Seattle Mama Doc™

A blog by Dr. Wendy Sue Swanson.

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

Listening To The Periphery

Published March 14, 2013 in: Mama Doc Philosophies, Parenting 1 Comment

hallway baconWe learn so much from our children. How to slow down, how to speed up, how not to behave. How to be present, mindful, and attentive to immediate needs. I’m not always entirely mindful and I certainly find myself easily distracted–it’s not just the phone I need to put down. Yet one low moment of distraction came to light late last summer when my 4 year-old literally put his body between my phone and my face to get my attention.

But ever since August I’ve felt more aware of the moments that pile on and feel more able to witness those I am lucky enough to work with and those with whom I am lucky enough to spend time. I enjoy clinical medicine more since I felt a more intimate proximity to my own mortality. I enjoy my children more and my time alone more, too.

It’s often those much younger and those much older and more experienced that clarify issues and help us focus the lens. It seems to me the simplicity of knowing what to do and what matters most stems up from those at the periphery. I’m not saying those of us stuck in the middle of this generational sandwich don’t have insight, I just think we draw heavily from those for whom we are indebted for their pace, their age, and their innocence.

I learn so much from children every day. In clinic today my stomach dropped at one point simply because of the story shared by a 6 year-old. The day had been laid out differently because at our morning huddle in clinic we review comments that come in. A patient had detailed in a comment card that he/she felt the nurse and medical assistant had spent more time listening to them than the doctor had. Sometimes we can do such a bad job showing those for whom we care we’re listening. It’s pretty obvious that as we work hard to witness our lives we often get more quiet. I feel so much more porous to the lessons in this wicked-packed-full-generational sandwich. Which reminded me of this: Read full post »

Salmonella From Food, Frogs, And Fido

Published March 11, 2013 in: Infant, School Age 1 Comment

African dwarf frog fr CDCSalmonella infections affect children more frequently and more severely than adults. Although most salmonella infections arise from contaminated or undercooked food (chicken, eggs, beef, and dairy typically), reptiles, pet foods and now amphibians are an important source of infection to keep in mind for our children.

Today, a new study published in Pediatrics links Salmonella infections to pet frogs here in the US. This is the first study to detail amphibians as an important source of Salmonella infections. 8 tips for preventing Salmonella are at the end of this post.

New research tracked an outbreak of a particular strain of Salmonella between 2008 and 2011. In 44 states, researchers identified 376 cases of Salmonella in children and adults with an average age of 5 years. Over 2/3 (69%) of the cases were in children under age 10. The source of these salmonella bacteria was tracked to a breeding facility that shipped an aquatic frog, the African dwarf frog, to pet stores and people around the country. Although the African dwarf frogs are not always handled, many people were presumably infected from touching the frog’s contaminated water bowl or may have been infected when aquariums and equipment were cleaned in sinks also used for food preparation.
The study uncovered an important truth:

Few patients and families were aware that Salmonella could be spread from reptiles and amphibians.

Even when we parents are aware, some children still get infected. It’s essential that children who handle reptiles and amphibians always wash their hands after playing with the pets or help clean or care for their aquariums. This data hits close to home as my son had Salmonella gastroenteritis when he was just 4 months of age after a trip to Central America. Read full post »

Emily’s Entourage

Published March 7, 2013 in: Guest Posts 10 Comments

EmilyThis is a guest blog from Emily Kramer-Golinkoff. I was lucky enough to meet her about a year ago & even luckier that she asked me to help her make a big impact with her final thesis for her Masters in Bioethics. Her story, insight, and strength are worth your time. She’s hoping to leave a big mark in understanding how to leverage the asset of empowered patients to advance science and healing. She’s working to integrate patient communities more intimately in the health system. Her post is about why she chose to be an empowered patient and it’s fairly clear why she’s attracted an entourage…

Truth be told, belonging to a disease community isn’t my clique of choice. An artist community, a running club, even a yogi enclave sound more appealing. But I’ve learned that when our hands are tied, we’re better off building muscles in our legs than spending all our energy trying to wrangle our hands free.

