Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

H3N2 And An Update on Flu

Lots of information floating around this past week about influenza. Of anything, remember this: it’s easiest to predict that influenza can be unpredictable and it’s also still true that a flu shot is the best way to protect your family from flu. I’ll explain why, along with a recap of what you should know about new data, here.

Flu season is just getting started in the United States (circulating infections in nearly all states) and this past week the CDC announced new information about a strain of Influenza A, H3N2. This is exactly what the CDC is supposed to do: keep us informed and help us prepare for an influenza season. This year the information standing out is risks surrounding the strain of H3N2 that has “drifted” and the reality that when H3N2 is the most common strain of flu going around it tends to cause more serious infections.
Did you know? Every year an estimated 20,000 children younger than 5 years old are hospitalized for flu complications. Like pneumonia. Everyone in your family who is 6 months and older should get a flu vaccine. This year, Next year, Every year. #getafluvax

When Influenza Virus “Drifts”

  • Vaccines for each year’s flu are formulated months in advance to allow time for vaccine manufacturing and distribution.
    • 100 centers around the world provide influenza surveillance and predict which strains will circulate to the US and North America. Decisions are made in February each year for the next year’s vaccine. Researchers look at trends to determine which viruses may be more prevalent.
    • The vaccine protects against three (trivalent vaccine) or four flu viruses (quadrivalent vaccine), based on the world’s predictions. Typically each flu vaccine has at least two strains of Influenza A and one or two strains of Influenza B. Of anything that is consistent it’s that flu seasons are unpredictable.
  • H3N2 is one strain of Influenza A in this year’s vaccine. The “drifted” vaccine is just another form of H3N2 that has different characteristics.
    • Flu viruses often “drift,” this happens every few years. The drifted H3N2 virus is one specific type selected for the 2015 southern hemisphere influenza vaccine (point being: this isn’t an unknown virus, it was just unknown how much it would spread in the US).

Read full post »

When A Child First Dreams At Night

boy sleeping My youngest had a dream a few months ago. In it he was a giant marshmallow (or maybe it was just about a giant marshmallow). Not necessarily clairvoyance or genius coming out here, but a monumental dream nonetheless. The reason: it was the first dream he remembered and reported to us at the breakfast table unprompted. It stuck with me (can you imagine dreaming about marshmallows and balloons and robots –these are things I hear about from my boys). I mean, do you remember the first thing you dreamed about that stuck through until morning? Some think of nighttime dreams as telling subtle stories of those we enjoy, facilitating memories we cherish or unleashing and un-roofing things we worry about it. I’ve also heard people opine that dreams are threads of life we need “to process” more. Reality is, we may know very little, scientifically speaking, about dreams, especially for our children.

The definition of dreaming is: “a universal human experience occurring during sleep in which fictive events follow one another in an organized, story-like manner and into which are woven hallucinatory, primarily visual, images that are largely congruent with an ongoing confabulated plot.” It’s been proven that those images tend to become more bizarre the longer we sleep, but does the actual act of dreaming have a link to child development? When and why do children dream and what do we know about it? I have been wondering…

Thankfully, sleep expert, the lovely Dr. Maida Chen weighs in. Here’s a quick back and forth we had about dreams. Stunning stuff she shares so well here… Read full post »

Power Of A Kiss And Family Oral Health

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Oral health doesn’t start and end with the dentist. Times are changing as the Washington Dental Service Foundation has trained 1,600 pediatricians and family physicians throughout the state on the importance of oral hygiene in young children. Pediatricians are now applying fluoride during well-child check-ups and counseling families more comprehensively on how to prevent dental decay while also referring to dentists for prevention and acute dental problems. Just last month I attended the 1-1/2 hour oral health training with a pediatric dentist. That learning coupled with a new policy statement from The American Academy of Pediatrics highlighting the importance of oral health inspired me to get the word out. I suspect we can all do a bit better protecting our children’s mouths. Recommendations for fluoridated toothpaste have recently changed (use it with the very first baby tooth!) as has knowledge and reminders about how we share our bacteria with our children. What we do for our mouth may have direct effects on our children’s.

