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How To Treat Head Lice

As parents, many of us have been there. You’re going about your day and BAM…fear and anxiety start creeping in as soon as you read the email, that perhaps again, there’s an outbreak of lice. Someone in your child’s school has lice and your child may have been exposed…blah, blah, blah. Nothing about this ever feels benign, even though it always is. Lice just feels a gross inconvenience. This post details the lice life cycle, the ways lice spread, and ways you can treat lice with both OTC or prescription medicines.

Lice infestation is common for US children and has nothing to do with cleanliness. The Centers For Disease Control (CDC) estimate 6-12 million lice infestations a year in the United States, but something you cross your fingers doesn’t make its way into your home or hair.

How Lice Live And How Lice Spread

Head lice feed on tiny amounts of blood from the scalp and if they are not on a person’s scalp, they can usually only survive about a day. This is good news for remembering that lice won’t crawl around your home for days — ever. They just can’t. Lice lay their eggs close to the scalp and when on the head can live about 28 days. They can multiply quickly, laying up to 10 eggs a day. It only takes about 12 days for newly hatched eggs to reach adulthood. This cycle can repeat itself every 3 weeks if head lice are left untreated.

Remember that head lice usually only survive for less than 1 day away from the scalp at room temperature. Their eggs cannot hatch at room temperature lower than that near the scalp. So once they fall off a child’s head, lice pose very little threat. You don’t have to vacuum the carpet, sterilize the toys, wash the house top to bottom after your child has lice. I mean you can, but don’t do it for the lice :-).

Lice is typically passed through close person-to-person contact.  Lice crawl, they can’t hop or fly (phew!). Lice mainly move from head-to-head and less commonly move from one person to another on a hairbrush or hat or costume.

Lice At School – Why Kids Don’t Get Sent Home Anymore

The American Academy of Pediatrics and CDC have fought hard against “no nit” policies in schools, in the interest of reducing the school absence associated with head lice. When recurrent infestations occur this can be frustrating but no child really ever needs to miss school for lice. Schools are increasingly unlikely to exclude children for nits, but still, in some schools, the policies persist. The rationale for not sending kids home:

  • Many nits are more than ¼ inch from the scalp. Such nits are usually not viable and very unlikely to hatch to become crawling lice, or may in fact be empty shells, also known as ‘casings’.
  • Nits are cemented to hair shafts and are very unlikely to be transferred successfully to other people.
  • The burden of unnecessary absenteeism to the students, families and communities far outweighs the risks associated with head lice.
  • Misdiagnosis of nits is very common during nit checks conducted by non-medical personnel.

 

Over The Counter Lice Products


Most of the time the very best bet for lice are OTC, easy-to-use treatments. The FDA has approved over-the-counter (OTC) lice products as safe and effective when used according to the Drug Facts label instructions. There are 3 main ingredients used to treat lice: Permethrin, most commonly found in the OTC product Nix or Piperonyl Butoxide and Pyrethrum Extract, most commonly found in Pronto or Rid. Each product has different and specific treatment instructions, like if hair needs to be shampooed first or if dry hair is needed, the age a child has to be for these products to be used on their scalp and if and when a second treatment is recommended. If the thought of dealing with lice makes you light-headed, there are lice-removal services available. They’re not cheap (starting around $100 in the Seattle area), but some parents may find the expense well worth the piece of mind of getting rid of lice manually by professionals. Read More »

How To Help Your Gassy Baby

Things to give to new parents: smart books. Awesome things to give to new parents: books about how babies eat and poop. What and how babies eat and how they fart and poop (and sleep) are basically all new parents think about. I’m not exaggerating — of course the most emotional part of new parenthood is the love and overwhelm that takes us over. But second to it is what the baby eats and how they poop. Period.

I’m standing on my chair clapping as I tell you that Dr. Bryan Vartabedian recently published a new book: Looking Out for Number Two. A candidly written, humorous, scientifically-backed poo bible. It’s an illuminating look into every parent’s secret obsession – their baby’s poop. I am thankful, both as a mom and pediatrician for his sound advice and expertise. Poop is a big topic in almost every well baby exam and I’ve written about it several times (see below). But I haven’t dedicated a post to something so many parents worry about and search for remedies: gas.

Most babies are naturally gassy, but it can be quite painful (obviously) and lead to lots of screaming and thrashing about. Signs that your baby has gas are: crying, pulling their legs into their bellies, wiggling & hard belly.

