Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Make A Customized Allergy Emergency Plan For Your Child

Let’s make things easier for children with life-threatening allergies. How we communicate what a child needs matters and can be essential to protect their safety but also reduce stress and anxiety for parents who worry. This week, experts in allergy and immunology at The American Academy of Pediatrics did us a favor and sorted through various allergy emergency plans living online and in doctors’ offices. Through experience with years of research on asthma action plans, the team created a Clinical Report that showcases a single, comprehensive and universal emergency plan to help ensure that parents and caregivers are ready to manage a life-threatening reaction called anaphylaxis. If you have a child or care for a child with food allergies, allergies to insects or a known risk for anaphylaxis, print one out, put it on the fridge and make sure your child’s school has it on file! The goal is to start having all families use the same form so schools, communities, sports teams and parents everywhere all get familiar.

 What Is Anaphylaxis?

  • Anaphylaxis is a potentially life-threatening, severe allergic reaction. I like how Food Allergy Research & Education defines it: “During anaphylaxis, allergic symptoms can affect several areas of the body and may threaten breathing and blood circulation. Food allergy is the most common cause of anaphylaxis, although several other allergens – insect stings, medications, or latex – are other potential triggers”.
  • Typically, children or adults with anaphylaxis have symptoms include itchy skin, hives, shortness of breath, swelling of lips/tongue, or wheezing. Some children vomit soon after eating a food they react to and some children get diarrhea.
  • Epinephrine should be given right away, in the thigh. If you ever feel you might need it, use it. Then call 911.

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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 full post »

If You Worry Your Child Is Depressed

Depression is far more common in teens than in young children, but I often hear families wondering how to know if they should worry about their child’s mood. As many as 1 in 5 teens can have a depressed episode so concerns about depression are a common challenge. Many of us wonder if young kids get depressed (yes, but not too often), what are the signs (detailed below), and what to do about it (6 tips below). It’s scary for every parent who thinks a child is depressed. It can be terrifying to worry about a teen. There is a certain innocence we reserve for childhood and no question for some, depression can seem antithetic to that. Depression can be very real, influenced by life events, inherited, and wildly disruptive. But there is great research to help guide what we do to support children, teens, and our families if depression becomes a challenge.

I talked with clinical psychologist and depression expert at Seattle Children’s Hospital, Dr. Gretchen Gudmundsen on this 20-minute podcast. I learned a lot as we covered the definitions of depression, which children are at risk for depression, classic depression symptoms, and when parents should seek help for their depressed child.

You can listen to the podcast right here on the blog, or you can listen while you’re commuting on your phone by going to iTunes (search “Seattle Mama Doc”) or Google Play or on Soundcloud. A quick summary of high-level points below:

What Is Depression In Children and Teens:

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New Tobacco Legislation: No Cigs To Those Under 21

Last week I had the distinct pleasure of working with Washington State Secretary of Health, Dr. John Wiesman on spreading the message and intent about Washington House Bill #1054. This bill aims to raise the age to purchase tobacco and vaping products from 18 to 21 years. Dr. Wiesman believes it is the single most important policy the legislature could adopt to protect the health of our kids and the health in Washington State. That’s quite a statement.

The reason for the suggested bill and increase in age for purchasing tobacco (including e-cigs, vapes, traditional cigarettes) is to prevent access to a curious, young, and vulnerable population. Most teens say they try e-cigs and cigarettes out of curiosity. And we know 90% of adult smokers get addicted before they turn into adults. As detailed in this post, Teens Using E-Cigarettes, use of e-cigarettes rose 900% between 2011 and 2015 as they have infiltrated middle and high school students’ environment. Most teens get tobacco and e-cigs from older teens. The Surgeon General even published a big report because of concerns for increasing addiction and use of tobacco products in children and teens and what it means for our country’s risks and our country’s health.

  • In Washington, 75% of 10th graders who used cigarettes in the past 30 days received them through social sources, especially older friends.
  • About 95% of adult tobacco users started using before they turned 21 years of age.
  • As I understand it, this proposed legislation isn’t about being a “nanny” state, it’s about the welfare and health of our teens into adulthood. It’s about access to tobacco products for our most vulnerable. The brain continues to develop until age 25 years and nicotine gets in the way.

