Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

An App For That?

Stop what you’re doing to read this The New England Journal of Medicine perspective by Dr Doug Diekema. It’s about vaccines, opportunities for health, and physician obligation. Written for physicians, it also speaks loudly to parents and includes a few very essential points. The whole time I read the article, my thoughts kept leaping to our imminent opportunities. Today, in 2012, we can harness the tools of social media and technology to solve many of these problems. It’s time. HPV vaccine? Varicella vaccine? Remember your yearly flu shot?  I really think there could an app for that.

Let me explain.

Dr Diekema opens describing a scene very typical in Seattle.

Recently, the mother of a young child confessed to me that she didn’t know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she’d like to follow an alternative schedule, the physician had simply acquiesced, leading her to assume that the recommended schedule had no advantage over the one she suggested.

Yes, the physician obliged her desired schedule for many reasons, I suspect: time restraints/desiring a partnership/a hope for future opportunities to provide education and update immunizations for the child. In a state (Washington) that leads the nation in vaccine exemptions, we encounter patients daily who prefer a delayed or personal schedule. I’ve written about parents and alternative schedules and physicians’ conditional comfort with alternative vaccine schedules. But when Dr Diekema mentions this family, he highlights what many pediatricians and family physicians realize: families may be clustered together in vaccine-hesitancy. Friends of friends instruct each about vaccine schedules and share beliefs about safety. We know that 40% of parents who use an alternative schedule create it themselves.

Family members persuade my patients not to get immunized. Even in the midst of a pertussis outbreak in the county in which I practice, grandparents and relatives of newborns refuse the Tdap vaccine. My patients are bombarded with advice and naysayers. Who we love (friends and family) and who we trust (friends and family) certainly affect what we do. My patients get confused. And most of health (care) conversations happen outside the exam room. Therefore, hesitancy clusters in neighborhoods naturally and poses regional risk. What if we had real time information about our schools? About our neighborhood? What if Google mapped our rates of protection from vaccinations? What if we had a smart phone app that provided us yearly data on school immunization/exemption rates when we selected a kindergarten? Why not an app for that? Read full post »

What About Chores? Seattle Mama Doc 101

So what about kids and chores? My take is that it’s personal. But also I’ll hint that I think chores are a great opportunity to build community and citizenship. Research has found great lifelong reward from doing childhood chores (think: less drug use, higher self-esteem, more sound relationships, beginning a career path, less anxiety, etc). I mean with those findings, sign me up! But it’s possible not everyone agrees and research may not be what sways you. It may be a need to get things done around the house. A popular poll (done way back in 2001) found that 75% of people feel children do fewer chores today than 10 or 15 years ago. I don’t know if that’s just recall bias or pessimism or favorable historians talking. But…

A smattering of opinions about chores:

What do you think; is there controversy here at all? Do you think chores help transition our children into responsible adults?

Carpooling Reduces Booster Seat Use

Survey results published this week found that the majority of parents report carpooling with their 4 to 8 year-old children. About three-quarters (76%) of those carpooling parents reported that their child used a booster seat when riding in the family car. But when carpooling–the seats were used far less often. For example, the survey found 1 out of 5 parents do not always ask other drivers to use a booster seat for their child. And only half of parents always have their child use a booster seat when riding with friends who do not have boosters. So what your friends do really may change what you do.

This makes sense. I guess. It’s clear people get tired of recommendations. Today, for example, when I sent out a link to the Washington State Booster Seat Law, someone replied on Twitter, “Oh come ON!” Read full post »

Sleep Through The Night

Getting your baby to sleep through the night is a major milestone for baby and for you. If I had to distill down the best sleep advice I’ve ever heard it would be these 4 things:

  • Your consistency with the sleep routine is far more important than what method you choose to help get your baby to sleep. The ritual at bedtime (reading, bath, rocking, etc) is one of the most important daily activities you establish for your child from day 1 (or day 30).
  • Letting your baby learn to fall asleep all on her own at 1 to 2 months of age will serve you and your child again and again. Research shows that infants and children who are allowed to learn to self-soothe and get themselves to sleep will often be far better sleepers, even as adults. Consider letting your baby learn to self-soothe and “cry it out” in the middle of the night after 4 to 6 months of age.
  • If you’re concerned about your baby’s sleep challenges, talk directly with their doc. Recent research found that 1 in 10 children under age 3 has a sleep challenge, and often sleep trouble persists from infancy to toddlerhood.
  • Sleep needs to be a priority (for us all). Making sacrifices to support routine bedtimes and sleep routines will always be worth it.