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Online Interventions Improve Vaccination Rates

The flu season is upon us and I hate to be so prescriptive, but when it comes to avoiding influenza, I feel like I have to be. I get the flu vaccine each year as does my entire family — I think you should, too. I’m passionate about vaccines and have had the luxury of blogging and deploying vaccine science education to the world since I began the Seattle Mama Doc blog in 2009. I’ve been particularly vocal about the flu shot and have leveraged traditional, digital and social media tools ever since I began. I’ve used my blog, book, Instagram, Facebook, Twitter, and my podcast to share information about recommendations and rationale for why a flu shot makes sense for every infant over 6 months, child, teen, and adult. Of anything I’ve learned over the years, it’s this: building public insight into why this annual flu vaccine recommendation makes sense, is a marathon…it’s not a little sprint. Influenza can be a nasty virus with life-threatening and life-ending complications and it’s an ongoing obligation to ensure everyone in this country understands ways to decrease risk.

Data is on our side that online efforts in social media are worthwhile for spreading valuable research, expertise, and education. Every parent wants their child to stay healthy and live long into adulthood. Those who decline/defer vaccinations or don’t get the flu vaccine are clearly no different in that regard when compared to parents who do immunize with flu vaccine. But levels of trust and understanding for the science of safety in vaccinations between the groups may differ.

Thankfully, new research shows these online efforts by doctors like me may help families understand rationale for immunizations, especially if moms were educated even before the baby was born. A study published this morning in Pediatrics leaves those of us sharing information online validated in our efforts.

US Study Finds Blogs And Social Media Influence Infant Vaccine Status:

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10 Things To Know About 2017-2018 Flu Shots


The flu season is soon to be upon us and I hate to be so prescriptive but when it comes to influenza I feel like I have to be. I immunize my entire family and I think you should, too.

Hard to believe, but with our children going back to school and swapping snot around the classroom, it’s time to get fall flu immunizations on your radar. Last year during the 2016-17 season, more than 100 U.S. children died of the flu (influenza), and thousands more were hospitalized for severe illness or complications from the virus. Historically, more than 80% of children who died of influenza were not vaccinated. The flu shot is the best way to teach your own immune system to fight back if exposed to the virus. The flu vaccine “recipe” was changed this year (one different A strain compared with last year’s vaccine) to accommodate for predicted viral strains that will likely come and circulate around our neighborhoods.

The recommendations this year are the same as last year. Every child over 6 months of age should be immunized.

10 Things To Know About Flu Shots:

Here’s what you need to know based on my experience as a pediatrician, The Centers for Disease Control and American Academy of Pediatrics policies:
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Limit The Juice: None for Babies, Only Ounces For Kids

Not news that pediatricians recommend against juice. But the news this week is clearer: no juice for babies, only tiny bits for toddlers, and less than a cup a day for the rest of us. Fruit juice is widely thought of as a healthy and natural source of vitamins and hydration. And although I won’t vilify having juice in the diet of an older child, I can’t endorse it’s ever good for a child. Pediatric recommendations for juice got stricter this week. Juice is never really recommended in an a child’s diet past ounces to a cup a day but now it’s recommended as a NEVER during infancy.

Although whole fruit (i.e. an apple or an entire avocado or apricot) is one of the main focus foods in the Dietary Guidelines of Americans, fruit juice may feel a thoughtful substitute, but it’s not. In fact, even 100% fruit juice offers no real nutritional benefit and it’s never needed. The short list for why?

  • Juice is just a bunch of water and simple sugars (naturally occurring sugar is sugar) and lacks fiber or protein.
  • When you obtain calories from juice you take them in at a faster rate than is ideal. Juice is known to contribute to overweight and excess energy imbalance in children. We don’t need to drink these calories.
  • Whole fruit has the advantage of containing quality fiber that’s good for us.

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How Genetic Technologies May Change How We Approach Parenthood

Seattle writer Bonnie Rochman has a new, smartypants book on genetic testing. It’s not a “how-to,” per se, rather a storytelling look and near confessional at how confusing it can feel when you’re pregnant (or plan to be) and faced with the marketplace of ideas and opportunities for knowing more from genetic testing. Simply put, she articulates the quandary nestled in the “to know” or “not to know” more about your expected baby, genetically speaking.

