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“Like I Needed Another Reason Not To Sleep At Night”

Today was the Great Shake Out. My boys let me know what happened at 10:15 today at school: “the ‘ole drop, cover, and hold” said my 6 year-old. The technical instructions are “drop, cover, and hold on” but we get his drift. The numbers couldn’t have been better today 10-15-2015 for a 10:15am reminder of how important it is and how good it can feel to know what to do when an earthquake strikes.

Another thing: when you’re having a bad day, why not practice the drop, cover and hold? I mean…..

Okay but seriously, Dr. Suzan Mazor and I are teaming up again to work on updating our emergency/disaster kits. You might have seen us putting together our first kit back in 2010. The New Yorker article that made headlines this summer re-ignited my decision (and remarkable fear) to have a plan in place should the worst happen. You read the article and I know you’ll say, “like I needed another reason not to sleep at night?” Great thing is planning and preparation truly is the antidote to fear.

My REFRESH card prompted me to realized that our water expires this year and it’s pretty obvious since it has nearly evaporated. True.

All instructions for what you need in your kit and what you need in your communication plan are below. You’ve waited until now. Seriously no reason to wait any longer if you don’t have a 3-day kit in place. A promise for me that is easy to make:

I know you’ll feel better having done this.

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Measles Outbreak With A Baby At Home

baby-O-e13075541951481Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe?”

I hate that I can’t completely say they are safe. Measles is wildly contagious and during an outbreak it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to you!). Some parents are also wondering about getting the vaccine before the baby turns 1 year because they’ve heard the recommendation for infants traveling abroad: infants traveling outside the U.S. are recommended to get an MMR (measles, mumps, rubella) shot if they are over 6 months of age (of note, babies who get the shot as an infant also get the usual shot again at 12 months of age). Without travel plans we wait to immunize babies with their first MMR vaccine until they are 12 months of age. Over 95% of babies who get the shot at 12 months of age are protected against measles and over 99% are protected for a lifetime after the 2nd dose (given at least 1 month later). Wow, right?

“This is not going to be the end-all-be-all post on protecting your infant or child from measles'” Dr Matthew Kronman, a pediatric infectious disease expert at Seattle Children’s, reminded me as we chatted today. Advice and guidance for protecting babies and children will change as we learn again how to protect our population from measles infection while unvaccinated pockets of people remain.

The CDC warns that the outbreak could grow (there’s over 100 cases in 14 states as of today) and nationally there’s a palpable dialogue going on between the herd (those immunized) and those not. Politicians are involved — Governor Christie talked today about “choice;” Obama is urging parents to immunize right along side the president of the American Academy of Pediatrics who released another urgent statement. Pediatricians, family docs, nurse practitioners and health workers everywhere are encouraging parents to get shots up-to-date to protect their own children and vulnerable populations (this includes infants).  Here’s a bit of evidence and information that can hopefully curb anxiety for parents to babies. I teamed up with Dr Edgar Marcuse, a lifelong scholar with vaccines, former pediatrician at Seattle Children’s and an emeritus professor of pediatrics at University of Washington and Dr Matthew Kronman. Here are 7 tips about infants and families that may help shape your thinking: Read more »

What To Know About Baby Teeth

Image courtesy: American Dental Association

Image courtesy: American Dental Association

Things have changed over the past couple of years regarding how to care for baby teeth. Official recommendations for fluoridated toothpaste begin with the very first sighting of the very first tooth. This is news to many.

What we do early in our child’s life can have lasting consequences. Some quick reminders for new parents, grandparents and anyone out there lucky enough to be hanging out with an infant. Keep their mouth delicious!

5 Things Every Parent Needs To Know About Baby Teeth

  1. Use fluoridated toothpaste at tooth eruption. The minute those baby teeth come in consider it the start of the lifelong brushing habit for your baby. Brushing and rinsing the teeth after breastfeeding or formula, solid meals or snacks will always be recommended.  In minimum, build brushing into everyday, ideally morning and night, with a tiny amount of fluoridated child toothpaste (see image above). This may be most important after the last evening feeding.
  2. Tap water! Brush with tap water twice a day and provide tap water for your infants and children when serving water. After you brush teeth DON’T RINSE with water. Let the tiny amount of fluoride from the brushing sit on the teeth as long as possible to prevent decay.
  3. Use the right amount of toothpaste (image above). This provides protection from bacteria and acid but also avoids concern for too much toothpaste.
    1. < 3 years of age – rice sized smear of toothpaste on the brush.
    2. > 3 years (including adults) pea sized amount of toothpaste is all you need on your brush once you know how to spit.
    3. Don’t rinse after brushing.
  4. Timing: Most infants and toddlers, preschoolers and young children can brush their teeth and tongue in about 1 minute — goal really is to brush at the gumline on all sides of each tooth, paying special attention to back teeth, molars, and lower teeth where bacteria love to reside. For older children, teens and adults the rule of thumb is typically 2 minutes of brush time to brush teeth, tongue and rid mouth of dragon breath!
  5. Bacteria: Baby teeth enamel is thinner than adult (secondary) teeth so the mix of sugar and bacteria in the mouth must be deterred. We unfortunately transfer oral bacteria to babies when we share utensils, kiss them, clean their pacifiers with our mouths (don’t do it!), and drink from shared cups. If you have a history of lots of cavities the American Academy of Pediatrics’ new policy says, “Parents/caregivers, especially those with significant history of dental decay, should be cautioned to avoid sharing with their child items that have been in their own mouths.” I’m all for smooching babies so I say this: get to the dentist yourself to make sure your mouth is in tip-top shape to avoid some bad transfers…

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Does Your Child Need A Daily Multivitamin?