To Make Time Stand Still

It would be nice–every once and a while–to make time stand still. To catch the blades of a propeller mid flight and have the ability to hover effortlessly.

Just for a moment so that we could look over, savor our children…their beauty and all that they are all in one precious moment…all to ourselves. The march of childhood moves quickly. And what a thing to be weightless and into the air without the distraction of aging and the ticking clock of time. Innocence preserved, our unconditional love packaged, and our children just as they are. Because we all know tomorrow will look different. To get them in a gasp of time, beautiful and unique, even if only for a moment. Wouldn’t it just be so nice–every once and a while–to make time stand still?

What Does TV Do To My Kid’s Brain?

If you want to understand more about the effects of television on the brain, you need to watch this TEDx talk by Dr Dimitri Christakis…the science around television and its effect on children and concentration astound me. Not because any of it is counter-intuitive, but because television is as powerful as it is. Television is a [large] part of most children’s lives here in the US and this presentation of fact and observations may change what you do at home. Although it seems like there is no controversy here, last week I stumbled upon one mom proclaiming the benefits for TV at bedtime from infancy up.

We gotta get the word out.

A few take-aways on media and early learning:

  • Early experiences condition the mind. Connections between brain cells change based on experiences our children have while their brain triples in size between birth and age 3.
  • Initiation of television viewing is now (on average) 4 months of age.
  • Prolonged exposure to rapid image changes (like on a TV show designed for an infant) during critical periods of brain development may precondition the mind to expect high levels of stimulation. This may then make the pace of real life less able to sustain our children’s attention. The more hours a child views rapid-fire television, the more likely they will have attention challenges later in life.
  • Cognitive stimulation (reading books or going to a museum) reduces the likelihood for attention challenges later in life.
  • What content your child watches on TV matters: the more frenetic or violent the TV show, the more likely your child will have attention challenges later in life. Television shows that move at a typical pace may be far better for our children.
  • New studies (using mice) may demonstrate that learning suffers with excess TV viewing.
  • We need more real time play for children. (Get out the blocks or get outside!)

I’d suggest the 15 minutes or so it takes to view this video might profoundly change your thinking about TV. Direct from the mouth of a father, pediatrician, and researcher, Dr. Dimitri Christakis explains how the brain develops, what television may do, and theorizes why ample time in front of the TV as an infant and/or toddler may reorganize how a children thinks and solves problems. More than anything, watching this made me want to reverse time and go back to do even more for my little boys and their developing brains. If only the daily museum trip was plausible…

Enjoy, leave any comments or questions, and I’ll wrangle up Dr. Christakis for specific answers, as needed.

How To Pack A Healthy Lunch: Mama Doc 101

Although you’ll see these lunch ideas don’t look exceptionally fancy, I think the point is this: you don’t have to spend a ton of time or money giving your children healthy lunch choices. But you do have to spend some. After the pizza debacle (“a slice of pizza still counts as a vegetable”) bubbled up when congress blocked proposals for changes in school lunches, I was reminded we still have to have a significant responsibility to watch over our children’s lunches. Don’t leave lunch in someone else’s hands unless you’re reviewing the menu. At our sons’ preschool we sometimes feel they do a better job than we do (!) so this is not a post to trash school lunch programs. Some schools really are doing an exceptional job. Is yours?

