Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

10 Reminders And Updates to Pediatric Check-Ups

Pediatric Wellness Visit

Prevention is genius medicine. By making smarter choices, detecting risk early, not only do we improve our quality of life, but we can prolong people’s lives. Pediatrics is the perfect place to master this. Because of the incredible opportunity we have to prevent injury and illness during a person’s childhood, the American Academy of Pediatrics (AAP) updates and refreshes their schedule of recommended screenings and guidelines for wellness visits every year. It’s put into a huge “periodicity table,” basically a chart that reminds us all what to do when. This year some of the recommendations are making headlines. I’ll explain reminders about what you should expect from wellness visits, include all the new updates, and explain a bit more about a couple of the new recommendations (HIV screening for all teens 16-18) in these 10 tips:

  1. Vision: annual, regular vision screening is important. Pediatricians evaluate vision from day one but your child should stand in the hall and screen vision formally at age 4 years (at 3 is great if they can follow directions!) and yearly until  age 6, and then every two years. At age 18, the vision screen will only be given to those at risk or who flag concerns.
  2. Oral Health: an oral exam from physician or dentist is a must at the time of baby’s first tooth eruption. This year, the AAP also endorses that pediatricians provide annual fluoride varnish to children between 6 months – 5 years to reduce cavities.
  3. Drugs & Alcohol: CRAFFT (Car, Relax, Forget, Friends, Trouble) tool will be used to screen adolescents for drug & alcohol use. This screening tool is used to help teens share ways they use alcohol or drugs and identify any risks. Writing it down can help teens share information that may be hard to talk about and the recommendation to formalize this and build this into our electronic health records so it is captured each and every time is smart.
  4. Depression: all children ages 11-21 will be screened for depression. Screening can be done through a combination of filling out survey questions and also questions we ask teens and their families directly. Suicide is a leading cause of death among adolescents — picking up depression or sadness, intervening with counseling, social support, and sometimes medication is essential for supporting teens without proper treatment or support.
  5. Cholesterol: the AAP recommends a blood test will be given to patients between age 9 and 11 universally to screen for elevated blood cholesterol and other blood fats. Because 1/5 children between 12 and 19 have one or more abnormal lipid level, screening is a way to pick up those we don’t suspect. The reason for recommendation is this: atherosclerosis (cholesterol sticking to the insides of your arteries) begins in childhood and accumulates throughout our lives. The more atherosclerosis, the more your risk of a heart attack or stroke. Because heart disease is the #1 killer of both men and women, PREVENTING the accumulation in childhood can potentially lower lifelong risk. If children have a family history of high cholesterol, early heart disease or death in the family (under age 55 years) are obese or have other underlying health conditions like diabetes, children will be screened even earlier (between age 2 to 5). With no risk factors, all children should be screened once between age 9 to 11. The original policy and statement with this recommendation came out in 2011 and I’ve picked up children with elevated cholesterol since. I’m thankful for this recommendation!
  6. Development & Autism: developmental screenings will happen at all ages and all wellness visits. Formal autism screenings will occur at 18 months and the 2-year check up. No changes to this schedule this year.
  7. HIV: every teen age 16-18 should be screened for HIV regardless of sexual activity. In years before 16, and after 18, this is based on risk, social history, exposures. But the reason for screening teens universally is help children know their HIV status, keep them negative, and ensure we’re picking up HIV early when it’s unexpected for early treatment. The facts behind this recommendation:
    1. 1 in 4 new HIV infections occurs in youth ages 13 to 24
    2. 60% of all youth with HIV do not know they are infected
  8. Pap smear & HPV: doctors and nurses will do internal gynecologic exams if any concerns (pain, unusual discharge, menstrual cycles concerns, sexually transmitted disease exposure or diagnosis) but will wait to do a pap smear and HPV testing as screening to look for the presence of pre-cancerous cells on the surface of the cervix, at age 21. Here’s a video where I explain recommendations for “well-women and well-girl” gynecologic exams.
  9. Newborns: AAP recommends all babies get screened for heart disease by auscultation of the heart using a stethoscope and ALSO by using pulse oximetry before leaving hospital or in the first 3-5 days of life.
  10. Growth & Nutrition: your child’s doctor should show you and teach you at EVERY VISIT how your child is growing. They should review their height and weight gain as well as their BMI (or weight/length at young ages) at every visit. Growth is a great marker of thriving health and concerns around growth can really help change a child’s live.
    1. 1/2 of parents underestimate their children’s weight so it’s important to review the numbers every year as they sometimes surprise. 1/3 of children in US are overweight or obese and knowing this early can provoke big changes.
    2. AAP recommends toddlers be checked at 15 and 30 months for iron deficiency — iron is not only important for building strong blood it’s essential to support proper development.
    3. Supplemental Vitamin D also very important for infants and children — 400 IU typically recommended for all infants and children, every day. Ask your pediatrician or family doc for more information.

