobacco use is steady with teens (5%) and many teens are now turning to novel sources of nicotine (dissolvable tobacco, snuff, snus) in addition to tobacco cigarettes. I consider myself fairly up to date, and until the AAP report came out in August I’d never once heard of snus. You?

Some people are wed to the concept that e-cigs may reduce the burden of illness and smoking-related morbidity from tobacco cigarettes. Even if you believe in harm-reduction for adults (switching from tobacco cigarettes to e-cigs to reduce use or quit) this is an entirely different issue for our middle and high-school students. A nice summary of the data for e-cigs from pediatrician, Dr Aaron E Carroll, with numerous associated comments helps frame the issue.

I wish I could remain agnostic about these devices, but I can’t. This is pretty easy to say:

I don’t recommend e-cigarettes for a teen.

Compare two stats: One in five adults who smoke has used an e-cig with one in ten of ALL high school students have tried an e-cig. Teens aren’t wired to conceptualize the power of nicotine addiction.

The e-cig really does feel like the gateway to the gateway drug.

There is still a lot of unknowns about e-cigarettes. More research will come out and the FDA is likely to regulate e-cig use shortly.

In the meantime, check in with your teens, look around, and I urge your to support regulation of e-cigs and advertising of e-cigs to teens. This just can’t be good.

Your Phone And Your Life


I love it when I forget my phone. Especially if I’m with the boys. But I admit it’s gotten more complicated for most of us to leave the phone at home. It’s harder and harder to function without our online resources and phone connection to those we love.

Watch the 2-minute video and read the 3 tips for making unplugging a weekly habit (below).

The Pew Research Center confirms that more than 9 out of 10 adults in the US have a cell phone. More than 1/2 of adults (56%) are now using a smartphone and rates for cell phone adoption start at earlier ages. Teens between 12 and 17 are rapidly acquiring cell phones of their own: more than 75% of teens have their own cell and 1/3 of teens have a smartphone in their pocket. We spend more time with our phones than our friends, it seems. Although sometimes we’re just looking at the bus schedule or our work email, The New York Times reported this summer that Facebook claims 40% of Americans are on Facebook every day. Every flipping day! So it’s not surprising perhaps that although I meant to take the month of August primarily offline I was mostly unsuccessful. It wasn’t until August 29th that I officially unplugged from all my inboxes and stayed off all apps and mail for 4 days. Read full post »

First Day Of School: Quick Reminders

first day first gradeIt’s the first day of school for us today. This time of year is momentous.

The photostream on Facebook this morning is striking: children in pressed shirts with clean backpacks. It’s obvious the cameraman for each photo is smiling, just so much pride… There is something clearly resonant with we adults about a clean slate, a new day, a first moment of each new grade level. We have our memories tucked neatly into our pockets (yes, I know my 1st grade teacher’s name) and this first day often represents an important line in the sand. First day of school is clean, hopeful, and sincerely wondrous for most. I told someone yesterday I’d move a mountain to be present for first day drop-off.

I know today is also complicated for some parents. Not everyone can get time away from work for the drop-off at school or the bus pick-up. Some parents have doctor’s appointments or illness that prevents an easy morning and send-off. Nearly 1 out of 10 children are living with their grandparents. So today isn’t all white-picket-fence-two-parents-at-the-door perfect for all children in the US. But for most, it’s a very exciting transition.

I also know amidst the sparkle of the fresh start  today we have to remember that the beginning of anything does come with significant anxiety for many children and teens (and their parents). The rapid ramp-up to full speed this week required by early start times and homework schedules with afternoon +/- sports practice can incite anxiety and real fatigue for children, especially those with social phobia, underlying anxiety, depression, or learning challenges. Here are a few quick reminders that may ease the September transition for us all.

4 Tips When Starting School

Sleep is essential. 

  • Preschoolers: 10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
  • School-age children: 10-11 hours total sleep. Most children get to bed around 8pm but as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm.  Puberty brings on changes to their sleep cycle and thus shifts them later.
  • 12 year-old to teens: 8 1/2-9 1/2 hours total sleep.  Read full post »

Savoring Versus Saving

dock calling me

If the world were merely seductive, that would be easy. If it were merely challenging, that would be no problem. But I arise in the morning, torn between a desire to save the world and a desire to savor the world. That makes it hard to plan the day.

E.B. White

It’s an entirely challenging task getting to live this     just     one     life.

E.B. White summarizes the dilemma as well as I can imagine when he describes the tension between wanting to savor and wanting to save. For most of us who are raising children there is a constant tug-o-war in our minds/hearts as we decipher how best to live each day, especially when making choices about how we work. Nothing better than savoring the delight of our children, though, most all of us agree on that. Sure my boys fight and squabble, they ignore me when I ask them to put on their shoes, they leave their room a mess, and they forget to say, “please” in front of Grandma. But not a cell in my body denies this: my boys are simply miraculous. I constantly remain awestruck while in the midst of my family. And yes, just like those ahead of me warn, it does feel as if their childhood is coming at lightening speed.

So as the torrid waves of “work-life-balance” perpetuate, I’m unplugging for a few weeks just as I’ve done the last 2 years.  A true believer that digital-free time is essential,  I’ll use this post to ensure I check-out of the Internet for a bit. After sundown Friday I’ll be off Twitter, Facebook, LinkedIn (maybe even Instagram), off the blog, and only sporadically into my email. I’ll still be at clinic and also on KING5 News. The rest of the time I’ll be with my family as we work to live mindfully, enjoy the end of summer, and prep for the onslaught of autumn.

Be well until September. In the meantime here’s some good reading: