Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Know Your Role: Parents and Sports

soccer lightIn any youth game or match there are typically four roles: player, coach, referee, and parent. You only get to choose one. We’re headed off to the first of 3 soccer games today. A joy, really, to watch these little boys enjoy their team, struggle to do their best, wrangle their wits and learn to play on a team. My boys aren’t the star players (that’s for sure) but they love it when something goes well. They work hard for goals that rarely come. They really do enjoy knowing when they’ve passed a ball successfully. There is no question they love feeling they belong on these teams and they really do enjoy playing the game. That’s why we have kept it up.

I used to debrief after the games with my boys — discussing what went well and what didn’t — at first they seemed to love that. And then I heard the advice from other parents ahead of me and from those who have dealt with the not-so-great coaches:

Know your role. You only get one.

In any game or sport there are the players or competitors (your child), there is a coach, and there is the referee keeping it fair. You’re none of those and even if the person in one of those roles isn’t performing at their best it’s earnestly not your job to correct it. You just don’t want to be the backseat driver here (and your child certainly doesn’t want to hear it) and you really don’t want to have the ugly habits we’ve all seen.

In any game or match you’re observing you’re only one thing: the parent.

I’ve spent the last few years telling my boys how much I enjoyed watching them play the game at the end of each game as opposed to discussing how much I liked watching them succeed or how I felt for them while they failed.

I’m thankful for the advice I was given — it’s made the soccer Saturday madness a bit less high-stakes and it’s focused and honed the joy.

I hope the advice I heard helps you, too. I welcome any more advice or pearls you have.

Also, this sign is legendary and spot on:


“Like I Needed Another Reason Not To Sleep At Night”

Today was the Great Shake Out. My boys let me know what happened at 10:15 today at school: “the ‘ole drop, cover, and hold” said my 6 year-old. The technical instructions are “drop, cover, and hold on” but we get his drift. The numbers couldn’t have been better today 10-15-2015 for a 10:15am reminder of how important it is and how good it can feel to know what to do when an earthquake strikes.

Another thing: when you’re having a bad day, why not practice the drop, cover and hold? I mean…..

Okay but seriously, Dr. Suzan Mazor and I are teaming up again to work on updating our emergency/disaster kits. You might have seen us putting together our first kit back in 2010. The New Yorker article that made headlines this summer re-ignited my decision (and remarkable fear) to have a plan in place should the worst happen. You read the article and I know you’ll say, “like I needed another reason not to sleep at night?” Great thing is planning and preparation truly is the antidote to fear.

My REFRESH card prompted me to realized that our water expires this year and it’s pretty obvious since it has nearly evaporated. True.

All instructions for what you need in your kit and what you need in your communication plan are below. You’ve waited until now. Seriously no reason to wait any longer if you don’t have a 3-day kit in place. A promise for me that is easy to make:

I know you’ll feel better having done this.

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Do You RWDD? Pot At Age 12 And Teen Driving

Teen Driving Pie ChartNew acronym for me this week: RWDD. It’s “Riding With a Drinking Driver.” Not a drunk one, but someone who has been drinking. Risky at any age, but particularly when it’s high school. But before I get to that lemme acknowledge that texting has changed the lexicon, upped the capacity for quick communication in our lives, and earnestly transformed some of our relationships. Clearly we’re all learning a ton about shortcuts in communication. I think about this in my personal life but also what impact texting and digital technology has on how we deliver health care, how we partner and listen to populations, how we hear the worries of parents and caregivers and how we share what we know. Sometimes it seems we’re just always trying to catch up. I learned all sorts of new teen texting acronyms & idoms last week on CNN that extend past “lol” and “ICYMI” (see: OOTD, KOTD, and smash <– phew). But no one mentioned RWDD.