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Ban Baby Crib Bumpers

bumpersI cleaned out the closet for houseguests last week and discovered an old bumper. Instead of giving it away I am literally cutting up the fabric for crafts and putting the rest in the garbage. A no-brainer savvy parenting tip: baby crib bumpers are dangerous. Don’t use them, don’t even give them to charity, don’t pass them on to friends. Let’s get them out of circulation, outsmart the marketers, protect these little babies.

Smart parents just don’t use crib bumpers. More data out this past month to prove it.

Crib bumpers are soft bedding that can pose risk of suffocation, entrapment, strangulation, or additional risks from causing a baby to be wedged into an unsafe position. It may seem like they protect babies, but there is no evidence they prevent serious injury in infants. Choosing a crib can be an exciting nesting activity, here’s tips for doing it with smarts.

Banning bumpers feels to many like an inconvenient truth. Perceived risk is low and they are so darn cute. But with all the time we spend as parents spend doing everything we can to protect our babies this is an easy opt-out. Forget spending time worrying about organic baby food and what brand of stroller of you want and just get rid of your bumper. Or better yet, don’t buy one in the first place. Let’s get them off baby registry lists, out of marketing and advertising and most importantly OUT of baby’s crib. Read full post »

No Kitchen Spoons! Correct Medication Dosing

OTC Dosing Image

Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools sometimes making it confusing for parents to ensure we are giving our children the proper dose. To add to the confusion, sometimes the recommended dose is written with different units (mLs, mg, or teaspoons) than the dosing device. For example, the box might have dosing in “teaspoons” and the measuring device be divided up into milliliters. This issue is not new but guidelines and protections around the problem are increasing. A win!

This has concerned me for a long time. To drive this point home even further, I gave a dosing conversion quiz on my blog to my colleagues in medicine (also parents) who even struggled to get the dosing correct. The dosing struggle is REAL to non-pediatric docs and parents everywhere.

For example, you may even see differences in devices that would seem to be standard across medications. The dropper that comes with liquid acetaminophen may look very different than the dropper that comes with liquid vitamin D or infant multivitamins. And remember, the most important way to avoid a dosing error is to keep the original dosing device with the actual OTC medication. Read full post »

Why To Buy An Antibiotic-Free Turkey This Thanksgiving

Like I said last year, there’s one little thing we can do this month to change our safety and preserve the value of antibiotics. And although not all families can be without antibiotics on Thanksgiving due to chronic or even acute medical problems, we all can eat smarter turkey. This is an easy awesome.

I partnered with Dr. Scott Weissman this week for “Get Smart” week. On Monday we explained that we’re dependent on antibiotics for all sorts of medical miracles (bone marrow transplants, joint replacements, healing from a large cut, routine surgery, and chemotherapy). We when use antibiotics responsibly in the clinic, in the hospital, in raising food and in our agriculture we’ll preserve antibiotics for decades to come. Trends show if we don’t, we’ll contribute to more and more resistant and untreatable infections. Tuesday we explained how antibiotics are used in agriculture, Wednesday how to be a squeaky wheel in the hospital (speak up, ask about antibiotics EVERY day), and yesterday we reviewed 5 tips for avoiding antibiotics in clinic. Today…..drumroll…….we provide something super easy to be smart:

Make an effort to buy an antibiotic-free turkey this Thanksgiving. Animal agriculture uses four times the amount of antibiotics as human medicine, and mostly in healthy animals for growth promotion or disease prevention on crowded farms. It’s also worth noting that safe preparation is also key. Read full post »

5 Ways To Avoid Antibiotics At Clinic When Unnecessary


Most parents know that it’s not a good idea to beg your provider or child’s pediatrician for antibiotics — hoping to find a quick fix or relief for certain conditions doesn’t work when the medicines won’t help. Although we want to fix our children’s illnesses, antibiotics only help when an infection is caused by a susceptible bacteria.

