Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Half & Half

I had a great trip to the grocery store today with the boys. Life has been so hectic these past few weeks, we haven’t had weekend time for a leisurely trip to the aisles of fruit and fondue. Today, we had the luxury of time, a list, and a proper plan. They weren’t hungry (and neither was I) so our stomachs didn’t drive the cart and the boys were uniquely engaged. We perused the produce area. We made peanut butter in the machine that crushes raw peanuts. We talked about some of the beginnings of the food we bought (the avocado came from Mexico, the mini-oranges from California). But I thought most about how pleased I am when I end up at checkout with more fresh food in the cart than food stuffed into packages. Today I think I came close.

And that’s the lesson. One thing I say over and over again in clinic is, “If at all possible, for every single meal you offer your child at home, make sure 1/2 the plate is covered in fresh fruit and veggies.”

So if that’s the goal, the cart should always look the very same way.

Pacifiers: A Love Affair Worth Having?

Pacifiers, a love affair worth having? It’s up to you, of course. Pacifiers are hotly debated among some parents, some pediatricians, some lactation consultants, and some dentists. I say some, as I believe not all clinicians have strong impressions/judgments. That’s because pacifiers don’t cause excessive harm. Yet most parents agree on one thing: they all have an opinion about what to do with one. Some hate them, others adore them. Just like babies. Silicon pacifiers can be all the rage, or none of it…

At our house, we had a love affair with a pacifier. Twice. Without even trying. And it all happened by accident.

Although the American Academy of Pediatrics and National Institute of Child Health and Human Development recommend using a pacifier at night to decrease the risk of SIDS, if your infant doesn’t like one, you certainly DON’T need to force it upon your content baby. Don’t over-think or over-value the pacifier, either.

With F (our first born), I waited, held off, and withheld the pacifier hoping to improve my changes of successful breastfeeding. We had a few sleepless weeks (with the fussing and crying normal for a newborn) until a couple weeks of age when we realize it really was the “plug” he was looking for. F’s crankiness improved, and we had another tool to help support him when holding, rocking, feeding, changing diapers, or swaddling didn’t soothe him entirely. The pacifier was just something he loved.

With O (our second), I didn’t get the choice. While in the NICU, the nurses used the pacifier to “quiet” him down. I asked that they didn’t, but when I returned to feed him, there it was again, in his mouth. And he was in love. So we continued to use it and I didn’t take it from him. As I’ve written before, I loved to see him enjoy and indulge with that pacifier. I mean, he really craved and adored the time he got with it (mostly during sleep or in the car). Weaning him from it was harder on me, it turns out. And I faltered a couple of weeks after the wean during a moment of weakness…

We used pacifiers in our homes until both the boys were just under 2 years of age. And like I said, it really was a love a affair.

The reason is simple, babies soothe by sucking and pacifiers are a perfect tool. My advice on pacifiers: follow your instincts. You’ll be able to find studies both that support use and studies that dissuade use to back up either decision. So don’t over-think this. And stop beating yourself up for using one if you are…

Mama Doc’s Cliff Notes On Pacifiers:

  1. These are things you already know: Wash the pacifier regularly (dishwasher safe are easiest) in warm soapy water, get rid of old pacifiers that show cracking or damage, and use a one-piece silicone design if possible. Don’t dip the pacifier in anything (ie sugar water, honey, etc) ever. And never tie the pacifier around your baby/toddler’s neck.
  2. As your child grows, the pacifier should, too. Don’t let toddlers have infant sized pacifiers due to choking risk. Smaller pacifiers may rest more on their front teeth as well and cause more malocclusion or “bucking” of teeth. Get the correct size pacifier if your older toddler or preschooler still uses one.
  3. When your child approaches 6 months of age, consider weaning. If neither of you are interested in breaking up with pacifier, try again at 2 years of age. By 3 years, get it out of the house or the love affair will cause a most terrible break-up.

Additional Safety Tips on Using Pacifiers:

Mayo Clinic’s Do’s & Don’ts on Pacifiers

Review article about dental problems caused by pacifiers after age 3.

Satisfying your baby’s needs: Pacifiers

Measles At The Super Bowl

Like the makings of a Hollywood movie, I learned this week that there were an estimated 200,000 people in Super Bowl Village this past weekend in Indiana. Amongst them on February 4th, was one (or maybe two) child with infectious measles. Fortunately, the child didn’t attend the game. Yet, measles is highly contagious. The period of infectivity starts before symptoms in some cases and usually 4-5 days before the typical rash, when many think they have just a bad cold. Measles is spread by the respiratory droplets infected people share when breathing, coughing, or sneezing. And the virus can survive for about 2 hours on surfaces or in the air after a person leaves the room. Measles has a wild history and although most children/adults do well after recovering from the illness, measles can result in severe complications like pneumonia or encephalitis. Fortunately, the majority of those in attendance last weekend who may have walked by or been near the infected person were protected by the measles vaccine.

The incubation period (the time it takes to get sick after being exposed) is about 10 days with measles. So if unprotected people contracted measles last weekend, they may get sick this weekend or early next week. Hopefully, we’ll hear of no one.

Measles spreads easily. There are reports of measles infecting every single unvaccinated person at a picnic. The public health department, even here in Seattle, sent an advisory email last night with instructions for what we doctors should do if we suspect measles in someone who was in Indiana last weekend.

But this is a global thing not just a US national sport thing. Starting in 2009, the number of cases of measles rose sharply in Europe. In 2010 for example, there were over 30,000 cases of confirmed, reported measles and in 2011 (through October), there were over 25,000 cases, with over 14,000 cases in France alone. Fifty percent of those with reported measles were children, less than 14 years of age. Immunization rates for measles have declined in Europe and public health officials point to waning vaccination as one reason for the surge. Read full post »

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 »