A study out yesterday in Pediatrics is worth a quick mention to any parent or any adult or any family doc or any pediatrician or any nurse practitioner or any medical assistant or any coach or any teacher that has contact/supervision/leadership/influence with a teen. The study, conducted on middle school students in the Los Angeles area, found that positive beliefs about marijuana at age 12 were predictors of later getting a DUI or RWDD when a new teen driver 4 years later. Translation: middle school is a wild time of transition and the time we should check in about marijuana’s lack of safety and risks associated with alcohol. Researchers conclude that 6th grade is when we should be talking with our tweens, that “positive beliefs and ability to resist marijuana in early adolescence, not actual alcohol and marijuana use, had the strongest association with DUI and RWDD ∼4 years later.”

No question that we send a wildly confusing message about pot to children and teens with our state’s legalization. Most teens think legal = safe and that’s where we’re potentially setting up our teens for big mistakes. Getting high seems fun to teens and it may seem more fun with something that appears to be “safer….”

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When Did You Last Have 48 Hours Alone?

FullSizeRender (4)This past weekend I had 48 hours alone. I mean really, f-o-r-t-y-e-i-g-h-t hours with no commitments. No one expecting me home, zero rushing, zero obligations, and no racing home. I did things I haven’t done, well, ever. I went to a movie alone, woke up and read a magazine cover-to-cover, went for a couple runs, sat on a hill at the sculpture museum for just shy of 2 hours without my phone in my hand. I spent time just letting my mind wander. This wasn’t the kind of alone time I experience when I’m traveling for work. This was real, true alone time at home.

Although it’s rare that the stars align, and it’s a challenge to make sure our families and our children are being cared for and in good spots without us, I can’t endorse enough finding time to just be alone.

Because my boys and husband were off camping this past weekend I went out to dinner entirely by myself with absolutely no end time. I read a book. I slept 9 hours straight for 2 nights in a row. At one point I seriously did NOTHING for a couple of hours. I didn’t accomplish anything I could check off a to-do list. It was perfect.

Opting out may be essential for thriving, creativity, and refueling. This may be one skill we’re regularly forgetting to model and teach our children.

I mean earnestly, when is the last time you had a couple of days entirely alone? For me I realized it was way back in medical school….some 12 or 15 years ago.

Part of my unscheduled time during the 2 days my family was away was prompted by listening to this 15-minute podcast: The Case For Boredom

Maybe we really can prioritize white space for ourselves and our kids

What kind of time-alone parent are you? I mean I get it that things have to be in good balance in life for this to make sense, no one can be ill or hurting in a big way. But I wonder if we can do this more. Will you take the poll — are you better at this than me? If so, just HOW do you pull it off?

Head Lice, School, And OTC Treatment

Raise your hand if you never had head lice before going to college. Your hand isn’t in the air, is it? Turns out, lice is common. And no question, it’s wildly unsettling for us all. It’s a new world when it comes to prevention and treatment though — more choice, less stigma and less school disruption. Twentieth-century lice care is no more.

Back in 2010 the American Academy of Pediatrics (AAP) updated its recommendations on lice. Basically, schools are no longer encouraged to send children home with lice or keep them away from school. Lice spreads from child to child but it’s certainly nothing like measles. Sending children home from school for a “non-health issue” doesn’t make sense. Further, lice can be living on your child’s head for up to 30 days without hatching (horrifying I know) and can be around for weeks before causing itching the first time around so an urgent send-the-lice-infested-kid-home policy just doesn’t make a lot of sense. Thing is, this changes the game. We all want to get rid of lice on our child’s head immediately, but we’re dependent on all the other families in school doing the same so we don’t get it AGAIN…

In the midst of a lice “crisis,” don’t beat yourself up. This has nothing to do with hygiene. It has more to do with bad luck.

“Head lice are not a health hazard or a sign of poor hygiene and, in contrast to body lice, are not responsible for the spread of any disease.” American Academy of Pediatrics

KYOTC Lice 1New 2015 guidelines from the AAP offer some tips for getting your family lice-free as quickly as possible. Lots of over-the-counter (OTC) ways to deal with it. OTC treatments are safe and effective. However, lice are tricky and have been found to have resistance patterns that aren’t entirely understood at this point (the prevalence is unknown)– so rarely a parent needs to switch treatments. That means sometimes we do all the right things and even with the BEST routine and adherence and lice possibly remain. If you suspect you’re not getting rid of lice at home despite great treatment routines, involve your pediatrician. Often ongoing lice is simply that your child is getting re-infested at school or sports. Or they weren’t gone in the first place.

