Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Radiation Disasters And Children: Why No Potassium Iodide Now

There is a lot of talk about radiation and radiation effects because of the ongoing tragedy in Japan. It’s a bit overwhelming and confusing, to say the least. Ultimately, fear motivates us to act in bizarre ways and this current catastrophe in Japan is no exception. I find myself a bit nauseated when my mind drifts to Japan, yet I can’t seem to curb the urge to watch the updates. I don’t normally watch live news because I sincerely don’t think it’s good for me. But this horrific human tragedy steals me away from my typical distance while simultaneously reminding me of two quotes, one posted earlier:

Disasters are about people and planning, not nature’s pomp.” ~The Economist

and

Human inability to detect radiation can pose more of a psychological threat than a physical one. ~The Washington Post

The ongoing tragedy in Japan will help motivate us to prepare. But fear of the unknown can eat away at us, too. Anxiety surrounding Japan’s struggle may be higher than what we experience typically with catastrophic events, in part because of the complexity in understanding the effects of radiation. Because radiation is invisible to the eyes and undetectable to the nose, its presence is difficult to detect. We know that fear and anxiety are common in children affected by natural and radiation disasters but its psychological effect may be the most lasting and intrusive to health.

We can do things to protect our health, too. First, if your children are watching TV, sit with them and provide honest, age-appropriate explanations. Turn the TV off whenever possible. Next, discuss what your family is doing to help prepare for unexpected emergencies. Preparing your home and family for disasters with both a communication plan and an emergency kit can be a great way to decrease anxiety for both you and your children and will arm them with tools to protect themselves. A great antidote to fear is to regain your sense of control. I hope this post, and ongoing ones, help us all calm down.

The bottom line is this: with what we know now about Japan’s current disaster, even with the possible worsening nuclear crisis, medical countermeasure such as potassium iodide (KI) are not indicated here in the US. Don’t pop the Potassium Iodide (KI). And don’t feed it to your kids! Although Japan is advising KI use in the close vicinity to the damaged reactors, the US Nuclear Regulatory Agency and the Washington State Department of Health have both said that harmful effects of radiation are not expected in Hawaii or the US West Coast.

I believe every decision we make in medicine is a balance between risk and benefit, from intervention to doing nothing. This radiation question is no exception. Potassium iodide can protect the thyroid gland from the devastating effects of high levels of ionizing radiation. But, when used inappropriately or unnecessarily, potassium iodide has the potential to cause very serious side effects such has abnormal heart rhythms, bleeding, nausea, vomiting, and electrolyte abnormalities.

The risk of using KI far exceeds any benefit right now. Read full post »

Play

Recently, I started asking a standard question, exactly the same way, to children during their 3 to 10 year old check-ups. This wasn’t premeditated. Like all physicians, I go through phases of what I ask kids to elicit their experiences and beliefs, listen to their language and observe their development. I learn a lot about my patients from what they choose to answer. Both in their receptive language skills (how they understand me) and their expressive skills (how they speak–fluidly, articulately, with sentences) to their cognition (how they understand concepts and theories). No one talks as much when in the exam room as they do at home. Pediatricians know this (of course!), but these questions are a great way to learn a lot about a child’s wellness and get to know my patients. It’s also the part of the day I enjoy the most.

But when I started asking a recent question something became utterly clear. I’d say,

“What do you like to do at home?”

I expected the usual suspects. Things like, “Watch TV,” “Play the DS,”, or “Play with princesses or doll houses.” Not that I expected stereotypes, I just expected specifics. But instead, there has been a uniform, single-word response. Breath-taking. These children are all saying the exact same thing.

“Play.”

One word. Read full post »

Japan Tsunami: Reminder For Parents To Prepare

I was up until nearly 1:30am today watching the Tsunami in Japan live online. Terrible for the psyche and hard on the heart, I simply couldn’t stop watching it unfold. It’s utterly terrifying to imagine the devastation and separation that catastrophic events like this cause for people. In the face of this terrible news, there is much we can do as parents. In addition to donating to relief organizations, we can prepare our families. We have incredible strength and insight as the proud providers and nurturers of our children. Now, today, is the time to utilize this reminder for good and harness your concerns into preparedness.

On the news last night, reporters kept repeating that every home in Japan had an emergency kit…that every family had a plan for an earthquake. They detailed how children knew at a very young age what to do when an earthquake began and families had communication plans to re-unite.

Today is a day to begin to create the same for your family. Emulate the universal emergency plans of families in Japan. I trust these kits and plans have saved many lives in the past 12 hours and lessened the worry of the millions of parents reuniting with their children as I type.

Last year, I made a disaster kit and blogged about the experience. Today, in the wake the Japan Tsunami, please consider doing the same. I’m re-posting some of the content here.

I’m gonna be honest, making a disaster kit completely stressed me out. I hope my experience will make it better for you. I guarantee with each step you take, you’ll feel an incredible sense of relief as you ready your family. I’m no expert at this but have learned a lot along the way. And there is no question, I feel so much better with my family prepared and my preparedness tidied.