There’s a decent amount of confusion when it comes to the decision to give our children vitamins and supplements. Store shelves (real or virtual) are filled with tinctures and gummies marketed towards children. And you’ve likely heard that, in general, pediatricians don’t recommend vitamins for children who eat a “normal” diet. There are exceptions to every rule (see below, especially as it pertains to vitamin D) but the bottom line is that supplemental multi-vitamins are not an essential part of a child’s diet. If your child eats a rainbow of foods, it’s unlikely they need pile of additional minerals and vitamins in pill form.

4 Things To Know About Children And Vitamins

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You Mamas Taking Iodine?

A new policy statement from The American Academy of Pediatrics finds that many women, including up to 1/3 of pregnant women, may have low levels of iodine putting them at risk for iodine deficiency. The reason for the deficiency is the changing food source. Over the last 20-30 years our major source of salt has shifted away from table salt (supplemented with iodine) to salt from processed foods, sea salt or gourmet salts that have no supplemental iodine. This is especially important for breastfeeding and pregnant women as iodine is essential for thyroid function that supports fetal and newborn brain development.

This policy statement was news to me. I had no idea that the salt used to make most processed foods lacked iodine, that the majority of prenatal vitamins didn’t provide iodine, and the number of women who may have a deficiency. I’m not alone; when I polled my Mama Doc Facebook community most moms & many doctors also commented this was a newsflash. Here’s more:

Iodine Deficiencies– Shifting Sources Salt

  • WHY ARE WE DEFICIENT? Most processed foods made are with salt that is not iodized.  Since we get most of our salt from those foods we’re taking in less iodine than we used to.
  • TABLE SALT INTAKE: Table salt is iodized, many gourmet salts are not. Consider ensuring that when cooking in your home (ie putting salt in the pasta water or salting the veggies) you use iodized table salt so your intake of iodine goes back up. REMEMBER: this doesn’t mean you should eat MORE salt, just swap in the table salt for the fancy salts when you can.
  • WHY DO WE NEED IODINE? We need iodine for thyroid hormone synthesis as thyroid is essential in brain development and metabolism. The policy reminds us that even mild iodine deficincy can affect fetal and early childhood neurocognitive development stating, “adequate thyroid hormone production is critical in pregnant women and neonates because thyroid hormone is required for brain development in children.” The recommendations from AAP spelled out:

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3 Reminders For Summer Sleep

Bed as throneOur house is teeming with excitement about the impending reality: it’s almost summer break. As the hard-core school, sports and carpool coordination chaos eases up, you wanna know one thing I’m really hoping for this summer break? A bit more sleep. I do a great job protecting my children’s sleep and a mediocre job protecting my own. I work on sleeping with my cell phone off and away from while getting 7 to 8 hours of sleep but reality is my phone has a tendency to creep back up next to the bed and I am often up early to start working. Clearly I’m not unusual in this way. Parenting and sleeping a lot don’t necessarily go hand in hand. Studies find 14% of grade school children are still getting their parents up. The news is grim when it comes to sleeping with our phones, even 4 out of 5 teens say they sleep with their phone (on or near the bed). It’s becoming clear that quality sleep is one of the most undervalued power solutions to preserving wellness in our families. The more data I review, the more I know we have to get the word out on the value of sleep and the way that we protect it as we raise our children. Culturally, this is a swim upstream; we’re bred to revere those who do so much during the day they are left with limited sleep at night. Some new data, a funky article ending, and a 4-minute TED talk lay the foundation for my 3 quick reminders: Read more »

Constipation, No Fun For Anyone

Constipation is really no fun for anyone. No fun for baby or child, no fun for the parent who cleans the clogged toilet, no fun for the sister or brother who waits while someone works on solving the problem in the room next door. In general, constipation is a frustrating, sometimes embarrassing, and often chronic problem for young children. Here are a few ideas to get rid of the no-fun part and ways to protect your children, support them positively, and avoid dangers that can rarely come from over-the-counter (OTC) medications.

Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop. I usually break this down for children (and parents) in visual terms. I talk about things you find outside.

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

In my experience, parents worry a lot about hard infant or toddler poop in the diaper but constipation sneaks up on many families to school-aged children. After children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl. Long gone are the days of staring at every diaper as parents lose track of the daily poops, how often they poop, and how a child feels when pooping. But first, some definitions: Read more »

New Obesity Data And Tips To Avoid It

New data published in JAMA today finds that there has been no significant change in rates of overweight/obesity overall for children between age 2 to 19 years of age since 2003. This is unfortunate news in the big fight against overweight and obesity. Conclusions from the study, “Obesity prevalence remains high and thus it is important to continue surveillance.” Obesity rates remain high at with 17% of children and more than 1/3 of adults.

