Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Media Deprivation?

media deprivationMedia deprivation: do you think it exists? Although laughable at first glance I know I’m not the only parent who wonders if limiting screen time could change my child’s opportunity. Those of us who fiercely control screen/device time may have momentary lapses where we wonder if we’re doing things right. Even though I’m convinced there isn’t a study telling us that typically-developing children need media/apps/screen time to learn how to think and evolve into compassionate, successful, and happy adults, part of me wonders if my screen policing isn’t ideal.

Are You Screen-Phobic Parent?

There may be an inverse relationship worth noting: perhaps the more a parent loves technology, the more they see technology’s omnipotence and its invasive, devious elegance. Do those of us who adore technology consequently limit its use at home? Unsure there are data to back this up, however there are some nice anecdotes. Turns out Steve Jobs was a low-tech parent. “We limit how much technology our kids use at home,” he said. In addition, The New York Times reports that Chris Anderson, former editor of Wired Magazine and current CEO of a drone company draws hard lines:

This is rule No. 1: There are no screens in the bedroom. Period. Ever.

The American Academy of Pediatrics guides us that media should be limited (ideally to less than 2 hours daily) and advises us to protect the sanctity of the place our children sleep by keeping screens out. Pediatricians work heroically in the office trying to help families  get a sense of why moderation with media matters and the benefits for making media plans. You’ve probably heard about concocting a “media diet” and ways to reduce screen time, especially before bed. Some of us take it pretty far…our children may go days and weeks without screens while at home. Perhaps its my own technology enthusiasm and unending quest for balance with devices that has me locking up all the tablets and computers at home. In our home the phones, tablets and computer have taken the place of Drano — they’re up and out of reach. Read full post »

Spanking is Hitting Afterall

In my mind it’s no wonder the American Academy of Pediatrics has a statement against spanking. Spanking, in the simplest form, is the act of hitting a child, using physical force to try to get a different outcome. Thing is, spanking is an ineffective discipline tool in the long-run and research shows it’s damaging to a child’s mental health. Most parents don’t want to spank their children and may spank or strike a child while frustrated, making spanking more than just a tool for discipline, rather at times just another way to vent anger or frustration…

I’d say we spend countless hours teaching and modeling behaviors for our children in early childhood to ensure they do the opposite of spanking: we teach them to “use their words,” take “timeouts,” and to take deep breaths when frustrated or when throwing an enormous, inconvenient tantrum. We teach them to look for an adult for support if they need “back-up” during conflict resolution. When an adult turns around and uses physical force and strikes a child, they teach just the opposite. Spanking is hitting and hitting is always avoidable when enmeshed in a conflict.

If that doesn’t seem quite right to you consider it this way: under the US law, when angry or upset about the way things are going in your life the only person you can legally hit in our culture is a child. I’d suggest they are the most vulnerable and voiceless in this regard, the only members of our society with no capacity to change the law (vote). Just this winter lawmakers have argued to allow spanking at home and school that could leave a child bruised in the name of “parental rights.” In the US, you can’t punch or beat up your neighbor, your child’s teacher, your co-worker (assault), thankfully you can’t strike your partner/wife/husband (domestic abuse), and you can’t punch your other relatives (assault). But in many states in our nation, it’s legal to hit your child when they do something you didn’t want them to do. Of note, it’s still lawful to spank a child at school in up to 19 states.

As of 2014, up to 38 countries around the world have banned spanking, outlawing corporal punishment in terms of human rights in a different way from The United States. During an NPR interview yesterday, Professor Elizabeth Gershoff highlighted this in historical context to American opinion on spanking stating, Read full post »

Calling The Shots

Tonight, after President Obama speaks, PBS airs a NOVA documentary about vaccine science and safety. Vaccines: Calling The Shots. It’s told through the parent, pediatrician, and community lens. If you’ve ever wondered about vaccines in America, it’s time to tune in. I’ve been in touch with the team producing this documentary. Seriously excited to hear this story unfold tonight.

(update Sept 11: watch Calling The Shots online)

I think this is a big deal. This is an investigation on the science of vaccines.

The less the disease exists, the safer I am.