Also, the money matters. Each year, smoking-related illness costs Washingtonians $2.8 billion (Billion with a B) equating to more than $800 per household in taxes. This affects us all –$800 annually — per household goes to taxes to help deal with the effects of smoking! I think we could think of  a lot better ways to spend tax payer dollars. Read full post »

Teens Using E-Cigarettes Up 900%

We know more about e-cigarettes and teens than ever before. Recently, Dr. Vivek Murthy, US Surgeon General released a report on teens and young adults who use e-cigarettes. Perhaps one of the more staggering statistics in the report states that e-cig use has increased 900% in high school students from 2011-2015. That’s a jump. Especially concerning right on the heels of progressive data that teens were smoking less traditional cigarettes than ever before.

E-cigarettes are devices that create an aerosol (vapor) by using a battery to heat up liquid that usually contains nicotine, flavorings, and other additives. There are more chemicals in the solution than just nicotine and some contain heavy metals. Teens inhale this aerosol deep into their lungs where the nicotine and chemicals enters the blood stream. E-cigarettes can also be used to deliver other drugs like marijuana.

Reality is, the introduction of e-cigs has changed teen exposure to nicotine in a remarkable way, remarkably quickly. Nearly 1 in 5 high school students here in WA reports they have used an e-cigarette in the last month. E-cigs and e-hookahs originally entered the market unrestricted. Advertisements and celebrity endorsements arrived rapidly. And the price point of e-cigarettes kept them in reach for curious teens, as the price falls research finds, experimentation increases. Adoption of e-cigs came quickly extending down to middle school students.

These products are now the most commonly used form of tobacco among youth in the United States, surpassing conventional tobacco products, including cigarettes, cigars, chewing tobacco and hookahs. I think most people think your brain stops developing when you’re 5 or something, and certainly there’s a huge amount of development in the first couple of years in life, but we know that adolescent brains are actually very significant in development, and nicotine is a neurotoxin, and we know that it can cause lifelong problems for kids, including mental health problems, behavioral problems and actual changes in brain structure.” ~Dr. Vivek Murthy, US Surgeon General

Teens report using e-cigs primarily because of curiosity but also the fallacy that they don’t carry health risks.

Highlights From US Surgeon General Report On E-Cigs:

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How To Decrease Risk Of A Peanut Allergy

Strong evidence continues for babies getting peanuts before a year of age. Now, more than ever, I believe parents to babies at risk for allergies need to pay close attention during the first 6 months. Although the pendulum has swung about how, when and why to introduce peanuts to babies over the past years, more and more experts agree. There are 3 categories and 3 specific recommendations for babies. Babies at risk for allergies should get peanuts by 4 to 6 months of age, although there are conditions and specific recommendations, based on a baby’s family history and health, so read the 3 tips below carefully.

I’ve noticed with the advice swirling and moving the last decade, parents remain a bit shy about starting peanuts before a year of age. I have a comprehensive blog post, Peanuts During Infancy To Prevent Peanut Allergy, detailing the ground-breaking study (I truly don’t think I’m overstating the ground-breaking part) that came out last year. Basically, researchers found that babies at higher risk for allergies (eczema, family history of allergies, egg allergy) had less peanut allergy in life when given peanuts as babies compared to babies who waited to have peanuts. Since that time more data has unfolded that points the same direction.

Even as the data mounts, I think the shyness to introduce peanuts continues for some families. Simply because we’ve heard the opposite advice for previous years. Read on and please share this. Over the next decade we may turn some of the tide on peanut allergy.

Science shifts its weight a lot so it’s hard to register immediate trust in shifting advice. The shyness makes sense but I hope this post helps combat it. This New York Times article about why advice changes, by pediatrician Dr. Aaron Carroll, is worth your time if you’re curious about the rationale and reason for shifting medical advice. When it comes to peanuts I feel good about early introduction for nearly all children. Here’s why:

An expert panel published new guidelines in the Journal of Allergy and Clinical Immunology this month about when to introduce children to peanut-containing foods to help prevent food allergies. Here’s a summary of the panel’s report written for parents. The science, as detailed in the post I wrote last year was strongly influenced by previous research. The panel says, “recent scientific research has shown that peanut allergy can be prevented by introducing peanut containing foods into the diet early in life. Researchers conducted a clinical trial called Learning Early About Peanut Allergy (LEAP) with more than 600 infants considered to be at high risk of developing peanut allergy because they had severe eczema, egg allergy, or both. The scientists randomly divided the babies into two groups. One group was given peanut-containing foods to eat regularly, and the other group was told to avoid peanut-containing foods. They did this until they reached 5 years of age. By comparing the two groups, researchers found that regular consumption of peanut-containing foods beginning early in life reduced the risk of developing peanut allergy by 81 percent.”