Antibiotics are used specifically for infections caused by bacteria. In general, most common cold symptoms—such as runny nose, cough, and congestion—are mild and your child will get better without using any medicines. HealthyChildren.org

Antibiotics should be used to treat infections like strep throat, whooping cough (caused by pertussis) and urinary tract infections. We just don’t want to use them for strep culture-negative sore throats, runny nose, most rashes or cold caused by viruses. When we use antibiotics at the wrong time we don’t improve the likelihood of a cure in the short-term and we set ourselves up for more antibiotic-resistant infections. Not only do antibiotics carry short-term side effects (diarrhea, rashes, sometimes allergic reactions) there is some data that early use of antibiotics in life changes long-standing risks for chronic medical conditions (things like Crohn’s disease).

Overprescribing  antibiotics affects both individuals and society as a whole. Each time a person is prescribed an antibiotic they risk having a severe reaction to the medicine. These reactions bring approximately 30,000 visitors to emergency rooms across the country every year. Antibiotics can also cause diarrhea or clostridium difficile colitis (C. diff), and early childhood exposure has even been associated with the development of asthma and Crohn’s disease. —Dr Matthew Kronman

5 Ways To Avoid Antibiotics

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Ask About Antibiotics Every Day In The Hospital


Today’s main takeaway: if you or a loved one are at an inpatient setting, ask every day what antibiotics you’re on, why you’re on them, and when you can stop taking them. Every day. Your care team is likely doing the same thing but you bringing it up helps ensure it remains a priority.

How To Be Smart Using Antibiotics:

  • Take the antibiotic exactly as the doctor prescribes them and take them for the shortest duration.
  • Try not to skip doses or stop taking an antibiotic early unless your doctor tells you to do so.
  • Only take antibiotics prescribed for you; do not share or use leftover antibiotics. Do not save antibiotics for the next illness — makes little sense and can contribute to resistance.
  • Discard any leftover medication once the prescribed course of treatment is completed. There are a variety of safe ways you can do this. No flushies!
  • Prevent infections by practicing good hand hygiene, cough in your elbow (not your hand), and get recommended vaccines (vaccines don’t contribute to antibiotic resistance).
  • Remember antibiotics have side effects. When your doctor or nurse says you don’t need an antibiotic, taking one may do more harm than good. Often walking out of the office WITHOUT a prescription is the best outcome…

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Antibiotics Used In Meat Changes Our Health


Using antibiotics on the farm to raise animals contributes to the production of antibiotic–resistant germs or “superbugs.” All animals carry bacteria in their intestines and on their bodies. Giving antibiotics to animals will kill large amounts of bacteria, changing their microbiome (<–good explanation here) and regular “good” bacteria too. Because 60% of the antibiotics used in animals are also used to treat human diseases, with time when antibiotics are used routinely, the bacteria become resistant, survive and multiply. If those resistant bacteria are transmitted to people, we don’t have as many medicines to eradicate them. Therefore, risks develop to humans when these “superbugs” thrive in animals and are transmitted through our food source. Over time, more and more infections carried in the food we eat will lack proper treatments. What we choose to eat will shape our risk.

Susceptible and resistant animal pathogens can reach humans through the food supply, by direct contact with animals, or through environmental contamination. American Academy of Pediatric Technical Report

Antibiotics used for infections in animals should be encouraged but antibiotics used to promote rapid growth and weight gain in animals likely should not (overuse). The majority of tonnage of antibiotics used in raising animals are often used for growth promotion and efficiency meaning they are used to keep meat cheaper, not necessarily safer. Hard to find clear data on exactly what % is used for disease treatment and what % is used for growth. Read full post »

This Matters: Getting Smart About Antibiotics


Super smartness in the world of health care is always a goal. This week is Get Smart About Antibiotics Week, an annual observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use. This isn’t just about NOT begging for antibiotics when our children have a runny nose and this isn’t just about docs and nurses being smarter about using antibiotics only when we need them. If we want antibiotics to be around and useful for generations to come, this will take a multi-prong approach.