In the book (and the podcast and TV seg she joined me for —  included below) Bonnie talks of her own journey as a mom but also interviews researchers, geneticists, families, expecting parents, and ethicists along the way. It’s researched; the pages of notes and references at the end could overwhelm, if you let them. Thankfully, the book reads like a story and yet Bonnie doesn’t shy away from complex ethical spider webs like the implications (for some) in getting tested for fatal diseases and the option to enter the abortion debate. More than anything, Bonnie takes on the reality that when it comes to prenatal genetic testing, the tests themselves, the official guidance, and the technology itself is moving faster than our public and medical understanding…

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5 Things To Stop Worrying About

It’s a hard time to be a human in the United States. We’re all so worried right now as the universe seems to spin every day and the divisions among us seem to project on every wall. Yesterday I escaped the city, the news cycle, and dread by sledding with my boys in the mountains. Those outdoor be-without-a-ceiling interludes help, but the reality is Sunday morning just arrived and the newspaper is sitting on the front porch. To open it?

The hesitancy to even open the newspaper brings me to an essential truth: most of us are doing a wonderful job raising our children and what is in front of us is precious and safe. Most of us have inner critics that knock us down every day and criticize how we’re doing. But most of us can stop worrying about things so much at home. We really can and should chill out and enjoy this.

Looking to shorten your to-do list, maybe sleep better and reduce anxiety? I’ve shared 5 things I think we as parents can STOP worrying about in the latest podcast. It’s just me talking in this one (no experts join) and even so, I like this podcast. In a world where were are inundated with competition, guilt, data, and comparisons, take these ideas and feel better about the (likely) most wonderful job you’re doing raising your children.

Also, you should know I’m recording, “5 Things To Perfect As A Parent” this week as I feel we all need reminders of how much we have already mastered. We have to frame-shift and realize how great things really are while raising children amid these spins and unease. Read More »

Get Rid Of Constipation In Children

Children's legs hanging down from a chamber-potConstipation is really, very truly, no fun for anyone. No fun for baby or child, no fun for the parent who worries and watches and cleans the clogged toilet, and clearly nothing wonderful for the sister or brother who waits while a family supports a child in the room next door. In general, constipation is a frustrating, sometimes hugely embarrassing, and often a chronic problem for young children. In my experience, parents worry a lot about hard infant or toddler poop in the diaper (goal is always peanut butter consistency or softer) but it’s when constipation sneaks up on many families in school-aged children that BIG suffering ensues.

I can’t say this loud enough: if you’re worried about constipation in your child do consider seeing your pediatrician, nurse, family doc or physician assistant to make a long-term plan. Constipation DOES get better but do know it’s over weeks to months. When your child’s intestinal tubing is stretched out for weeks it takes weeks to re-configure sometimes — quick fixes won’t be long term solutions. More below on which remedies to use and how.

Constipation sneaks up because after children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl so gone are the days of tracking daily poops. Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop (below). I usually break this down for children (and parents) in visual terms. I talk about things you find outside:

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet? Or at least a report?

Lots of foods, hydration and OTC medicines can quickly change the game with constipation. Before I detail more specifics on constipation and highlight some remedies, I do want to call attention to some potential concerns of polyethylene glycol (PEG 3350). The medicine PEG 3350 is an odorless, tasteless laxative that can be easily diluted in juice or water. It’s a big polymer and can’t be absorbed by the intestine so it works by binding to water so that water ingested can’t leave the intestines, colon, and rectum. The great news is it doesn’t cause cramping or more pain and isn’t addictive. Used daily (often for days or weeks) the powder binds to water and disallows the colon to dehydrate the poop so it just doesn’t get hard. Therefore the poop that comes out is soft and often helps produce less painful pooping — and often it comes out more often! It’s commonly sold under both brand (Miralax) and various generic names. However, the Food and Drug Administration (FDA) has only approved its use in adults, not children. Currently, PEG 3350 is being studied as well as the bi-products of PEG 3350, specifically ethylene glycol (EG) and diethylene glycol (DEG), to determine whether it might be absorbed by children and whether use of the laxatives is linked to development of psychiatric or neurodevelopmental problems. The New York Times has done 2 stories on this topic: one in 2012 and one more recently in 2015, both worth a read if you are debating giving your child PEG3350. For children and families with severe constipation often the benefits of using it far outweigh the concerns.

What Is Constipation And Why?

