Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Surviving Separation Anxiety

Separation anxiety varies WIDELY between children. Some babies become hysterical when Mom is out of sight for a very short time, while other children seem to demonstrate ongoing anxiety at separations during infancy, toddlerhood, and preschool. I’ve got one of each in my home. The trick for surviving separation anxiety demands preparation, brisk transitions, and the evolution of time. I would suggest we parents suffer as much as our children do when we leave. Even though we are often reminded that our children stop crying within minutes of our leave-taking, how many of you have felt like you’re “doing it all wrong” when your child clings to your legs, sobs for you to stay, and mourns the parting? As a working mom, separation anxiety creates questions for me. Although it is an entirely normal behavior and a beautiful sign of a meaningful attachment, separation anxiety can be exquisitely unsettling for us all. Here are facts about separation anxiety and 6 tips to improve the transitions I’ve learned the hard way (I’ve made about every mistake). Read full post »

5 Ways To Avoid Cavities And Still Feel Like A Celebrity

Dental caries (cavities) are preventable for most children. To keep those pearly whites pearly it takes being thoughtful about eating habits, brushing habits, drinking habits, and being knowledgeable about your child’s water supply. Although physicians are making robots to perform surgery and putting tiny cameras in our bodies to explore the inside, we may sometimes lose sight of easy, affordable ways to improve the lives of millions. Maybe we simply retreat from those prevention efforts…or maybe it’s something else.

The CDC reported this spring that for the first time in 40 years, preschoolers have more cavities than they did 5 years ago. And many children have so many cavities that they show up at the dentist with double-digit numbers requiring general anesthesia for repair. In one month alone, I’ve done a number of pre-op visits for dental anesthesia for patients in my clinic.

Many national headlines have covered this data over the last few months. And I would suggest there is one thing to stress here. Part of this increase in cavities may be a cultural issue, a parent-culture issue. That is, many parents may not be brushing their children’s teeth because of push-back from their children and a goal to maintain harmony at home. And many parents believe bottled water is safer than that from the tap. When it comes to teeth, that isn’t the case.

Sometimes we really have to act like adults and do the flossing.

I think this bump in cavity numbers is a parenting issue more than anything else. Read full post »

TIME Magazine And The Mommy Middle Road

You saw the TIME magazine cover in the last 24 hours, right? Me, too. In the midst of 25 patients yesterday, moms and dads weren’t really talking about it in the office. It was in my inbox. But I hear and feel and witness the anxiety/angst we all swim around in every day as we compare parenting styles and essentially swap (pacifier) spit about how best to do this. The monogram of this parenting era is the quest for perfection. The epic win that’s constructed for us is built on prevailing over the rest. It’s not about juggling it all anymore, it’s about being tough enough to do it better than your peers. TIME magazine wants us to contemplate if we’re really “Mom Enough?”

Before you know it, you’ll be 13 decisions down the road wondering why you worried so much about what you did. You’ll care even less about what you called it. Of anything I hear over and over again from parents ahead of me on the road it’s this: “I simply wish I worried less about my choices.”

It’s a mom-eat-mom world right now and the media wants us perpetually navel-staring. Doubt sells magazines, pageviews, and books. I saw moms post opinions on Facebook this morning only to quickly take them down as they got too controversial. We’ll keep questioning ourselves and our decisions as TIME takes a supermodel, airbrushes her body and paints the cover the magazine with a provocative image for Mother’s Day. This article, this cover, this timing–this is the engineering of our age. The dinosaurs once ruled the planet—now it’s the voices online.

Your motherhood, your parenthood, your decisions. You know what? Of course, they’re Mom Enough

The cover really isn’t really about breast feeding but I’ll bite. Read full post »

Never Say Never: On Trying New Foods

We went out for sushi on Friday at one of those mall-type restaurants that has little pieces of sushi spinning around the perimeter of the kitchen on a conveyer belt. The gimmick is genius for families with young children. The boys were starving and urged that the sushi spot was their choice for our night out. The conveyer belt provides instantaneous food and also fulfills the need for entertainment. As any normal parent knows, that’s a recipe for perfection. More than half of the people in the restaurant (at 5pm) had kids our boys’ age. It was a typical meal until the most wonderful thing happened: my son proved the husband wrong.