Follow instructions on the bottle — many treatments need to be repeated about 7-10 days after first application.

Sometimes it may be that you need to swap treatments. It’s RARE that you need a prescription treatment. Your child’s clinician can help recommend a transition to prescription medications. The prescription meds are expensive and often unnecessary but one does have the benefit of requiring only a one-time treatment and no combing.

If the thought of chemicals of any kind on your family’s skin is unappealing, manual removal by “wet-combing” or suffocation through hair is acceptable and can sometimes be effective (things like mayonnaise, butter, oils) yet there is no real hard data about effectiveness. It’s important to note that wet-combing should be repeated once a week for at least three weeks if you do this to ensure all lice and nits are removed as you must comb through entire scalp and hair fastidiously.

Discovering lice is clearly in the no-fun parenting category, but it’s also NO BIG DEAL. From experience (x 2) I can say best thing we can do is calm down, head to the drug store, comb away, wash the linens and move on.

What Parents Need To Know

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Flu Season, Pregnant Moms, And The GOP Debate


A selfie with Dr. Tom Frieden, Director of Centers for Disease Control (CDC)

It’s been a whirlwind this past week. Last week I flew to Washington D.C. as an invited speaker at the NFID Influenza News Conference at the National Press Club in Washington D.C. I joined thoughtful experts: Drs. Tom Frieden, Kathy Neuzil and Bill Schaffner to present the 2015/16 flu season recommendations and explain rationale for every-year flu vaccine. It’s an essential vaccine for children, especially as young children are at elevated risk for more serious or even deadly influenza infections. Timing auspiciously peaked interest in the news as the press conference was in the morning immediately after the presidential candidate debate where wild myths were shared on stage about vaccine science and safety. I was able to also share my refute of Trump’s false statements here on NBC Nightly News.

I got my flu vaccine at the event in front of the cameras. Thanks to the new jet-injected vaccines (truly a needleless “shot”) it didn’t even hurt! As expected, I was sore in my arm for a day or two thereafter.

Prepping for the press conference, I was a little underwhelmed to learn that only roughly 50% of pregnant women get the flu vaccine. If you’re expecting, here’s what you need to know about the flu vaccine. Quick 1-minute video below. SPOILER: it’s an essential and safe vaccine to get at any point of your pregnancy. Read full post »

Using Melatonin To Help Children Fall Asleep

Melatonin Boy SleepingWhen I recently shared this article on my Mama Doc Facebook about a “magic” children’s bedtime story promising to make the going-to-sleep process easier, many parents inquired about melatonin.

No question that supplemental melatonin has a role in children’s sleep dysfunction but also no question that parents are turning to melatonin out of a need for convenience. I’ve had COUNTLESS curbside consults from parents asking me if melatonin is safe to use in the short-term but also for years on end. The short answer is we don’t entirely know because studies just haven’t been done. Often when I get the story of how families are using melatonin, I end up advising changes in the sleep schedule more than a need for meds. What we do know: melatonin can help children fall asleep with sleep dysfunction, sleep dysfunction and inadequate sleep have serious health consequences, and although melatonin only helps with sleep initiation (falling asleep) it can be hugely beneficial for children who lie awake at night for hours at bedtime. The other thing we know: melatonin is not regulated like medicines (it’s overseen as a food supplement) that has been studied in very few pediatric populations so it’s difficult to generalize safety for children everywhere. Lots of definitions, dosing info, and pediatric sleep expertise below.

If your child can fall asleep in about 30 minutes after the lights are out (especially when you have made sure no screen time for 1-2 hours prior, no caffeine in afternoon) then melatonin is unnecessary.

If it were my child I’d use melatonin if sleep dysfunction at bedtime was getting in the way of necessary sleep, but I’d also do everything I could to get them off of it as soon as I could. Many children respond to the hypnotic effect of higher doses of melatonin, but many children are also given it for family convenience, too. In my experience, sometimes families use it to treat anxiety (those kids whose mind spins and spins and spins and worries) at bedtime. Although sometimes melatonin helps kids fall asleep, it’s just a band-aid.