The Most Common Chronic Childhood Disease

  • The facts about oral health in children are a little surprising. By their first birthday 8% of toddlers have cavities in their mouth and the Pediatrics policy detailed 24% 2-4 year-olds, 53% 6-8 year-olds and 56% 15 year-olds also have dental disease. Since oral health (even in babies and toddlers) is an integral part of overall health of children this is problematic. Dental disease has strong links between diabetes, respiratory infections and heart disease. The numbers for children with dental disease are high (!!) which makes dental disease the most common infection of childhood.
  • Good news is much of this disease can be prevented (or corrected) and because infants and young children see the pediatrician more frequently than the dentist, it’s becoming clear that pediatricians need to hone skills on oral health, the disease process, prevention and dentist interventions when necessary.

4 Things I Learned About Oral Health

Read full post »

Boring, Bare, Basic: Keep The Crib Safe

bare, boring,  basicWe’ve known for several years that a crowded bed and a decorated crib (pillows, quilts, stuffed animals, bumpers) can put babies at risk for sudden infant death syndrome (SIDS) and unintentional sleep-related suffocation. Boring, bare and basic beds are still best for babies. Tell every mother, father and grandparent to an infant you know. A Pediatrics study out today shows hazardous, soft bedding is still being used by as many as 50% of US parents despite years of public health messages urging the opposite. I see where these numbers come from– we parents love to dote on our babies. We instinctively provide warmth and coziness to our babies all day so images of abundant bedding at nighttime can look divine. Further, our families (mothers or mothers-in-law!), coworkers and neighbors may encourage soft bedding because of old habits; many feel warmer bedding is better. However when it comes to the crib, our instincts may deter us from providing the safest sleep. As friends, parents, relatives and co-workers we have to support new parents in creating a basic, boring, and bare crib. Our responsibility extends from our own home to the workplace and to our neighborhood — what we buy and hand-down for that baby showers matters! The study out today reminds us we have lots of work to do, especially as data finds some groups of parents may be at more risk for using the soft stuff…

Soft Bedding Increases Risk

Several studies around the world dating back to the 1990’s have found SIDS risk increases with soft, loose bedding. This includes blankets, pillows, stuffed animals, quilts and similar materials either covering/on top of or underneath the infant. Read more about risk modes for SIDS, and why I hate sleep positioners. What we know: data in the early 1990’s was so compelling that in 1996 the AAP began recommending that infants sleep in firm, stark bedding environments on their back. The great news is that parents took notice of the “back to sleep” campaign and there was a sharp decline in the use of bedding in the 1990’s. Between 200-2010 the progress slowed. More from the study about moms and babies at risk: Read full post »

5 Things You Should Know About Concussions

This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them.


Soccer is the highest risk sport for school-age girls.

Soccer is the highest risk sport for school-age girls.

What Happens During A Concussion?

A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain, resulting in a mismatch where the brain needs more energy but receives decreased blood flow to the brain temporarily. This mismatch in blood flow is believed to last up to 10 days following an injury and helps explain the symptoms associated with a time-limited injury such as a concussion.

Unfortunately this also explains why diagnosing and managing concussions can be vexing. Unlike a broken bone, we do not have validated imagining or blood tests that enable definitive diagnosis. The best practice of diagnosing concussion currently relies on obtaining a detailed history and physical following an injury. Depending on the severity of the injury and initial presentation, a sideline assessment should performed to look for common post-concussive symptoms. If the initial injury is more severe one may need to be evaluated in the emergency department and imaging may be obtained to help rule out a more severe injury. Each traumatic brain injury is unique, and should be treated with respect. There is nothing more heart breaking than a traumatic injury being improperly respected and identified, leading to a delay in care and permanent deficits.

 It can be challenging to determine which concussions are mild, severe and which may progress. Ultimately the goal is to prevent injuries, screen for potential head injuries when appropriate and diagnose and treat injuries in a timely fashion to limit their severity.

How To Prevent Head Injuries

Read full post »

The Seriousness Of Concussions

J. Forrest Bennett, ARNP, Rehabilitation

J. Forrest Bennett, ARNP, Rehabilitation

This is a guest post from J. Forrest Bennett, an ARNP at Seattle Children’s and Dr Samuel Browd (@DrBrowd) a neurosurgeon who, together with their team, care for children after concussions. Clearly, we’ve all heard more about concussion these past few years. Not just because of pro-football tragedies and lawsuits but also because of the increasing expertise the medical community is acquiring around how to care for children and young adults after getting hit in the head. We’re also learning how to prevent head injuries in the first place. Forrest and I first started discussing this last spring when I began to see his passion in getting great information out to families. He’s convinced the more we parents (and community physicians) know about what to do with head injuries the less children suffer. In some cases what we do in minute 1 or day 1 after an injury can really change how a child recovers. Take a peek at this awesome post and please post comments/questions if you have them. More content will also be published later this week.