That’s the philosophy I’ve embraced as a 28-year-old with big eyes, a bright future, and an advanced, incurable and fatal disease called Cystic Fibrosis. Cystic Fibrosis (CF) is a progressive genetic disease that primarily affects the lungs and digestive system. It causes thick mucus to build up in the lungs, leading to life-threatening infections.

My winding path to patient empowerment started as a headstrong, sassy little girl who clashed with my pediatric CF clinic’s authoritative culture. My perpetual questions of “why?” and efforts to integrate my disease into my life were met with disdain and labeled “difficult.”

Read full post »

When Should I Start Baby Food?

Published March 5, 2013 in: Infant 33 Comments

first foodsWhen to start baby food? The timing on starting baby food may seem confusing. If you survey your neighbors, your own moms, the doctors you see, and the child care or daycare providers who help you, I bet you’d get about 4 different answers backed with 4 different theories and rationales. The reason is, the pendulum on when and how to start baby food has changed. Bits and pieces of old data mixed with contrasting new research findings are getting tossed around. Most new parents I talk with are a bit puzzled on what is truly best.

It’s okay to start your baby on baby foods or “complementary foods” when they show signs of readiness if they are at least 4 months of age. Signs of readiness include watching you eat (following your spoon’s every movement at a meal), lip smacking and licking when they smell food, and opening their mouths when you present them with a spoonful of food. Most babies ready to eat have also doubled their birth weight and started cooing and laughing, sitting up with assistance, and rolling over.

I used to advise families to wait until 6 months to start baby foods but new research over the last couple of years has caused me to change my tune. Read full post »

What You Should Know About Energy Drinks

Published March 1, 2013 in: Seattle Mama Doc 101, Teens Post Comment

I think of energy drinks as the new liquid accessory for many teens. Something to hold onto with nervous hands and something to spend money on when they’re really tired or need a “boost.” Teens report drinking them because of inadequate sleep, a need for energy, and wanting to mix them with alcohol. It’s big business to market energy drinks to those in high school or college and that big business is remarkably successful. More than a 1/3 of teens (39%) say they’ve had an energy drink in the last month and “jock identity” is associated positively with a frequency of energy drink consumption.

These drinks may really make you look cool…

College students may be even more compelled to drink them; one study found 50% of students had consumed at least one to four drinks in the last month. It’s hard to remember from our vantage point, adults aren’t really the target of energy drink advertising and sponsorships. Because of that paucity of advertising, only 15% of adults say they drink them.

Trouble is, there’s nothing really good for us in these energy drinks. We don’t ever need the caffeine, guaranine, ginseng, and sugar from these concoctions. Energy drinks can have 3-4 times the amount of caffeine in a regular cup of coffee but you may never know it. The labels can be opaque and misleading. The labels aren’t regulated and the content of caffeine isn’t mandated. A can of soda can have no more than 65mg of caffeine while one energy drink (Wired X505) has 505mg. I think this should make you mad.

A recent summary came out in Pediatrics in Review to help guide teens (and their doctors) on what they need to know. But many of us are still catching up. These are not “health” drinks although some of the claims on the bottle and advertising may suggest so. Most parents would prefer their athlete drink water over energy drinks. Thing is, their athlete would do far better. Caffeine can make you anxious, have palpitations, elevate your blood pressure, cause digestive problems, and increase insomnia. The sugar in these drinks will likely just add weight, not great energy, to your athlete.

Things To Know About Energy Drinks

  • Energy drinks are not regulated by the FDA like soda is. The FDA is investigating health effects but there are no current mandates in place for manufacturers. A can of soda is limited to 65 mg of caffeine. Energy drinks don’t have those limits and often the bottles and cans don’t even list all ingredients that have stimulant-like effects. Popular energy drinks have anywhere from 150mg of caffeine per bottle to up to 505mg. For reference, a typical 6 oz cup of coffee has about 100mg caffeine. Read full post »

Is It Really An Ear Infection?

Published February 26, 2013 in: Infant, School Age 13 Comments

Screen Shot 2013-02-26 at 9.46.22 AMEar infections cause significant and sometimes serious ear pain, overnight awakening, missed school, missed work, and lots of parental heartache. For some children, infections in the ear can be a chronic problem and lead to repeated clinic visits, multiple courses of antibiotics, and rarely a need for tube placement by surgery. For most children, ear infections occur more sporadically,  just bad luck after a cold. Fortunately the majority of children recover from ear infections without any intervention. But about 20-30% of the time, they need help fighting the infection.