Children are sleeping less than ever before and there are mounting impediments to a good night’s sleep (screens, early school start times, stimulants in the food source, busy school days and activities keeping kids up late). However inconvenient, I think sleep hygiene (routine bed time, no screens before bed, bed used only for sleeping) and consistency with what we do as parents may be the only magic wand to wave for sleep throughout childhood. Awakenings typically rise from all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically. When it comes to challenges falling asleep, sometimes melatonin can really help, especially in children with underlying autism spectrum disorder, attention deficit disorders, or children with shifted sleep schedules.

Only a few long-term studies have looked at prolonged use and associated effects, but most sleep specialists consider melatonin safe, particularly for occasional short-term use. The bigger question is why parents feel the need to give their child melatonin.  –Dr. Maida Chen

What is Melatonin?

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Another 20 Questions, Another School Year

last gasp of summerTime is so slippery. As we get older we feel the slip of time differently, having children pulls these time-space continuums to extremes. Nothing slower than a night with an infant who won’ t sleep and nothing seems faster than a school-age child flying through grade levels. As we prep for the beginning of the school year again this year I cannot help mentioning that it is clearly a delight to see our little humans head back into the classroom. But a little part of me whimpers inside, too. Tomorrow school really is supposed to start.

When O got up this morning and joined us at the breakfast table his first muttering was, “Why is it so dark?” I know some have been back in school for weeks but in the Seattle area many of us are just getting back to it.

There’s heartache and anxiety that comes with day one of school because the day is so emblematic for a year of what is to come. First day is packed of a blend of hopes and dreams, worries and insecurities, and pure unbridled excitement. For the last few years I’ve been asking the boys 20 standard questions just before they start. Here’s what they said this year:

20 Questions At School Start:

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More Teens Getting HPV Vaccine: Boys And Girls

The vaccine schedule is the same schedule for boys and for girls. The path to today’s human papilloma virus (HPV) vaccine has not been entirely straightforward for parents as recommendations have changed over time. Know this: the clear and simple message is that HPV vaccine is safe and effective for boys and girls. We know it works best when given earlier in the tween/teen years and we know the immunity it produces in our bodies is durable and lasting. HPV vaccines is an anti-cancer vaccine that works best when given to boys and girls at age 11. For me it’s a no-brainer to recommend this vaccine enthusiastically before children head off to 6th grade.

Earnestly, it’s not a “new” vaccine as pediatricians began giving the vaccine back in 2007 and it’s been given well over 50 million times. In the U.S. we starting giving the vaccine to girls first yet because human papilloma virus can infect boys and girls, men and women, HPV vaccine is also recommended for boys age 11 and older. Uptake by boys has been fast and steady since recommendations included them. Three different HPV vaccines are now available: a 2-HPV strain (protects against the viral strains that cause 70% of cervical cancer) or a 4-HPV strain vaccine (same 2 strains plus two more that protect against HPV strains causing warts) and now a 9-strain vaccine (expansion of strains causing warts), upping the number of different viruses that the vaccine protects teens against. The new options improve protection against HPV viruses that cause genital warts and also HPV viruses that can cause cancers of the cervix, mouth, throat, vagina and rarely, the penis.

HPV Vaccine Protecting Teens

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How To Read OTC Medication Labels

reading labels 1Reading and familiarizing yourself with the drug facts label is perhaps more important than it seems before you administer an over-the-counter (OTC) medicine to your children. I think we may get more hands-off at times than is ideal. And I think caregivers who casually help us with our children (grandparents, babysitters, nannies, neighbors) can too. Although it’s inconvenient to fill out forms for medicine administration in daycare, preschool and school, these locations seem to be the environments with the most safety around OTC medicine delivery. Those forms help remind us how important this stuff can be.

With little ones and children all heading back to school, as parents we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the inevitable fall, wintery illnesses resume, it’s a great time to set aside some time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, etc. In some ways it’s combination medicines that make me worry the most.  Read full post »