Boys 1, Husband 0.

As the food spun around, the boys eyed their favorites: avocado rolls, noodles, and nori. O asked about the orange “bubbles” he kept seeing. F announced that they were fish eggs. O instantly wanted to try them… The husband: Read full post »

Picking A Summer Camp

As you construct a schema for your summer, plot vacation time, and plan for summer camps, more than anything I think you should build in some unstructured time. Carve out hours, half, or even full days each and every week with an absent itinerary. Wide-open days inspire creativity (in us all) and allow children to stumble upon a little boredom. I would suggest boredom is a helpful tool for everyone here and there, especially our children. Just think of the motivation that comes from it! Read this perspective: What Caine’s Arcade Teaches Us About Modern Parenthood.

Good thing for those of us who are less organized: unstructured time comes without difficulty as the camps fill up and we run out of options. Now (May) is the time to sign up for many camps, so get on it. The unstructured time I mention is only delightful if peppered into a summer filled with adventure and discovery. Summer camps offer a great place and space for fostering independence, building skill and esteem, and forging new friendships. Choosing a camp may feel entirely daunting if your child has special health needs, you have limited money for camp, or you’ve never separated from your child for long periods prior. Here are a few tips and resources I’ve found that may help: Read full post »

Imperfect Pediatrics

I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said,

But I must say, it’s a sincere fortune to be a doctor some days. Yesterday was one of those…

It was typical day in the sense that my schedule was crammed full of well child check-ups, newborn visits, and a few scattered visits for acute care–colds, depression, and belly pain. As is typical, I arrived in the morning with absolutely no open spots on my schedule. I saw 25 patients, squeezed in 2 patients to “double book” who needed to be seen by a pediatrician more urgently, and we provided vaccination updates for over 1/2 the patients. The “productive” feeling washed over me a number of times. At one point a mom said, “I knew that but I just needed you to guide me to know that I was right.” Another moment when I confirmed the correct diagnosis for a patient who’d been into doctor’s offices twice where the diagnosis had been missed. It’s exhilarating to help people understand health, highlight their understanding of science, and calm them down. Parenthood can be extraordinary (understatement of the century). The best part of my job is when I can help clear off the windshield of doubt. I do want parents to see the road…

But the day wasn’t perfect. Read full post »

Idaho: Vaccine Safety, A Desert, And A Networked Community

I’ve just returned from a week in Idaho where I had the privilege to do a series of talks for the Idaho Department of Health (DOH) about using social media to communicate about vaccines. The best part of the week was all of the education I received. I traveled around the state (see those photos!), witnessed the DOH at work, connected with Idaho physicians & politicians & advocates & volunteers, and talked with many Idahoans about changing the understanding of vaccine science. Three times I heard Dr Melinda Wharton from the CDC present on vaccine safety. And more, in a matter of 4 days we talked with a clinician, nurse, or medical assistant from every single office in the state that provides vaccines to children. I mean, that’s a wow–a sincerely networked community circa 2012.

If all states had the opportunity to convene like they do in Idaho we’d really improve understanding, communication, and opportunities in health care surrounding vaccine safety and decision-making.

After arriving home to my boys, I’m compelled to share 3 things I learned in Idaho:


I think it’s essential that we talk about the risks associated with vaccines when we give them–each and every time. Dr Wharton discussed known risks to vaccines and the science to support those risks. She also talked about inferred risks that aren’t backed up with science (autism, for example).

Take fainting: we know teens faint after shots sometimes. Read full post »

Concerns About Autism: Reasons To See The Pediatrician

When it comes to autism, we’ve all been rocked by the recent CDC data that found ongoing increases in the number of children diagnosed with autism annually; it’s estimated that 1 in 88 children has autism in the US. The rates are unfortunately higher for boys. The number is unsettling to say the least, particularly as the cause of autism is multifactorial and not entirely understood. Although we know genetics and family history plays a role, we don’t know what causes the majority of autism.

Read more about the science of autism from Autism Science Foundation.