Trouble is, sometimes I look at example lunch ideas for parents and I feel overwhelmed. Read full post »

Snow Day

It’s a snow day. Snow day is a word combination in the English language that has two meanings, divergent and separately defined only by age. To a 5 year old–“snow day” sounds a little bit like “Nir-va-na”–a day that is one of life’s greatest gifts. To a 37 year-old with a few jobs, it sounds a little bit more like “stresssssss.” Snow days, of course, often leave us without child care, without a school system, and without a back-up plan. And when our work doesn’t stop, we’re left juggling a set of very cold knives.

It would be nice to exist in a culture where snow day meant the same to all of us—a perfect reason for a big gasp in the productivity machine. Play and a little more unrestricted, unscheduled time outside is good for all of us. But that’s the onerous and stark reminder we get on days like today: we really are grown-ups and there is work to be done. And since snow days aren’t a national phenomenon, those of us that collaborate with others outside of our community, “snow day” sounds a little like a fake cough when it comes to an excuse for extending a deadline…

Don’t get me wrong, safety should always remain a priority. We should fiercely protect our children from driving and walking on roads with moving traffic when it’s icy and snowy; we should stay off roads when we are urged to do so. I’m not saying schools and routine businesses shouldn’t shut down. I think we need help juggling and understanding the multiple demands on our attention even when weather intervenes. We need a plan. Our work doesn’t stop demanding our attention and sometimes our bosses’ priorities aren’t aligned with our own. Read full post »

Learning To Lose?


We spent a fair bit of our time on vacation last week playing two games with the boys: UNO and Spot It. Our son F is wholly competitive; he likes to know all the answers and he likes to win. He really likes to play and giggles when things go his way or when throwing a SKIP or DRAW 4. But he is also beginning to show how much he hates to lose. It turns out he’s rarely wrong about things, so not having things go his way isn’t really a part of his evolving schema. Thing is, he is also really polite. So when his behavior disappoints us, he takes things seriously.

After losing at both UNO and Spot It Thursday afternoon he began collapsing in the chair, throwing his excess remaining (losing) cards onto the table (or the floor) in frustration. After a second dramatic display, I’d had it. I told him he must sit out a game the next time we all got to play. I used the rationale, “Your friends won’t want to play games with you if you can’t celebrate when they win.” And, “Everyone playing the game is aiming for the same goal, we all want to win. Sometimes it just won’t be in the ‘cards’ for you.”

The next game he got to play was UNO and his grandmother won. He said, “Congratulations, Grandma. Well done.” He held onto his cards. He smiled. It was verbatim to how I’d instructed him. And I must admit, something about it didn’t seem quite right.

About 2 hours later the husband read a passage out loud to me from The New Yorker about Peter Thiel and his desire to win, stemming back to his math prowess as a child and his inclination for chess.

He became a math prodigy and a national ranked chess player. His chess kit was decorated with a sticker carrying the motto “born to win.” On the rare occasions when he lost in college, he swept the pieces off the board; he would say, “Show me a good loser and I’ll show you a loser.”

And there you are. A parenting perplexity. The question really is, do you want to create an obstinate-genius-winner or a good loser? I must admit, part of me really doesn’t know. But I’m certain there is something in between…

Preschoolers: Movers And Shakers

The most amazing thing about vacation is how much time you get to spend outside and how much time you get to move. We’ve just returned from a week away where the boys spent the far majority of their days without a ceiling. Delicious.

Sure, it’s easy to live outside when you’re on vacation. The challenge is in our “normal” lives–the ones where we go to work, school, and complete activities. It turns out our parental efforts for safety and our need to cultivate “learners” may be getting the way of our children’s health. Sometimes we may be over-thinking things.

We’ve been touring preschoolers and kindergartens these past few weeks. I’ve been thinking a lot about the 3 dimensions in which our boys spend their days. So a qualitative study on preschool centers and physical activity published by the Academy of Pediatrics last week caught my eye.

Three-quarters of all preschoolers between the age of 3 and 5 years are in child care and more than half of them are in either preschooler, day care, or nursery school center. Most children spend the majority of their waking hours, after age 3, outside of their home. Many children spend very long days at school, leaving around 6pm to head home. After 6pm, there is little time for outdoor play. Read full post »