Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

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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6 Tips To Help A Child With Autism Eat Better

There are ways to support picky eaters and children who refuse new foods. I’m back with Dr. Dolezal further discussing feeding challenges for children with Autism Spectrum Disorders (ASD). The first post explored why children with Autism have challenges with eating (almost 90% do). I often say that a typically developing child will not starve with a full refrigerator, but this advice just doesn’t hold up with ASD children. I love Ellyn Satter’s advice and mission in helping adults and children be joyful and confident with eating. Her resource and guidance inspires a “division of responsibility” that basically a parent’s role is most simply to provide great healthy food and a child’s job is to choose what and how much of it to eat. But we have to acknowledge that parents to children with ASD need more information about challenges and often far more support. Here are Dr. Dolezal’s 6 tips to help a child with autism, or any child who choses to eat only a few, certain foods, eat better.

Children who graze are really not open to trying new things. — Dr. Dolezal

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Why Children With Autism Struggle With Eating

If you’re a parent to a child on the autism spectrum, take some comfort in knowing that up to about 90% of children with autism struggle with significant eating challenges. You are NOT alone in this. The challenges can range from picky eating to dependence upon PediaSure or g-tube for caloric intake. We know that children thrive in an expected world. But children with autism can take that to the margin where a preoccupation with sameness can drive them to eat only the same thing every day. Despite these staggering numbers, there are evidenced-based treatments and models of care that can help improve the lives of children and families from a nutritional and quality of life perspective. I had the pleasure of having Dr. Danielle Dolezal on the podcast to discuss this topic. The first podcast here is an overview of why children with Autism Spectrum disorders have these challenges with eating.

Rigidity and sameness contributes greatly to feeding picture. Eating is one of the most sensory experiences you can have.” ~Dr. Dolezal

Dr. Dolezal is the Clinical Supervisor of the Pediatric Feeding Program at Seattle Children’s Autism Center. She’s super smartypants and created the highly sought after (nearly 500 families on the wait list, unfortunately) interdisciplinary team model and program at the Autism Center. That means patients that have multiple factors contributing to feeding issues (medical, skill, motor, physiologic, and psychology) get to see a variety of team members under 1 roof. She started off her career with a masters in special education with special emphasis in early childhood and children who struggle with severe challenging behavior. She then got her PhD in child psychology with further emphasis in behavior analysis specializing in feeding disorders and severe challenging behavior. So needless to say….she knows her stuff. Her podcast is so good. Insistence on sameness is a common theme and can be horribly challenging for families who worry about their child’s nutrition.

A Few Quick Tips:

  • Try to not let your child slip into patterns of grazing, which is very common and leads to disrupted hunger/satiety patterns. This makes it difficult for them to try new foods because they graze to take the edge of the hunger all day long and are never really sitting down to eat a full meal at set meal times. They will be more apt and ready to try new foods if you keep to a set schedule. They don’t have to stay seated in a seat. They can stand up. But the food stays at the table.
  • Try celebrating and reinforce flexibility with something the child is already doing. So if they are eating dry/crunchy textures, try branching out to ANY type of cracker. Go from white cheddar Cheez-It to regular Cheez-It. Celebrate that as a new learning experience and new demonstration of flexibility.

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Alternating Acetaminophen And Ibuprofen For Fever

Lessening a fever in your baby or child, with multiple medicines, can be tricky. And it may not always be necessary. Many pediatricians urge avoiding “fever phobia” and allowing a fever to stick around, especially if your child is acting well. See this recent piece, “The Case For Letting Fevers Run Their Course,” by Dr. Paul Offit, an infectious disease expert on this take, the data behind it, and why fevers can sometimes help children fight infection.

Lots of families consider alternating medications like acetaminophen and ibuprofen at home to treat pain and fever, but I’m unconvinced that this leads to better outcomes for kids and/or improved fever control. It’s not my recommendation that you try alternating medications, and this post is not here to endorse this approach, rather if you choose to, I’m hopeful that this will help you do it more safely.