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New Data And 10 Ways To Reduce SIDS And Suffocation Risk In Babies

Mommy-copy-e1273260009105Any parent to a newborn worries about Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID) and what they can do to prevent it. SIDS deaths are unexplained while SUID deaths in infants are secondary to things like suffocation, entrapment, infections, or trauma. The new recommendations take research on all of these risks into account and are specific to guide parents to reduce risks for SIDS and sleep-related suffocation, asphyxia, and entrapment among infants in the general population.

I’ve been interviewed a lot lately about all the fancy new baby trackers, monitors and even smart cribs available to the public being marketed as SIDS reducers. These are not the answer to safer sleep — no data to prove it. I’m a digital enthusiast but it doesn’t change my concern that these devices are entering the market out of the place of fear, not science for improved safety. I think we have to acknowledge that these trackers might amp and rev up anxiety more than they will decrease it in some parents.

What we CAN do to decrease risk of SIDS is follow new research-based guidelines published this month from the American Academy of Pediatrics (AAP) to reduce the likelihood of SIDS and suffocation. This new set of guidelines are updates to the 2011 recommendations, some being similar, and others a bit different. Big changes from my perspective are the stronger recommendations for pacifier use in infants, the strong recommendation against feeding babies in the nursing chair at night, and the ongoing urging to have your babies in BARE, BORING, BASIC sleeping environments in a parents room. Pillows, blankets, bumpers, and stuffed animals are cute but not safe for infants under 1 year of age. Where we feed our hungry babies in the middle of the night matters, too. The recs out this month help define ways to do this with more confidence you’re reducing risk.

“Parents should never place the baby on a sofa, couch, or cushioned chair, either alone or sleeping with another person. We know that these surfaces are extremely hazardous.” ~Rachel Moon, the lead author of the new guidelines and professor of pediatrics at University of Virginia School of Medicine

10 Ways To Reduce Risk Of SIDS And Suffocation

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How To Dose OTC Medicines In Babies

kyotcs_feverinfographic_weightageAbout 4 million sweet babies are born in the U.S. every year. And since September & October are two of the most popular months in the year for the birth of babies I’m taking a moment to share a couple of reminders for new families and those of you who support them.

1. Nursing Moms & Over The Counter (OTC) Medications: Every new parent feels a sense of overwhelm and exhaustion after welcoming a new baby. It can be especially exhausting when moms are breastfeeding and carry the new concerns about what they’re eating, how they’re both supporting themselves and their baby’s milk and when moms and dads have concerns about passing OTC medications (or Rx ones) through mom’s milk. Here are a few guidelines and reminders:

  • Don’t take aspirin if you’re breastfeeding.
  • It’s always best to avoid extra strength formulas of any medication, as they stay in the blood stream longer.
  • Always ask your doctor if you are worried or have questions about a medicine or supplement you’re taking if you’re breastfeeding. Always makes sense to ask.
  • Read the Drug Facts label as this will sometimes help you understand risks.
  • I like LactMed as a resource/search tool to help find information on medications. LactMed is updated monthly and is a database of over 1,000 drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects on the nursing infant. All data are derived from the scientific literature and fully referenced.

2. When Your New Baby Gets A Cold Or Fever: Your baby’s first bout with a cold or fever can leave you feeling scared (and exhausted) as you watch your baby deal with the inconvenience of mucus and snot, coughs and/or sneezes. Infants are more susceptible to infections because they don’t have fully developed immune systems hence why we all work hard to avoid exposures for them early in life. But upper respiratory infections (“colds”) do happen even with the best of protections.

Oral cough and cold medicines (including cough suppressants, cough expectorants and multi-symptom cold medicines) are not safe for infants and young children under the age of 4 or 6 years of age.

However, if your baby has a fever and is OVER the age of 3 months, you can give them acetaminophen to help relieve symptoms. The label on OTC medicines for infants and children only includes dosing for children age 2 and older; so talk to your doctor for dosing for younger children.

Always dose medicine by your infant’s weight, not their age, so at every well child check-up as your baby grows, ask your pediatrician to provide the proper, current dose for OTC medicines.

You can also give your child ibuprofen for mild infections, fever, or teething. Dosing for children 6 months and older is on the label; talk to a doctor for dosing for younger children although it is not typically recommended. Here’s more on dosing acetaminophen and ibuprofen by weight in infants and toddlers.

There are also several non-medicine interventions for colds. If your infant or toddler is too young to be given OTC medications or you’d prefer not to use them, there are other options to help relieve symptoms and keep your baby sleeping and comfortable. Read More »