There is an ongoing debate about how we should best assess, manage and prevent head injuries in sports. Given the complexity of the injury and the effects that a concussion can have on an individual there is no room for the outdated and dismissive terms such as “getting your bell rung” or a “ding to the head.” Being dismissive of head injuries can lead to premature return to play and can end tragically. These injuries really matter.

This isn’t to say that kids shouldn’t play sports of course. Sports promote cardiovascular health and play a crucial role in the character development of children and adolescents. Parents must balance the risk with the benefits of sports to promote healthy decision-making. I like to talk about an active risk-reduction lifestyle. Through outreach and education we can prevent debilitating injuries, identify concussions early, and provide care plans that stem from evidence to limit the impact injuries have on kids.

What Every Parent Should Know About Concussions

  • Helmets do NOT protect against all concussions
    • Helmets provide crucial protection against skull fractures and more severe brain injuries but you can still suffer a concussion even with all of the proper protective equipment.
  •  There is a right way to play sports
    • Teach your kids safe ways to play sports and adhere to the rules of the game. For example: no tackling in soccer and no head tohead contact in football. HEADS UP trained coaches teach actively safe participation in sports.
    • The majority of sport rules are intended to maintain a level playing field and enjoyable experience. Head to head contact in football is just one example of improper and unsafe play that has recently drawn national attention in increasing ones risk for injury.

Because injuries happen, a group of experts developed the Standardized Concussion Assessment tool- 3rd edition (SCAT 3). This tool can help guide trained coaching staff, athletic trainers and medical providers in the initial assessment, triaging, and monitoring of these injuries. Many concussions can be handled through the expertise of your pediatrician or primary care provider. Concussions with prolonged symptoms (lasting weeks to months) and\or more severe injuries frequently benefit from a team approach. Read full post »

Whoops: Over-The-Counter Dosing Errors Common

OTC revised infoIt’s that time of year again. The season of snot and mucus and colds….if you’re a parent you may even call this “sick season.” Typical cold viruses are getting readily exchanged as recirculated air in crowded malls, classrooms and daycares facilitate exchange of the germs. It’s more than inevitable that one of your kids will come down with something. Those 6-10 colds that children get on average, every year, have arrived which means there’s a good chance you’ll be up late one night with a feverish or coughing child reaching for an over-the-counter (OTC) medicine . Data proves we’re all at risk for making a dosing error. Remarkable how easy it is to do. As a pediatrician I always have to check (and double check) the label when I’m home dosing my kids. The bottles and doses are all so different.

A new study in Pediatrics found that every eight minutes a child under the age of 6 experiences a medication error (outside the doctor’s office or hospital). Over the course of ten years (2002-2012) 696,937 children experienced medication errors. Young children (under age 1) had the highest rate of errors making up more than 25% of the total number. For parents these may be easy mistakes to make as containers and dosing devices aren’t always clear (nor are they consistent) even after FDA rule changes were made a few years back.

It’s important to note that the study referencing dosing errors (above) found dosing errors from cough & cold medicine are thankfully going down while dosing errors around other meds are actually rising. It’s also of import to say that most pediatricians don’t recommend OTC cough and cold meds for children under age 6 anyway as they provide little benefit and put children at risk for side effects and dosing errors. Read full post »

Is Overuse Of Antibiotics The New Global Warming?

Desinfecting.JH

Antibiotic resistance is like global warming; it feels like it’s someone else’s problem to solve and much bigger than all of us. Yet the simple choices we make – whether or not to use antibiotics and which ones we pick – do affect us and our community. ~Dr Matthew Kronman

This week is Get SMART About Antibiotics Week, aimed at raising awareness of antibiotic resistance and the importance of appropriate use. Dr Kronman’s “inconvenient truth” reminder serves up the importance of our choices; what we do everyday with our food and our medicines changes not only our own health but also the health of others now and in the future. Antibiotics in food, water, and our clinics and hospitals change our environment. Each dose of antibiotics given to our children, ourselves, or the animals we eat change our community’s health in general. The more we use antibiotics that kill off susceptible bacteria, the more we select bacteria for survival that are resistant to known treatments. The consequence over time for us all is that there are more resistant bacteria or “superbugs” around causing harder to treat infections.