It’s important to note that the dosing amount for one medicine AND the duration of time between doses for medicines can be different from one medicine to another. So it can get confusing, FAST. However, armed with a plan, alternating medicines can be a good way to feel in control of supporting your child with medicines that relieve fever, improving your child’s behavior and comfort.

First….and I know I said this but I gotta say it again: it’s not necessary to treat every fever. And it’s certainly not ideal to treat the numbers on the thermometer. What always matters most is how your child looks to you and how they appear. Fever is a natural response of the immune system — it’s a response to illness, not illness itself. Fever ultimately can be productive and may assist your child’s body in fighting off infection. There may be no reason to make a fever disappear if your child is otherwise acting well, playful, and staying hydrated.

Second…there are some fevers that do require a visit with the pediatricians. It’s important to seek care when fever persists after 3 days in infants and children, any fever in a baby 3 month old or less, and if fever is over 104 degrees it’s wise to get support. Talk to your doctor before giving a pain reliever or fever reducer containing ibuprofen if your baby is younger than 6 months. Talk to your doctor before giving acetaminophen to a child younger than 2 years to obtain the proper dosing instructions, or see charts below.
Before giving your child any medicines, make sure you know your child’s weight. Dosing is always based on a child’s weight, not age.

Last… trust your instincts! If your child looks unwell in the face of fever and doesn’t seem to be improving as you would expect, call your pediatrician for help! If the fever is unexpected in a way, consider calling in to get support and education.

Ok…now that we’ve got all that out of the way, here is one way you can alternate between medicines (acetaminophen and ibuprofen) every 3-4 hours: Read full post »

After The Vegas Shooting: What To Do Now And How To Talk To Children About Firearms

In the wake of the recent Las Vegas shooting, I went on the Seattle NBC affiliate, KING5 News, to discuss how to talk to your children about guns and violence. Frankly, it’s not the first time I’ve covered this topic and as horrifying as it is, it probably won’t be last. I’m upset and sad that these shootings are becoming a part of American culture and I’m committed to doing my best to learn and translate what the experts advise us to do to decrease deaths from firearms.

I have lost people I love dearly to firearms so like so many of you, this is personal.

No question that we can feel helpless after horrific events. Focus on what you can do and share that with your children. If there is a gun in your home, keep it locked, unloaded & separate from ammunition. Remember that exposure to violent media and violent video games will change your child’s relationship with firearms – the “weapon effect” is real – so think carefully about what video and media your children use. Common Sense Media is a great site to help you sort out your choices.

Guns And Violent Media – A Toxic Mix With An Available Antidote. <— read this, it’s amazing. Basically the gist: violent media changes what children think of and may do with firearms and firearm safe storage reduces firearm suicide and accidental shootings by 75%. Seventy-five percent reduction of suicide deaths and accidents from firearms just with storage. Talk about it, do it.

As individuals we obviously can’t prevent mass shootings by what we do in our homes today, but we can communicate openly and honestly in age-appropriate ways with our children, we can build a safer culture with our firearms in America, we can vote, and we can remind children all of the things we do to increase safety in their lives. We can make sure that those around us know how much we want to keep firearms out of children’s hands, too. This will help. Read full post »

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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1 Small Hack For Smarter Smartphone Parenthood

It’s the last official week of summertime around here. My babies love school and are eager about the beginning; it’s me nursing an increasingly bigger pit in my stomach as summer wanes and September nears. While my boys grow up I feel like I see more clearly the ways summertime affords juicy glimpses into the innocence of childhood. This summer I watched these little boys stay in their jammies past noon and watched as they dabbled in stories and books, make believe, competition, mindless daydreaming, Lego-building, risk-taking, and an earnest growing concern about safety in the world. To me the collection of those interests feels so earnest and utterly serene. Summertime is just slower.