We do know one thing: research proves the earlier you intervene to get a child additional services, the better their behavior, the better their outcome, and the better their chances for improved communication. You don’t need a diagnosis to access services for your child.

When you worry and can’t find resources online that reassure you, it’s time to check with your child’s clinician. That’s the point of a real partnership and a true pediatric home. Fight to find one if you don’t already have one. Fight to improve yours if it’s imperfect. The feedback I receive from families in my clinic allows me more leverage to make change. We’re all responsible for improved health communication…

Signs of Autism In Infants & Toddlers:

There is not one specific behavior, test, or milestone that diagnoses autism. More than any one behavior,

  • You should observe your infant demonstrating curiosity.
  • You should observe your baby expressing joy nearly every day after 4 months of age. Your child should smile when they are 2 months old, 4 months old, 6 months old and thereafter.
  • Your child should show you they know their name by 1 year of age.
  • You should see that your child tries to communicate thoughts more effectively with each month that unfolds during infancy and toddlerhood.

Here’s a list of specific Autism Warning SignsRead full post »

The Right Choice

Every once and a while I make the right choice. I mean when it comes to work and life and striving for balance. Sometimes I say “No” just when I should. Those “No’s” gain access to the best “Yes’s” in life.

Last week at the end of a series of 3 weekends of work, I was finishing up a conference and decided at the last minute to decline the dinner with peers. I felt pressure to go but just couldn’t stand missing out on the night with my boys. I had that longing in my heart–you know the kind–where you can feel the ache of absence, where you sincerely feel the separation from your kids like a missing body part? It was strong; all at once I said “No,” just in time.

We went to a baseball game here in Seattle. We sat only 8 rows back behind the dugout. The foul balls flying near our heads (me ducking for cover), the crowd screeching, and the sky blue. The husband and the boys had their gloves. We counted airplanes flying above. We cheered and jumped up with home runs. It was a perfect night out. Delighted to be there I had these passing waves of mindfulness, or gratitude, for being with my family and not missing out once again. We were all a little giddy to be at a real baseball game and then 2 things happened that affirmed my “No” was really a magical “Yes” afterall:

  1. A teenager caught a foul ball. Then he caught another ball. Then he did what many kids do—he acted generously. He saw F sitting right in front of him with his glove up and he tossed him the ball. I mean, can you believe that? A teenager gave my little 5 year-old boy a Major League baseball…bliss.
  2. During the middle of the sixth inning, after a bag of popcorn, a small tantrum from O, a bag of peanuts, and 4 hot dogs, Pennington went up to bat. Jon leaned over to F and said, “This guy’s hitting a ball to us.” They got their gloves up and ready. The foul ball did come. And the husband really did catch it. And my boys (all 3 of them) really did leap up for joy. We even made it onto TV (see photo above)!

Two foul balls, one perfect “No,” and a Saturday night with my boys illuminated a momentous “Yes.” It doessn’t always work this way yet every once and a while we make really good and really lucky choices. And then we’re fortunate enough to witness and celebrate them while they happen. For all the suffering that remains in so many of our lives, these little spots of light must be spoken…

How Do Doctors Screen For Autism?

Pediatricians, nurse practioners, and family doctors start screening your baby or toddler for signs of developmental or communication challenges like autism from the very first visit. As a pediatrician, how your baby responds to you (and to me) during the various visits during infancy and toddlerhood guide me in their screening. In the office I get to observe how a baby giggles, how they look to their parents for reassurance, how they try to regain their mom’s attention during our conversation, how they point or wave, how they respond to their name, and even how and why they cry when I’m around. Those observations in combination with family history, health exams, and parental perspectives remain extremely valuable for me in helping identify children at risk for autism.

However, more formalized screening is recommended at both the 18 month and 24 month well child check. In most offices, clinicians use the M-CHAT, a 23-point questionare parents fill out. Often, I have to help parents answer one question in particular, (“Does your child make unusual finger movements by their face”) but other than that, most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for autism and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a toddler at risk with additional genetic, neurologic, or developmental testing.

It’s important to note that screening isn’t diagnosing. If your child has a positive screen for autism, it doesn’t mean they will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about autism, don’t be shy. Read full post »