Ear infections can be caused by viruses or bacteria when excess fluid gets trapped in the middle portion of the ear, behind the eardrum. When that space fills with mucus or pus it is put under pressure and it gets inflamed causing pain. Symptoms of ear infections include pain, fever, difficulty hearing, difficultly sleeping, crankiness, or tugging and pulling at the ear. This typically happens at the time or soon after a cold—therefore the fluid in the ear can either be filled with a virus or bacteria.

The most important medicine you give your child when you first suspect an ear infection is one for pain.

Antibiotics only help if bacteria is the cause. When a true infection is present causing pain and fever, antibiotics are never the wrong choice. Often you’ll need a clinician’s help in diagnosing a true ear infection.

Three’s been a lot of work (and research) over the last 15 years to reduce unnecessary antibiotics prescribed for ear infections. There has been great progress. Less children see the doctor when they have an ear infection (only 634/1000 in 2005 versus 950/1000 back in the 1990′s) and they’re prescribed antibiotics less frequently. Recent data finds that less than half of children with ear infections receive antibiotics (only 434 of every 1000 children with ear infections). However, the far majority who go in to see a doctor do still receive a prescription for antibiotic (76%).

The American Academy of Pediatrics(AAP) just released new guidelines to help physicians do a better job treating ear infections. Sometimes children really benefit from using antibiotics and new research has led to an update on the 2004 previously published recommendations. Over-use of antibiotics can lead to more resistant and aggressive bacteria so we want to use them at the right time. These recommendations may help improve care for children.

In my opinion, NPR published the best article I’ve read covering the new recommendations. I especially liked the balance provided: Read full post »

Baby’s Ears When Flying

Published February 22, 2013 in: Infant, Seattle Mama Doc 101 1 Comment

First off, I have connected with a few engineers and pilots — I may be wrong on one point here: Commercial airplanes typically ascend/climb faster than they descend for a landing. My apologies. I’m clearly no pilot…

That being said, you can help support your baby or child’s potential ear discomfort during flying by having them suck on something like a pacifier, having them breast feed, or offer a bottle during take-off and landing. The motion of their jaw and mouth during sucking and swallowing will help them equalize to the pressure changes. When they move their jaw to suck and swallow this helps facilitate venting in the Eustachian tube that allows your child to equalize pressure from the outside world with the middle part of their ear. That click or pop you feel when you yawn is your ear drum moving back to middle after getting pushed one direction in your ear from a pressure change.

It’s true that discomfort is far greater during pressure changes when there is fluid in our middle ear (from colds to ear infections). Check in with your child’s doctor or nurse practitioner prior to flying if you’re concerned about a potential infection. If that’s not ideal, consider getting Cellscope (an iPhone app that helps you look into your child’s ear, and/or allows you to send the image to their doctor) if you’re a frequent flier and your child is prone to fluid in the middle ear.

Here’s tips for parents about fluid in the middle ear and nice summary about ears & pressure changes from Kid’s Health.

Something For Parents At The Park

Published February 20, 2013 in: Guest Posts 9 Comments

Screen Shot 2013-02-16 at 5.37.00 PMThis is post from my friend, Anne Gantt. I love this concept and am inspired by the idea of parents pumping iron at the park. I’m hoping we can move this conversation forward. Please share ideas from your own neighborhoods in comments.

As a stay-at-home mom, I spend a ton of time at our neighborhood park while my 2 ½ and 4 year-old children zip down slides, scramble over the jungle gym, or chase each other in the woodchips. While they’re running around like little olympic athletes, I mostly just stand there doing nothing. A lot of nothing. Sound familiar?

That’s originally why I daydreamed about putting fitness equipment for adults in our park. I’d love to get a little exercise without having to resort to taking a turn on the monkey bars. The interesting thing is that installing adult fitness equipment will improve the park…for kids. This truly can be a win-win.