I crave the de-clutter of long days without so much chaos. Without the stresses that the school schedule ushers in, the summertime-alarm-clock-free space lends priority to an actual circadian rhythm. We eat better, the days are less driven by rule following. I think we might laugh more. Less time spent rushing and shuttling from one thing to the next and more time listening. A lot more time goofing off. I mean my 8 year-old ran into my room first thing this morning in a cape! What life (with children) is ultimately about.

As this summer, in particular, wraps up I’m also recognizing with increasing fortitude the peril we’re under because of technology in our lives.

Nothing new or profound but I really feel it right now, more than ever. My work over the past years with The American Academy of Pediatrics Council on Communication and Media has shaped the study on device-use as a station in my work, but it’s my role as a mother that screams out louder in me right now. We could really mess this up. Not our kids, per se, I just mean how we all experience this precious gift. Read full post »

Tips And Facts For Families On The Solar Eclipse

I know, everyone is writing about the eclipse. I’ve got just a few messages. One is, this is gonna be cool. Two, the caution messages are real. The cool part is because when our world goes a little dark mid-day next week it will be fairly startling. Even the animals are expected to change up how they behave. And the cautionary messages just make sense. Our eyes and our vision are clearly worth protecting ferociously. Damage from the eclipse can be permanent so taking a few steps to understand how and why just makes sense. And for framing this whole thing up in life? Thank goodness many of us have children in our midst. Their enthusiasm about how BIG this event is can help scale how exciting it is when the sun disappears in the middle of the day. Children harbor amazing perspective of what matters. Monday is a great day to stop reading the news and stare up into the sky (carefully). Thank goodness.

Quick Summary Of The Total Solar Eclipse

On Monday, August 21, 2017, all of North America will be treated to at least a partial view of an eclipse of the sun. Anyone within the path of totality can see one of nature’s most awe inspiring sights (as I’m told) – a total solar eclipse, which has not happened in 99 years. This path, where the moon, the sun and the Earth all line up such that the moon completely blocks out the sun will stretch from Salem, Oregon to Charleston, South Carolina. The New York Times created the above video that captures the science and awe of this event. Even NASA created a website to provide a guide to viewers. Out West, people are talking of little else and Slate is reporting that Oregon is expecting 1 million tourists view the eclipse. People are changing up their weeks to view this. Two little girls from Seattle are getting real – they’re launching a weather balloon into space, in partnership with NASA, with live GPS tracking (and an Amelia Earhart LEGO) and some live video coverage links, too. I mean, it’s a big deal.

Can The Eclipse Hurt My Eyes?

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New Breast Pump Cleaning Guidelines From CDC

Every tool can carry risk when not used properly. The story about breast pumps and infection risk in the media recently is no exception. Attention all breast feeding & pumping mamas out there (and all the lovely people who support moms who pump milk): The Centers For Disease Control (CDC) has issued new guidelines for properly cleaning your breast pump & parts. The new recommendations come in the wake of a devastating story of a premature baby girl who showed signs of sepsis (bloodstream infection) at age 21 days due to an unusual bacterial infection. She developed spastic cerebral palsy, developmental delays and later passed away. This case is an outlier, for sure, but did prompt learning that the CDC felt the public should know.

After a full investigation, the CDC traced the infection source back to the breast pump and parts. The way the breast pump equipment was cared for may have allowed bacteria to grow. The CDC reported that the girl’s mother typically soaked the collection kit from her personal breast pump in soapy water in a wash basin for ≤5 hours without scrubbing or sanitizing. She then rinsed, air-dried, and stored the kit in a plastic zip-top bag until the next use. It’s possible how she cared for the pump allowed for bacteria to grow and be transferred to the baby. Because the baby was young and born prematurely, the baby was at greater risk for infection that most full-term older infants.

In response to the investigation, we reviewed existing resources for women about how to pump breast milk safely, but found little guidance that was detailed and based on the best available science,” Dr. Anna Bowen, a CDC medical officer, told Parents. “As a result, CDC developed its own guidance.”