How To Reduce Peanut Allergy Risk For Your Baby:

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5 Rules For Dosing Medicines For Colds And Ear Infections

In clinic the last couple of weeks I’ve been reviewing medicine doses with families for common over-the-counter (OTC) medicines repeatedly. It’s the time of year when goopy illness comes into our homes and is chased by fevers and aches and discomfort, screams and coughs, and overall gloom. Sometimes the goop turns to things that cause bigger pains (ear infections, strep throat & influenza) that have bigger solutions. But most of the time these gnarly colds just disrupt our lives and our holiday harmony and then go away thanks to the magic of our immune system. No question the holidays gather us together but those Whoville-Circles-of-Love also have us exchanging common colds like nobody’s business. We all wanna make the symptoms from colds go away, especially in our infants and toddlers who just can’t explain how they feel and seem to have their sleep disrupted in wildly unfortunate ways. Obviously, there aren’t a bunch of wonder drugs out there for these wintertime illnesses. But there are some lovely solutions that do help our children feel better (acetaminophen and ibuprofen — tah dah!)…

5 Things To Know When Using Medicine From The Drugstore:

  • Less Is More: My key takeaway for using OTC medicines is that often, you don’t need them. Don’t ever treat the thermometer. If your sweet human is bounding around the living room playing Twister and she feels warm to touch and you then confirm she has a fever with her sniffles (the thermometer reads 101.7 degrees) you don’t need to reach for acetaminophen. Keep her hydrated, have her cover her cough (yes, please!), make sure she gets rest so her body can do the dirty work of clearing out the infection. The acetaminophen should be used when she’s achy, not feeling well, or not wanting to be herself because of overall yuckiness. Treat your child, not the thermometer.
  • Pain Medicines For Ear Infections: Without question the most important medicine for most ear infections are the OTC medicines (acetaminophen and ibuprofen around the clock for the first 48 hours of an ear infection). After age 2 year, most children won’t need antibiotics — and most can avoid them and their side effects — if given time to heal. But the best bridge to getting there is making sure you take away the pain from those infections. More information about when to treat ear infections with antibiotics here.
  • Cough and Cold Medicines Only For School-Age: I think parents to infants and toddlers are desperate for solutions when their babes are unwell because of the profound amount of disruption a nasty cold virus brings to their life. Anyone who blows off the degree of ick of a 17 month-old with a bad cold and cough who isn’t sleeping nor eating and is coughing and choking and vomiting hasn’t parented one in a while. But quick reminder that not only are cough and cold meds not helpful in young children, they can be dangerous. Reach for a teaspoon of HONEY before anything in the medicine cabinet (as long as your little one is over 12 months of age). Research from 2007 found that honey has been found to help reduce nighttime cough better than OTC remedies.
  • Dosing Device: This time of year all sorts of people want to “baby” your baby. Grandma, Cousin Judy, whoever. Make sure someone isn’t dosing the medicines with the kitchen spoon. Use the dosing device that comes with the bottle of medicine always.
  • Weight Over Age Dosing: Always dose medicine by weight not age in young children. Here’s a dosing chart for acetaminophen and ibuprofen that includes doses for children under age 2 years. Here’s another version of acetaminophen and ibuprofen dosing that is easily downloadable! Print it out, keep it in the kitchen cabinet where you store your medicines. Call your pediatrician’s office if ever concern about how and when to dose. Those are never silly calls. Even if some jerky, tired, on-call provider makes you feel that way (I’m sorry if someone does). But it’s true, those are never silly calls if you’re confused or unsure.

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Mumps! What To Know During An Outbreak

There is a mumps outbreak here in Washington State, as well as various other outbreaks across the nation. The CDC reports that mumps infections are currently at a 10-year high. This post is a quick update on the outbreak and why they occur, an explanation about the mumps virus, the infection and symptoms that are typical, and what parents should know now to avoid mumps.