Antibiotic resistance — “the rise of deadly germs no longer stopped by the drugs that once controlled them” — will only increase over time if we use continue to use antibiotics at our current pace. At home, in raising the food we eat, and in health care organizations.

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics. That means their infections aren’t easily treated, can grow and spread in their bodies without cure and can potentially cause serious harm. Those bacteria can also spread to others. At least 23,000 people die as a direct result of these infections every year. So this stuff matters. What soap we use, what medicines we avoid, what medicines we use, what food we eat and how it’s raised all change the game. I’ll be doing a series of short posts each day this week to share what I’ve learned about the negative effects of antibiotics overuse. Read full post »

Bigger Peace: Let Fear Spur Presence

FullSizeRender (1)Friday afternoon the terrorist attacks around the world certainly took our collective breath away. The stunning, horrific realities and the wild insecurity we can feel when somewhere familiar becomes unsafe is a potent storyteller. There is something in this though, that we can really listen to.

Things tend to happen in slow motion after this kind of news, almost like they do in our memories during scary recollections of a car accident or a big fall, because when some beloved familiar place is deemed unsafe we can tingle with such scare it pushes us towards vitality. It’s awareness. In ways, the fear these familiarities provoke shrinks the world, changes the scope of what is at stake every single day for every single one of us, and connects us again to how similar we are. Sounds have been crisper under our feet since Friday, the breeze on our face more notable this weekend, and all of a sudden the moment we’re in takes on quite a significance. We can feel so alive and connected to each other in this fear.

We all know fear hones priorities, even momentarily, and reminds us of the sincere gift of a day with those we love. With the news Friday the every day constructed problems at work or in our personal lives dim as the monumental relevance of connection, friendship, family, and freedom again takes on new light. This is a cycle, of course. We cannot hold the intensity and fears of our insecurity in our hands ALL the time to drive presence. Most of us can’t be mindful every single moment either. We’d be muzzled and paralyzed if we let this tincture of storytelling in too much too soon too constantly…but there’s this: Read full post »

U.S. Soccer Bans Headers For Kids Under 10

Soccer HeaderOur kids don’t have to play like the pros, even if we they think they’re ready. I mean really, what’s the rush?? I report this as a pediatrician & as a bona fide soccer mom to 2 boys under age 10:

The U.S. Soccer Federation yesterday announced a ban on “headers” for children under 10 years. There has been no new expert consensus (the new rule rose out of a lawsuit, not new pediatric expert opinion) that heading the ball causes changes/damage to the brain. Although headers have been found to cause concussions, more often children are concussed when hit by a falling ball or after a collision. Research published this fall in JAMA Pediatrics found about 30% of boys’ concussions and 25% of girls’ concussions in high school soccer are a result of heading. Regardless, more research is needed to determine the safety of heading the ball throughout young and late childhood. In the meantime there are 3 things we can all know (and advocate for)  as research teases out early head injury and the influence heading may have over an athlete’s lifetime:

  1. Headers require essential technique to reduce injury: If heading the ball, young players need to learn proper technique (head positioning, neck position, have appropriate muscular strength etc) so using their forehead they reduce likelihood for injury. Most pediatric sports experts opine that this is unlikely to be easy for little players to reliably learn this technique under age 10 years. It’s unclear what degree heading causes concussion and long-standing injury. “Collision,” pediatric experts wrote in 2010 for Pediatrics, “rather than purposeful heading, was found to be the most likely cause for acute head injuries in soccer players treated in emergency departments.” 
  2. Appropriate Balls: We need to reduce risk of injury by ensuring balls are appropriate size for players, that balls are NOT hyper-inflated and thus more firm, and that balls are water-resistant (so as to not take on water and be heavier). Smarter play, smart equipment. 
  3. Smarter Timelines For Rules: Graduated rules like this (no headers under 10, limited headers for young teens, and then routine headers thereafter) make sense. Not all 8 year-olds need to play by the rules of the pros. Why the rush?

Heading among pre-adolescents is usually a random act. Eyes shut. Head scrunched into neck. Shoulders clenched. ~ Slate.com

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