 4 Things You Can Do Today To Avoid Excess Antibiotics

Read full post »

Has Your Babysitter Had The Whooping Cough Shot?

Mama Doc w baby girlA Seattle high school recently announced a minor outbreak of whooping cough: 13 students were diagnosed with laboratory-confirmed pertussis. None of the teens are contagious as of today, but it poses an interesting question about protecting our children and communities. A health advocate and friend on twitter suggested a savvy reminder: we can help teenage babysitters get up to date to protect young babies and children. Yes! Is it our parental responsibility to make sure babysitters, nannies or even sweet grandmas are properly vaccinated? Should it be the question we ask before we inquire if they’ve completed CPR training? Perhaps.

It’s hard enough to ask grandparents and friends to vaccinate or “cocoon” to protect our youngest and most vulnerable. It may be a challenge with the neighbor babysitter as well. I’d suggest just saying, “Hey, did you get your 11 year-old shots and your flu vaccine this year?” Thing is, one hurdle may be that your 15 year-old sitter may not know if they’ve had their teen pertussis shot. As a reminder, all children are given immunizations for whooping cough (DTaP) at 2, 4, 6, and 15 months. They then receive another dose at age 4. Then a tween booster dose (the Tdap shot) at age 11 years.

Many children prepare for the big job of babysitting by taking classes. At Children’s our next Better Babysitters class is November 22nd. I’m working to ensure that instructors make sure they help teens determine if they’re up-to-date on immunizations during the course!

What Is Whooping Cough?

  • Highly contagious bacterial infection (pertussis) of the nose and throat causes “whooping cough.”
  • Easily spread by coughing and sneezing. Symptoms appear 7-10 days after exposure (on average)
    • Symptoms differ by age, babies & young children may have severe coughing spells or even pauses in breathing. We worry most about newborns, young infants under 2 months of age but also consider babies under 6 months of age “high-risk.”
    • Adults and older children could have fever, runny nose and bad cough that progresses into coughing fits, “whooping” sounds with cough, or even a cough that lasts over 100 days (even if treated). Treatment prevents spread, not the cough.

Is Whooping Cough Serious?

Read full post »

An Unfair Advantage

MIL photoI recently listened to an interview on This American Life that stuck with me. The show was entitled “It’s Not The Product, It’s The Person” and went through a series of examples uncovering the reality that great business (or great work) is more a product of the who than the what. Who people are, how much grit, tenacity, raw or natural talent, passion, or skill really matters when doing whatever it is that that they do. Far more perhaps than what they actually create, sell or even perform. And although this isn’t the point I mean to make (you’ll see) it’s worth noting that the show opens with details of a young entrepreneur, like really young (age 11 years) and demonstrates how her talents, bravado, and finesse allow her to sell things and attract attention that others can’t. The show rounds out as the narrator showcases the varying pitfalls in his own quest for success as an ex-NPR radio producer turned start-up entrepreneur. The story was somewhat lighthearted, of course, but one point stuck. As he was gleaning information from an established, successful venture capital investor he was asked a potent question. The investor was interrogating how this fledgling entrepreneur could get funding; assisting him in creating his “pitch” for the money people. He asked, “What’s your unfair advantage?”

Think about it, what’s your unfair advantage?

It stuck with me because it was so relevant for success in an often random, senseless world of building ideas and companies but also in parenting “like a pro.” An unfair advantage sometimes facilitates success and I would suggest nearly all of us have something in our pocket that we know makes it work. You can think of this unfair advantage in terms of celebrity or early success for some (Kate Hudson’s mom is Goldie Hawn after all, and it certainly seems easier to get a bedroom in The White House if your last name is Bush or Kennedy or Clinton for that matter). Yet we all also know that success isn’t only built of “unfair advantages,” that it does take advantage wed to sheer passion, purpose or intent. But clearly those unfair advantages help people get their ideas and skills discovered.

It was only recently that I realized my unfair advantage this past decade or so. Read full post »