Mumps Outbreaks In 2016

  • Numbers This Year: For the calendar year 2016 through early December, 46 states and the District of Columbia have reported a total of 4,528 mumps infections — well more than double the mumps cases reported in 2015 and creeping up in ways similar to 2006 when we had the last big mumps year. That outbreak was primarily housed in the midwest among college students.
  • Mumps In College Students: In general, we often hear more about outbreaks on college campuses in part because of students living in close quarters. Mumps is easily spread when those are in close contact who share cups, talk closely together and share respiratory droplets more readily. The intensity of these environments allows mumps to spread more rapidly and it’s also possible that during college some students have lost immunity from the vaccine they received as a child. In general college students are at higher risk because of how they relate. I love how CDC details the conditions, “certain behaviors that result in exchanging saliva, such as kissing or sharing utensils, cups, lipstick or cigarettes, might increase spread of the virus.”
  • Washington State Outbreak: As of 12/23/16 there have been 101 cases in King County (cases updated here by the Public Health Dept). In total, 32 cases are confirmed and 69 probable with additional cases under investigation. The majority of cases are in children under age 18. Some 65% of those cases are in people who are reported as up-to-date on Measles Mumps & Rubella (MMR) vaccine. This occurs in part because although the MMR vaccine works well, it still will leave some vulnerable to an infection if exposed. The MMR vaccine provides protection against mumps to about 88% of us after we get two shots, so it consequently leaves more than 1 in 10 of us vulnerable during outbreaks. We typically don’t know who is in that 12% so during outbreaks we make sure students are up-to-date in immunizations and those with suspicious symptoms are seen, diagnosed, and while infectious, they stay home.
  • Schools Send Children Home If No MMR Shots: The outbreak has been of big enough concern that The Auburn School District told more than 200 non-immunized students to stay home so they wouldn’t get the virus and go on to infect others. Public health officials sent letters to the students’ homes saying kids would only be allowed back once they had proof they’ve received the MMR vaccine. Otherwise, the students will be kept from school for at least 25 days after the last mumps case in the Auburn district.

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One Mom Shares Her Story: It’s Not Just the Flu

serese-families-fighting-fluThanks to Serese Marotta, Chief Operating Officer, Families Fighting Flu for sharing this vulnerable and truthful story about losing her son to influenza. Talk about gorgeous peer-to-peer health care. I hate that this story exists and yet I’m so thankful for Serese’s bravery in sharing it. May we all benefit from her experience and her wisdom ~ Dr. WSS

So often we hear “it’s just the flu”, but we need to take the flu seriously. How do I know this? Because my healthy, 5-year-old son, Joseph, lost his life to H1N1 flu in October 2009. I have always been pro-vaccination and Joseph and his sister received their annual flu vaccinations in September 2009, but H1N1 wasn’t in the vaccine that year. Sadly, the H1N1 vaccine didn’t become available in our community until two weeks after Joseph’s death.

Joseph’s Story

Joseph’s story began innocently enough. He was attending kindergarten in the fall of 2009 and threw up on the school bus. Later that day, Joseph continued to throw up and became increasingly lethargic. We called our pediatrician who suggested we take Joseph to the local urgent care. Upon arrival, they found Joseph’s blood oxygen level to be very low and immediately transported him to the local children’s hospital. The rapid flu test came back negative and Joseph was eventually diagnosed with pneumonia.

Several days into his hospital stay, the doctors informed us that Joseph’s culture was growing influenza, which was likely H1N1, but not to worry—it was “just the flu” and they’d start him on antiviral medications. Joseph’s condition over the next several days was relatively stable. Various specialists came and went; all of Joseph’s tests appeared normal and we were even discussing his discharge with the doctors. All of that changed on the ninth day of our hospital stay. Joseph’s blood pressure suddenly plummeted, and we were sent back to the ICU. The doctors couldn’t really figure out what was causing Joseph’s low blood pressure, but they didn’t seem overly alarmed. More testing went on throughout the night, while I tried to distract Joseph with cartoons and discussions about his Halloween costume.

The doctor came to me early on the morning of Oct. 18 to say she wanted to put Joseph on a ventilator because his heart and respiration rates were so high and his little body needed a rest. The doctor emphasized it was not a big deal, but Joseph would be unconscious while on the ventilator. I calmly called my husband, who was at home with our young daughter, and asked him to come to the hospital. Minutes later, while I was standing next to Joseph’s bed, he suddenly coded. The next scene was like something on a TV show—doctors and nurses rushing into Joseph’s room. I backed into the hallway so they could do their job, but honestly, I had no idea what was happening. As the minutes ticked away, I began to realize that something was seriously wrong. I continued to wait outside Joseph’s hospital room and finally, the attending doctor came to me, sobbing, and asked me to follow her into Joseph’s room because she needed me to talk to him. Looking back, I think she thought if modern medicine couldn’t save this child, perhaps the sound of his mother’s voice could. I entered Joseph’s room and held his hand as the doctors and nurses continued to work on him. Finally, the doctor turned to me and said “I’m so sorry.” My precious son lost his life to influenza that day, and my life was irrevocably changed as a result.