The park in question is here in Seattle– University Playground— it has a big grassy field, tennis courts, and beautiful new equipment for kids. It also has one of the very few public restrooms in the whole neighborhood–thus attracting a crowd. It sits in a tenuous location, one block from Interstate-5 and smack in the University District, which means the park sees a lot of illicit activity. Even worse, the illicit (I’m talking drug sales, etc) activity tends to happen in the section of the park right next to the playground.

Believe it or not, I’ve picked up more than a couple of used needles out of the woodchips myself.

Our park’s unsavory elements definitely scare some people off. I recently talked with a neighbor who refuses to take his 4-year old grandson to the park out of a concern for safety. This, even though their living room window looks right out onto the playground.

Something had to change. Urban dwelling can be better than this. Read full post »

Preschoolers Can Learn Good Things From TV

Published February 18, 2013 in: School Age, Toddler 2 Comments

tv watching when 4Television programming for children is abundant. Screens are a luxurious fixture in most of our lives and I’m not here to tell you to turn them off. Well, at least not today. In fact, that tactic, the one where we pediatricians urge families to turn off the TV, really isn’t working. Children tend to increase their TV viewing time as they age and preschool-aged children in the United States spend over 4 hours per day watching television at home and in day care. My good friend, Dr Claire McCarthy, offers up her opinion in this week’s Pediatrics.

Television viewing is only on an upswing over the past 5 years as more and more devices interdigitate into our children’s lives. I’m a perfect example. When my first son was born 6 years ago we had one television in our home and one computer. Today, we have a smartphone, an iPad, a computer, and a television. The screen choices continue to grow, the television shows continue to become more alluring, and the opportunities for viewing with new convenience is abundant. It’s true: some of the stuff out there designed to delight our children is awesome.

But not all of it.

So as our children continue to tug on our sleeves and hang on our pant legs asking for the iPhone just after they beg for TV time before dinner, we need to think clearly about an action plan. We need to make a thoughtful “media diet.” We need to think ahead of time what time we’ll offer up the devices and what content we want them to see. We should care–it really changes how they think and what they do. When we use a media diet, I suggest we’ll improve both our own satisfaction as parents and our children’s lives. Dr Dimitri Christakis, a pediatric researcher here at Seattle Children’s suggests:

We often focus on how much kids watch and don’t focus enough on what they watch

New research out today by Dr Christakis finds that our time and energy working to improve what our children watch, not just how much they watch, can have a positive impact on their behavior. Even for children as young as 3 years of age. Read full post »

The New Norovirus

Published February 12, 2013 in: Doctoring & Healthcare, Infant, School Age, Teens 9 Comments

Screen Shot 2013-02-12 at 10.27.08 AMNorovirus is a nasty one. It’s the leading cause of epidemics of vomiting/diarrhea and causes over 20 million cases of gastrointestinal disease (“stomach flu” with vomiting, diarrhea, abdominal pain, fever and achiness) in the US each year. Our experience with Norovirus historically is worse in years with “novel” or new strains of infection. Unfortunately there’s an new strain circulating around the globe. “Sydney 2012″ was discovered in Australia last March and just last month the CDC officially announced it’s causing the majority of Norovirus infections. Over 1.2 million people in the United Kingdom have had it and the FDA reports this strain may potentially cause more hospitalizations. Time will tell if we have more Norovirus this year, too.

When new strains arrive, we tend to see a 50% increase in the number of cases of “stomach flu.” Norovirus is remarkably potent and contagious. It often isn’t killed by hand sanitizer (see #3 below). You touch the virus and touch your mouth and you could get it. We can get Norovirus multiple times in our lives because our immunity wanes after infection and new viral strains develop which cause unique disease. We get Norovirus from contaminated food, contaminated surfaces we touch, and from other people who vomit or have diarrhea and spread the virus. This is the cause of the stomach bug that you often associate with cruise ship outbreaks or daycare outbreaks when everyone starts vomiting one afternoon…

Around the holidays a stomach bug swept through our home. It did so for many of my patients, too. During the first week of January, I had a day in clinic where approximately 75% of the families I saw in clinic mentioned someone in their home had been vomiting over the past week. Unusual. I can’t tell you what virus it was (I didn’t test any child’s stool or vomit in the lab), but my bet is on Norovirus… Read full post »