It’s a balancing act. The risks happen to be minuscule… the benefits are enormous

If inclined, follow a team of parents, pediatricians, and communities tonight on Twitter while it airs:  #vaccinesNOVA

Enterovirus D68 And Some Old Reminders

girl in mask (1)Widespread news coverage over the last 24 hours has heightened concerns by many parents about a severe-symptom viral infection causing respiratory illness in children, predominately in the Midwest. Over the last month there has been a dramatic up-spike in children hospitalized with severe cold symptoms and wheezing. The virus isn’t new, but its effect on children seems to be. The Centers for Disease Control (CDC) has confirmed tests on children both in Kansas City and Chicago pinpointing the triggering virus as enterovirus D68. The biggest burden of illness has been in the Kansas City and Chicago areas where dozens of children were hospitalized daily, but there are reports of infections documented in about 10 additional states to date. The CDC report issued yesterday detailed data from their investigations

Of the tested and confirmed cases from Kansas City, their ages ranged from 6 weeks to 16 years, with a median of 4 years. Nearly 70 percent of patients had a previous history of asthma or wheezing. Of the Chicago group, ages ranged from 20 months to 15 years with a median of 5 years. Nearly three-quarters had a history of asthma or wheezing.

No question the illness has taken many by surprise as it’s an unusual time of year to see huge numbers of children with cold symptoms with severe wheezing. In areas where the infections started to pop up, schools been in session for a month or more so kids have been doing what they do best, playing in close contact and exchanging germs… Read full post »

Can’t Stop Time

photo (58)I take solace sometimes knowing I can’t stop time. When I look to the clock and trade panic for solace it’s a way to distance myself from the reality that as time marches on in its infinite human construction, I don’t have to think about moments with the boys lost. Every parent hears over and over again that, “it just goes so fast.” I find that advice never helps. Just makes us feel like time with our beloved little humans is slipping through our fingers and I can’t imagine a parent who feels good about that.

My little boy is no longer allowed to be entirely in my grasp as the doors of that big schoolhouse open forever next week. My 5 year-old starts Kindergarten and it’s pretty clear to me that from here forward there will be many forces facilitating his gradual exploration of the world away from our cozy nest.

The solace I mention is real though and it helps me. At moments I can feel the space and peace that comes in knowing I have literally no control over his aging and what it provides — like giving into the wind I can lean into this space and know what a privilege it is to witness this wild ride. It certainly helps that he clearly loves the speed with which life is hurling at him. I see it in moments where he looks at the Kindergarten class list and in the moments where he sticks his right foot out while standing next to his bike and poses as if he’s ready to take a big stage and I feel his thrill as he looks over to his older brother and realizes he finally belongs at the same school. Growing up really is quite a thing to behold.

Being a part of something bigger is a huge part of being human and school is an essential first (or second) step

And although that solace I just mentioned is real I can’t help but tell you that there is certainly a part of me that suffers in these waning summer days. I feel the excitement yes, I lean into the solace yes, but as a working mom I can’t help wonder, “did I do this all right?” Were the last 5 and 1/2 years exactly what I imagined for his time at home preparing for the onslaught of schooling? Was I present, available, ready, and everything I wanted to be? Well, surely not. It’s clear my iPhone got in the way, as did my job, and my ambition to improve children’s health. Thankfully there are ways he shows me he knows he’s got my attention but I can’t help but trip (and fall) sometimes knowing there are infinite ways to raise a child and I do look at those other paths with curiosity.

Today let me tell you this: I’ll hold onto the solace every single moment I see it and I’ll let it mix up with the suffering. I can gently mute the parts of pain that comes with aging and losing the intimacy found between mother and son during toddlerhood and the preschool years. I’ll find that solace when I feel the thrill from peering over the edge of this great big world ahead of him. One thing I know for certain is I’ll enjoy the first moments of Kindergarten next week, too. This little boy of mine is growing up to be a thoughtful, curious, kind, and happy little man. It’s his excitement for the next giant step that will tug me along into September…

Shifting To An Ideal Bedtime For School

We know children are sleeping less now than they did 30 years ago. Our children are unfortunately more tired and can suffer side effects in life because of it. Studies show that school-age children who create a sleep debt (chronic sleep deprivation) and are chronically tired have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible, they can have difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Even if your kids have already started school, you can provide a boost for your child’s attention, mood, and health by focusing in on sleep.

Starting out the year with better habits can help everyone at home (ahem, wouldn’t it be nice to avoid late evening battles?). If you’re not already there, think about moving to ideal bedtimes during the next couple of weeks.

How Much Sleep Do Children Need?