As The Economist said last year when discussing Iceland’s volcano, “Disasters are about people and planning, not nature’s pomp.”

Prepare.

I believe in the 3 tiered approach you see everywhere:

  • Make a Kit (detailed below and in my video)
  • Make a Plan (how to communicate and find your family)
  • Stay Informed (what disasters are likely to happen, where to find info) Read full post »

Smoking At The Movies: Even When It’s PG

This week, Paramount released a new animated film entitled Rango. A film full of reptiles with cowboy-type roles, strong voices and adult choices. It’s an animated film marketed to and geared for kids and families. It’s rated PG. In the television trailer I saw last night, they specifically dubbed it a “family movie.” The movie had a great opening weekend, it turns out, but not without some controversy.

The film is full of tobacco imagery, where many characters use and play with cigars and cigarettes. And as I hear it, the hero of the story swallows a cigar at one point and subsequently breathes fire in the face of a villain. Funny. Silly even, maybe. But potentially instructive, too.

As most parents know, many animated films contain content, language, jokes, and plays in plot that go right over kids’ heads. These are cleverly designed to keep parents, adolescents, grandparents, and chaperons “stuck” in the audience, entertained as well. And to keep us coming back.

Problem is, it turns out not every theme goes over childrens’ heads as we’d like to believe. Read full post »

A little Bit Unhappy: $15 Well Spent?

I’m increasingly understanding that the busier I get, the more I find myself a little bit unhappy. This afternoon, I unscheduled the nanny in hopes that I would carve out 4 hours to be with my son O before I picked his brother up from school. He’s still sleeping as of now, so I remain tethered to the computer.

Despite the best of efforts, my son is having a marathon nap this afternoon, something I would normally be ecstatic about. But today, I’m not. I wanted to see him, play with him, have some time. But like we all know, parenting doesn’t work this way. Children don’t follow the script.

So here I remain, entirely plugged in. I’d had a nice conversation at the beginning of my day with an accomplished writer who was thinking of blogging for a cancer center. I gave her words of welcome, encouragement, excitement, and hopefulness for her proposed blog. At one point I said, “You’re the perfect person to do this!” (Because I believe this). But I still gave her warnings, too: this will consume you, eat you up, take over your mind. As any blogger (writer?) knows, the world becomes framed by your blog and every experience you have seems to vie for a possible leading role in your writing. I told her how I basically sleep with my iPhone (not kidding) and approve comments whenever I can and as quickly I can. It allows me to know exactly what’s going on on my blog and hopefully improves the readers’ experiences. But it comes at great cost. I’ve had a total of about one week entirely unplugged since I started this blog November of 2009. I really can’t remember what life was like before that time.
Read full post »

What To Do About Fever


Fever is often a part of life as a parent, particularly with young children in the winter time (read: 6-10 colds a year is the norm). Although I sincerely don’t like it and do feel naturally uneasy when my boys have a fever, as a pediatrician I know to take fever as one of many symptoms they develop when responding to infection. I certainly use medications like Tylenol when my boys are feverish, refusing to eat, punked out, and exhausted. Thing is, it works! And often they respond beautifully, bouncing back, regaining energy and improving their fluid intake and appetite. But I don’t treat every fever they have and I don’t recommend you run for the medicine cabinet when you feel that warm forehead. It’s not necessary to treat every fever. And it’s certainly not ideal to treat the numbers, themselves. Fever is a natural response of the immune system. Fever ultimately can be productive and may assist your child’s body in fighting off infection.

Fever phobia is pervasive though; we pediatricians are partly to blame. This week the American Academy of Pediatrics published a report on fever (and fever phobia) and the use of fever-reducing medications like acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). Listen to my take in the video. The main take home is not to treat fever per se, but your child. There is no reason to make a fever disappear if your child is otherwise acting well, playful, and staying hydrated. But do know there are some fevers that do require a visit with the pediatricians. It’s important to seek care when fever persists after 3 days in infants and children, any fever in a baby 3 month old or less, and if fever is over 104 degrees. Furthermore, trust your instincts! If your child looks unwell in the face of fever and doesn’t seem to be improving as you would expect, call you pediatrician for help!

What do you think; does fever freak you out? Do you feel like you need to treat fever immediately? Does this information help you feel more at ease with temperature elevation and fever in infants and children?

(Errata: The paper detailed above from the AAP this week isn’t a “Policy Statement” as I mistakenly said in the video. It’s a “Clinical Report.”…and well, that’s a different thing. I apologize if I caused any confusion.)

Tanning Bed Ban: 10 Tips on Tanning

I left the country, and went to a tanning bed, both for the first time while in 5th grade. I was 10 years old. Circa 1984, my parents had planned a trip to Mexico and my mom had been poorly-advised that it was a good idea to have my brother and me ready with a “base tan” prior to travel to prevent sunburn. This was unlikely to have come from a doctor, but who knows. It was the 80′s after all.