My story is not unique. I have met many parents who’ve lost a child to the flu or had a child suffer serious medical complications as a result of the flu. I want parents to understand how critically important it is for all children and their families to get their flu vaccinations each and every year. The flu vaccine is the best protection we have in our fight against influenza. The Centers for Disease Control and Prevention (CDC) recommends annual flu vaccination for everyone six months of age and older. I also want people to understand that getting an annual flu vaccination not only protects you and your family, but it also helps protect others in your community by limiting the potential for an outbreak. Read full post »

Vaccination Nation: How Healthy Is Your School?

aap-vax-mapFrom the moment we become parents, we work to keep our children’s environment safe. We child-proof our homes and make sure poisons and dangerous objects are secured wherever our kids spend time. But we aren’t always as diligent about making sure the community spaces where our children learn and play are protected from threats we can’t see, like infectious diseases.

Just this fall there was a vaccine-preventable disease reported in my son’s 2nd grade cohort. When he started kindergarten a couple years ago we were told the class was 100 percent up-to-date on immunizations, so I got done worrying about things like exposures to chicken pox, measles and mumps from his classmates. We know vaccines aren’t 100 percent protective, of course, but I took stock in knowing that his class of children was protected as best they could be.

So, when I heard about the case of chicken pox, it reminded me I needed to check back in.

Because he’s fully immunized, I wasn’t worried when I heard the news about this case of chicken pox (varicella vaccine has a high vaccine effectiveness, with 98 percent of children protected after two doses). But it got me thinking that I needed to contact the school and see how we’re doing. Not just on the state-mandated vaccines, where we scored 100 percent a couple years ago, but on influenza vaccine, too. Often we have no idea the percent of a class that is protected on this essential, every-year vaccine.

Influenza and complications from the infection are hardest on infants and young children, pregnant women, the elderly and those with underlying health conditions that make it harder to deal with the infection. Depending on the season, influenza causes anywhere between 4,000 and 50,000 deaths a year in the US. Thankfully, each year only a couple hundred of those deaths are children. The flu vaccine is recommended for ALL infants and children ages 6 months & up to protect them from the infection, their community, and severe complications. Even though the nasal flu mist isn’t recommended this year, now is still a great time to get your children and family immunized leading up to the holidays.

More than ever before, clearly articulating that you vaccinate your child and that you want your child amid a group that does the same is essential.”

Every parent should know if their child resides, learns, and plays in a safe environment, and knowing their child’s “world” is up-to-date on vaccines is an important data point. Knowing where your community stands just got a little easier. The new AAP interactive infographic is a great, high-level view into knowing how your state fares with status on vaccines and protections from outbreaks of infections like measles and pertussis, as well as influenza. 

Although we know 9 out of 10 parents immunize their children based on the AAP and CDC schedules, we know the public often feels like many more children aren’t getting vaccines. I’m haunted by the data published in Pediatrics in 2011 that found that more than 1 in 4 parents (28%) who followed the recommended schedule seemed to think those children whose parents who didn’t – who delayed vaccines or followed an alternative schedule — were safer. Not a single study finding a delayed or alternative schedule is safer and yet here we are with many parents following our recommendations but not entirely trusting them. Yuck. All those parents who immunize need to speak up.

To me, there is no question that pediatricians’ time and passion communicating truths and opportunities with vaccines will always be time well spent. Recent data out this year proves it: a third of vaccine-hesitant parents change their mind and agree to have their child receive a vaccine after their doctor provided vaccine education. But there is something else in me that knows, over time, we’ll tighten the gap on trust with parents when their peers step up and demand higher vaccine rates in their schools, their playgrounds, their communities, and even their play dates. When pro-vaccine parents share their feelings of trust, support, and desire to have a community up-to-date, that’s when we’ll reach the 95 percent level we want.

Pediatricians and parents can partner unlike ever before and with tools unlike we’ve ever had to make sure the spaces where our children spend their days is as safe as possible.”

Knowing where you live and how your community is doing on vaccines and speaking up about what you believe matters. More than ever before, clearly articulating that you vaccinate your child and that you want your child amid a group that does the same is essential. Check out your state’s data in the AAP infographic. Get even deeper into the data with online resources like School Digger that allow you to peruse the data on vaccine status at the school level.

Pediatricians and parents can partner unlike ever before and with tools unlike we’ve ever had  to make sure the spaces where our children spend their days is as safe as possible. Speak up, ask about rates at your schools and tell other parents how much you value vaccines that protect your children and their friends. 

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