Sleep debt is created when we don’t sleep enough — it causes kids to crave “catch-up” sleep like those after-school naps, sleeping in until noon on the weekends, or falling asleep in the carpool on the way home. That being said, each child’s sleep need can be a bit different but in general children need:

  1. sleep needsPreschoolers: 11-12 hours of total sleep
  2. School-age children: 10-11 hours total sleep
  3. 12 year-old to teens: 8 1/2-10 hours total sleep

5 Ways To Support Good Sleep

  • Keep to an 8pm bedtime for young children. Move bedtime back slowly (move it by 30 minutes every 3-5 days) to prime your child for success and avoid battles!
  • 10pm bedtime for children age 12 & up is age-appropriate. More info here.
  • Habits: No screens 1-2 hours prior to bed, no caffeine after school, no food right before bed.
  • Exercise or move 30-60 minutes a day to help kids sleep easier
  • No sleeping with cell phones (create a docking station in the kitchen)
  • Don’t use OTC medications (cough & cold, for example) to knock your kids out and get them to sleep. Using medications that have a side effect of drowsiness can cause sleepiness to extend into daytime which can negatively affect school and sports performance.

Read full post »

Let Them Sleep, Start School Later

Over the past decade mounting evidence finds that teens are chronically sleep deprived and subsequently suffering significant health effects. Chronic sleep deprivation is becoming the norm for our high schoolers and is known to cause both mental and physical health challenges. In fact The National Sleep Foundation found that over 85% of high schoolers aren’t getting the 8-10 hours of sleep they need while over 50% of middle school students are already falling behind in their zzzzz’s.

The evidence is in: teens who don’t get enough sleep can have academic challenges, an increase risk for sleepiness-caused car accidents, inattention, risk for overweight, risk for anxiety, greater use of stimulants like caffeine or prescription medications, and mood disorders.

This is a biology thing not a laziness thing. That teenager who can’t get out of bed until 11am on the weekends is just tired and trying to catch up! Puberty changes all sorts of things in our life, one major biologic shift occurs in the brain as children morph into adults. Around the age of 12, instead of naturally falling asleep at 8 o’clock like children in middle childhood, tweens and teens’ sleep cycle shifts about 2 to 3 hours making it a real challenge to fall asleep prior to 10 or 11pm. That means those teens up and awake until 11pm are really just acting their age.

The causes of sleep loss for teens are complex. Early school start times, use of electronics, smartphones, and tablets interfere with sleep as do homework, extra-curricular activities, and sports. But so do misperceptions — the same research that found over 85% of HS students weren’t getting enough sleep also noted that >70% of parents to those tired teens felt their child was getting enough sleep! We have to make sleep a priority in our homes. Read full post »

On Motion Sickness

I really love this TEDEd video explaining motion sickness. What I find most helpful is the admission that we humans still know very little about motion sickness, why gender differences exist (women get motion disturbance more often than men), and how to put a stop to it. No question children get motion sickness well before they’re old enough to tell us exactly how they feel. Often it’s screaming or fussing only in the car or a series of vomiting episodes that clues us in. A few tips for families, planning that last-minute summer road trip, to help support children who are prone to get sick in the car, on the train, at the park, or up in the air during a bumpy ride.

Motion Sickness In Children

  • Disconnect: Know that motion sickness comes about when there is a disconnect between what our eyes see, what the fluid in our inner ears knows about our position and direction, what our skin senses, and what our muscles feel while we’re positioned wherever we are. This disconnect in all these sensors around our body leaves the brain “confused” and for unknown reasons we’re left feeling nauseated, uneasy or achy. This can happen quickly and can happen even on a swing at the park. It really doesn’t take a jet airplane or an automobile driving quickly on a curvy road to elicit this unease and malaise. This can happen in the back yard! There’s often another disconnect, for those who don’t get motion sickness there is often little insight into how horrible a child or adult can feel while experiencing this. This reality, of course, only increases the displeasure for the person ill. But know this, some experts observe that everyone, given enough mismatch and motion–say a group of people in a life-raft in turbulent seas–will get sick from motion.
  • Common: Motion sickness is fairly common with most reports stating that 1/4 to 1/3 of adults may experience it. In school-age children, a recent European study found the prevalence of motion sickness was 43.4 % in car, 43.2 % on bus, 11.7 % on park swing, and 11.6 % on Ferris wheel. Like adults, most children report dizziness, nausea, or headache when their body is triggered by motion. And although some research claims motion sickness doesn’t start until age 2, I’ve certainly learned from parents that some young children don’t love riding in the car and show it. More preventing and treating it:

Read full post »

Knowing The Benefit Of MMR Shot

A new study out today in Pediatrics reminds us that parents want information about the direct benefits shots have on their baby’s health and wellbeing. Not surprising, of course, but a good reminder for pediatricians, parents, and those who speak out on the value of vaccines to remember that primary motivation for parents in getting immunizations is to protect their child, not just protect the community. As a mom I feel the same way. As vaccination rates have decreased in pockets around the US these past few decades, and as non-medical vaccine exemptions (refusing immunization on philosophical grounds) increase, and as media coverage around the benefits of immunizing “the herd” remain a mainstay, returning to the individual benefit of vaccines makes sense. Parents really want to do what is best for their baby. They want to hear how and why to protect their baby. Vaccines do that.

The MMR vaccine protects your child from getting the diseases measles, mumps, or rubella or the complications caused by these diseases. After receiving this vaccine, your child will not miss school or activities due to these illnesses and will be able to play with friends during an outbreak.   — The message shared with parents in the research study

I like this study for two reasons:

  1. Parents Want To Know Why: In the study researchers went right to parents, mostly moms (80% of participants) between age 18 and 65 years of age, to share messages about MMR shot benefits to their baby and society and then gauged their intention to immunize their baby with MMR at 1 year of age. What I also really liked was the way the benefit was framed around a child’s wellness and their ability to play and be with friends!
  2. It Serves Up a Great Reminder:  We pediatricians, nurse practitioners, family docs, RNs, and MAs need to tell families what shots children are getting and we really need to stress WHY they are getting them in the context of life. We need to make the protection a shot provides relevant every time we order and administer the vaccine!

Pediatrics Study:

In the study, researchers compared about 800 parent responses in 4 groups (each group had about 200 parents). In one group parents got information only from CDC Vaccine Information Statement (VIS) about benefits/risks of MMR vaccine. In another group, parents got information about benefits of MMR shot to their baby and the VIS information. In a third group, parents got information about MMR benefit to baby and to population, along with VIS. And in the last group parents got information only about benefits of the shot for protecting the community along with the VIS.

Results: Parents were more likely to report their intention to get their infants the MMR shot when they heard about the benefit of the shot directly to their baby or when they heard about benefits directly to their baby and the population. When they heard only about risks/benefits of shot and risks/benefit to society, the information presented did not increase their intention to get the shot.

Conclusions: Parents are more likely to want to get their child up to date on immunizations if they know direct benefit on their child’s ability to go to school and play and be with friends.

Let’s focus on what matters to parents to young children when we talk about vaccine benefits — health, wellness, play, friendship, and opportunity.

For more on benefits of MMR shot for children and the diseases it prevents read here. Immunizations do cause optimism…

Very Sunny Out: 5 Tips For Safe Sunscreen Use

sunshine in seattleIt’s really very sunny out these days in the Pacific Northwest. And although summer can be shorter up here we certainly compensate with idyllic, cloudless days. However, many of us can be out of practice protecting our skin. I’ve seen lots of tan lines and sunburns in clinic this summer. In fact, those of us living in Northern climates may carry an additional risk when it comes to the sun. One rarely known risk factor for skin cancer is living in a cool climate but vacationing near the equator. The reason? If your skin is unaccustomed to living in the sun, you tend to burn more when entering those areas of more intense sunshine.

Further, many people get confused about cool weather and sunshine. Sun intensity and Ultraviolet (UV) radiation (UVA and UVB rays) have nothing to do with temperature. No difference in intensity if it’s 60 or 80 degrees out when it comes to the sun’s effect. Reality is people burn more when it’s 80 simply because they have less clothing on and more skin exposed. As a reminder, UVB radiation varies throughout the year (it’s most intense during summer) and UVA radiation is constant throughout all the seasons.

Although the best ways to protect your family’s skin from the sun remain seeking shade (umbrellas, trees, etc), planning long-lasting activities in the sun outside of the peak sun times (not between 10am and 4pm) and dressing right for the the occasion by wearing sun protective clothing (hats and/or UV shirts often labeled “UPF” for ultraviolet protective factor). Research finds that those who rely solely on sunscreen tend to burn more, so sunscreen needs to be thought of as just one tool. 5 tips: Read full post »