New CDC Breast Pump Cleaning Guidelines:

  • Clean your pump parts after every use. Don’t skip a single feeding. I know it’s yet another step in the long process of breastfeeding and pumping, but it’s crucial. Annoying add but the recommendations are based in experts evaluating risks.
  • Wash your hands before touching your pump parts or pumped milk.
  • Key: keep a separate wash basin for the parts, the CDC doesn’t recommend you use the kitchen sink to clean pump supplies as the sink may house germs and bacteria from other food prep.
  • Have a dedicated cleaning brush for your pump and parts. Clean that brush every few days. Don’t re-use the sponge you use to scrub food off your plates and dishes.
  • Use running water and soap to clean breast pump parts that come in contact with breast milk.
  • Then let each piece and part air dry.
  • For extra cleanliness you can boil or steam the parts to sanitize in either a microwavable steamer or use the sanitize cycle in the dishwasher (HOT water). You can use the sanitizing bags that you use in the microwave or you can bring a pot of water to a boil and boil parts in the bubbling water for 5 minutes.

Bottom Line: this news isn’t meant to scare or drive moms away from breastfeeding and pumping. We know the many benefits of breastfeeding for both mom and baby (see below). This is just a reminder to be diligent when cleaning and sanitizing your breast pump. Read full post »

Driving Under The Influence of Electronics: The New Law

Getting a DUI just got easier. Driving Under The Influence of Electronics (E-DUI) is real and will cost you as Washington State gets serious about reducing deaths from car accidents caused by distraction. The reason is clear: we know distraction from cell phone use increases risks of accidents over 20-fold and we know the habit of using a device has quickly become the norm. Here’s to hoping the new law helps us think of our cars as the sanctuaries they can be for those we cart around and for those we love. Of anything I’ve learned from researchers about vehicle safety and distraction it’s the reality that finger-wagging and telling-us-to-change type advice won’t affect our habits — we have to be motivated to change the culture of our car. We have to want to connect there or we have to be fearful of being fined. Since I made the podcast with Dr. Beth Ebel (embedded below), whenever I get in the car with my boys I think of it more like I think of time at the dinner table. And I love thinking about the car in that way. It’s so much easier to make sure I won’t pick up the phone…

The New E-DUI Law In Washington:

Tomorrow a new law signed by Governor Inslee bans holding hand-held devices, like cell phones, while driving (and even when you’re stopped at an intersection). The law makes it so drivers can only use their phones to call 911 or by using one finger to trigger a voice-activated application on bluetooth. In addition to a $136 ticket for your first offense and $234 for the second within 5 years, these citations will be reported to insurance companies. Learn more about the law on Washington’s Target Zero website. The reason is pretty clear — just as we were seeing the death rate fall from good seatbelt use and clamping down on DUIs, there has been a rise in accidents and deaths. Many believe this is in part due to the rapid rise of device distraction.

Under the new law you can’t even look at your phone at stop lights. Reason is, you lose awareness of situations around you and many accidents occur when pedestrians are struck by distracted drivers in intersections.

Data Driving The New DUI Laws:

  • Fatalities from distracted driving increased 32 percent from 2014 to 2015 in Washington.
  • 71 percent of distracted drivers engage in the most dangerous distraction, cell phone use behind the wheel
  • One out of four crashes involves cell phone use just prior to the crash.
  • At any given time, 2013 research has found that about 10% of people driving are actually using a device and half are texting! Anecdotally it only seems to be getting worse. I mean we look around and constantly we see people flying down the highway while trying to send messages.

The law is a big step in the right direction for avoiding injuries and death from distracted driving. We know that it’s hard for us all (!!) to keep the phone off or in the backseat. And we know the fear of tickets — the ones that take away money but the ones that also increase insurance premiums — may change behavior. And that’s the goal. Public service announcements scaring us about risk clearly are not enough and are clearly ineffective as use of devices in cars rages on.
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