My mom took us to the local strip mall where I spent multiple 1/2 hour sessions in that warm, sweaty, purple glow encased between 2 rows of light bulbs, the grocery store to my left and the new VHS video store to my right. I remember the stomach sticker I used to obscure the UV light during tanning that marked the progress of our sessions. I remember how excited I got about traveling. I remember how this formed an initial groundwork for my skewed idea that getting a tan marked some sort of achievement. I remember how I used to get praised for my ability to tan when we’d return home to Minnesota.

I also remember that I got the only blistering sun burn in my life from a tanning bed while still under the age of 18. Not good.

I share this because tanning is a misinformation issue. Children and teens may have no idea what risk they take when getting a tan (or a burn) and some parents often have no idea the danger of these tanning beds pose. The argument for “this may cause cancer” often doesn’t resonate with a teen. It’s simply too remote, too far off, or too “grown up” a concern. I’ve found talking about the truth behind wrinkles may be a better angle…

This week the Academy of Pediatrics (AAP) stepped up. The AAP published a policy statement describing the effects of UV light exposure in children while pushing for a ban on tanning in children under age 18. The statement starts off by articulating that “sunlight sustains life on earth.” This time of year here in Seattle we’re particularly aware of this… Read full post »

An Amalgam In The Exam Room

This post is an amalgam. Not the kind that fits in your back molar, but the kind that exists in my head. I’m trusting you have this type of overlapping-quilt-like-consuming-idea-thread that resides in your head at times and ultimately becomes thematic. How one event in life opens a new window into others and then suddenly there is sense and commonality in different spaces and experiences. You know what I mean? Evolving wisdom or simply experience, I don’t know. But I mean how something persists in your every-moment and helps you define meaning  with each new space and time. I’ll explain…

On Monday, a blog post of mine from last summer was published on Dr Kevin Pho’s blog, KevinMD. The post detailed my mom finishing her chemo and 5 words that her oncologist spoke one sunny afternoon: “You’re the picture of health.” The post is about the power of a physician’s words and how words spoken in the exam room linger in our life. In this post, I spoke about words we hear as patients (and caregivers) and how it’s essential that doctors detail wellness when they see it (rather than always focusing on illness). But reading the post again brought me back to last summer. More than once this week (let’s be honest, maybe like 6 times) I’d think about the post and well-up with tears. Maybe it’s the reality that we all face mortality or that I’ve been ushered into a new moment with my mom in her current remission where I am not filled with worry every day. Or maybe it brought me back to the emotion that was in the exam room that day, too. The same emotion I’ve typically divorced myself from. But,

It got me thinking, how was it I was starting a blog, helping my mom through chemo, moving to a new home, and caring for two little boys while caring for a panel of patients during that time? Why wasn’t I in a puddle of tears? Well…see…we do this. Parents (and children) do this ALL THE TIME. They muster incredible courage. Parents face fears. They exceed expectations and bust through boundaries for their children. For example, in the exam room, I tell parents we’re admitting their child to the hospital and then they listen, they thank me, they discuss.  They rise up to what is asked of them without their heart falling out of their chest and landing on the floor. They endure. They “keep it together,” they advocate. They share. Yes, they break down sometimes, too. Yes, they tremble. But they always do what they need to. They endure.

Which got me thinking, we really can be the balogne in the generational sandwich. Read full post »

Formula, Breast feeding, And Solids

Here’s a response to some of the comments about the post I wrote earlier this week. As I’ve said before, I support parents feeding with breast milk and with formula. Studies like this aren’t designed to alienate parents who feed with formula. Take a listen. Here’s a post I wrote about the juggle/struggle to breastfeed while working. Ultimately, the goal of the Pediatrics study on timing of solids was to illuminate ways to improve obesity prevention. Not divide us or cause us to doubt ourselves.

If It Were My Child: No Baby Food Before 4 Months

Last week news of a study evaluating the timing of solid food introduction for infants emerged. It got a ton of press because the study evaluated the timing of solids on the likelihood of obesity at 3 years of age. Researchers divided babies into 2 groups, those that received partial or full breast milk until 4 months, and those that were weaned from breast milk and received formula exclusively before 4 months of age. Researchers then determined when babies were given solid food (rice cereal, biscuit, pureed “baby” food, etc) of any kind.

The results proved notable. Babies who received exclusive formula and solid foods before 4 months of age were 6 times more likely to be obese as a 3 year-old (defined as BMI over 95%, sum of triceps and subscapular skinfolds). This however, was not true for the babies that were receiving breast milk of any kind. So this study may not be applicable to many babies; in the US for example, 25% of infants are never breastfed and approximately half are breastfed for less than 4 months. Yet still, this sheds light on what we can do to help. Use this data when Grandma Trudy is urging you to feed your infant cereal at 3 months. Or why it’s best to wait until 4 months when you get excited about starting solids. Those of you who didn’t wait? Before you spin your wheels with worry about that bite of rice cereal you gave your baby at 3 1/2 months, read on. Because although, if it were my child, I wouldn’t give baby food before 4 months, there may be more to consider when it comes to timing. Read full post »