The good news is that there was improvement in one small group, toddlers age 2 to 5. Numbers from National Health and Nutrition Examination Survey(NHANES) show reductions in overweight and obesity for the preschoolers by as much as 43% during the last decade. Really hoping this is a canary in a coal mine situation — perhaps they’re chirping a clue. Learning the “why” behind the reduction in obesity for preschoolers feels like a huge opportunity. However for the mass of people researched in total (over 9,000 from birth to age > 60 years) the data confirms we’re not done tipping the scales.

The research article evaluated rates of overweight and obesity between 2003-04 NHANES data and 2011-12 data on children and adults. The CDC is highlighting the success in the toddlers, stating:

While the precise reasons for the decline in obesity among 2 to 5 year olds are not clear, many child care centers have started to improve their nutrition and physical activity standards over the past few years.  In addition, CDC data show decreases in consumption of sugar-sweetened beverages among youth in recent years. Another possible factor might be the improvement in breastfeeding rates in the United States, which is beneficial to staving off obesity in breastfed children.

It’s wonderful to see signs of improvement in the small population of children included in the NHANES data but this research article doesn’t investigate how the improvements were made and/if they are stable. More research will have to unfold. We’re all desperate — parents, pediatricians, public health experts — for solutions that work in not only curbing, but reversing the rates of overweight and obesity. This data can potentially focus the light on where we need to look to study cause and effect to determine possible success stories and strategies. Five quick tips for parents now: Read more »

Pain Is Inevitable But Suffering Is Optional

This is a guest blog from Lisa M. Peters, MN, RN-BC (in the video above). Lisa is mom of two children and a clinical nurse specialist for the Pain Medicine Program at Seattle Children’s Hospital. She holds a clinical faculty appointment in the Department of Family and Child Nursing at the University of Washington School Of Nursing. She is board certified in pain management from the American Nurses Credentialing Center and is a Mayday Pain & Society Fellow. Lisa has a passion for improving the lives of children in pain. I’ve learned so much from her already!

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Pain is inevitable; suffering is optional. That’s a key message when I partner with parents who bring their kids in for procedures and hear them recount stories of standing by, feeling helpless, as they watch their kids suffer with pain and distress.

It does not have to be that way.

Parents seldom realize the power they have as advocates and as partners with doctors and nurses in managing, and even preventing, their children’s pain. Could that shot at the doctor’s office really be a different experience? Do a few moments of pain really matter in the long run? If I speak up, will they label me and my kid as “troublemakers”?

As a parent, you can make a big difference in your child’s experience with pain. Knowledge is power.

3 Things To Know About Pain:

Poorly treated pain is harmful, both immediately and long term.
Science continues to teach us about the consequences of poorly treated pain on our bodies and minds. There is evidence that it can change how our bodies process pain signals, especially during critical periods of development in childhood. This can lead to highly sensitive areas of our bodies or a generally louder experience of pain. Memories of painful experiences have been shown to shape how we respond; studies show that 10% of the adult population avoids seeking medical care when needed due to fear of needles. Read more »

My Adorable Activity Tracker. I’m Streaking!

First Day With My Shine

Self-tracking, life-logging, activity-tracking, “the quantified-self (QS) movement” as the smarty-pants say, or as some have asked, “What’s with the weird watch?” Well, I’m hooked. I don’t go anywhere these days without my device. My activity tracker had me at hello.

Over the summer I started wearing the Shine. I’d been waiting for it–it had a significantly delayed shipping date–which only heightened my desire. I’ve worn it every day (except one) since. The world really is different to me now. Before you start to criticize and marginalize my proclamations, know that I waited nearly 1/2 a year to write about this to ensure it wasn’t just a fad.

How My Activity Tracker Is Changing Me:

First things first: I realized how sedentary some of my days are. Especially when I’m writing or working intensely; knowing this has changed how I think about walking. Secondly, I’m really much happier knowing how much movement I have during a day rather than guessing about it. Even when I’ve hardly moved a few paces, I’m thankful for the insight. I mean, some days we pig out, some days we aren’t as hungry and eat salad, some days we run miles. Other days we work and write and sit far too long. My activity tracker helps me understand the patterns and think about new ways to live differently. The boys always want to know how much we’ve moved. This tracker has power around here. If there’s any New Year’s “resolution” that may be worth committing to–it may simply be to check in on how you’re moving. Find a tool to give you observable data. Behavior change perhaps will follow.

To be clear, it isn’t the device I’m attached to that is changing my life, it’s the new experiences I’ve having because of it. New insight from my Shine changes my mood, the way I map out my day, and has undoubtably made me more self-aware. I’m thankful for my consultant.

Reality is, many of us are tracking our lives and our movement without realizing it. Before you write we trackers off, read on.

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