Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Treating Ear Infections With Antibiotics

New research on ear infections confronts a challenging conundrum: What should pediatricians do for a toddler with a real-deal ear infection? Treat with antibiotics or “watch and wait?” New research and a nice editorial published in The New England Journal of Medicine this week add to the stew of information about how to manage ear infections in young children. The new research confers benefit to using antibiotics at initial diagnosis of a true ear infection in children under age 2 or 3.

But wait. Seemingly simple, treatment decisions for ear infections are far from it. It can be easy for a pediatrician to prescribe antibiotics, yes. But those of us working hard to perfect how we care for children think long and hard prior to writing a prescription for the pink stuff. Current guidelines from the AAP (published in 2004) make us pause. The AAP recommendations embody the “watch and wait” approach in most children with uncomplicated, acute, middle ear infections between 2 months to 12 years of age. The AAP recommendations include:

  1. Proper inspection
  2. Pain control (Tylenol or Advil, etc). Ear infections hurt!
  3. Observation (waiting for 48-72 hours for relief)
  4. Treatment with high-dose Amoxicillin first and foremost if selected to treat.
  5. Return check after 48-72 hours if no improvement (then moving to treatment with Amoxicillin or changing to Augmentin if child on Amoxicillin)
  6. Prevention efforts (encouraging breast feeding, no bottle propping, working to decrease exposure to cigarette smoke)

But the “watch and wait” approach can be challenging for parents, pediatricians and family practitioners alike. Particularly with a child in pain, a gnarly looking eardrum, and/or a fever. Because of this, studies have found that the majority of physicians who see ear infections in the US don’t necessarily subscribe to these recommendations; we all really like to do something to make our kids feel better… Read full post »

The View: 5 Truths WhenTraveling With Children

We arrived home late in the day Monday from Central America (hence the near silence around here). My family traveled to Costa Rica where we visited my father, old friends, my family’s ecolodge, and had some real honest-to-goodness time together. I remained essentially unplugged for the 10 days (except for a few brief moments online). Wondrous. Life really feels different without an iPhone in my pocket and a diaper in my purse while on the way to preschool. I didn’t have the iconic stethoscope along either. In the absence of routine and my typical tools, I was reminded that travel and how you deal with it is often about perspective. And optimism.

Time brushes your body differently when you’re out of the country, as if it attains a new temperature. Startling news like the shooting rampage in Arizona or the deeper disappointment in Andrew Wakefield hit me differently than I would have expected. Sometimes what we infer really depends on the view. When sitting in a country without an army, surrounded by family and wide open spaces, priorities came into focus, minutia disappeared, the resume of my life diminished in importance, and tragic news penetrated less deeply. For me, travel was a break from responsibility but also a break from the internet, the demands of the constant worry we can feel when taking care of others or bearing witness to the hydrant stream of ideas and news in the (social) media. While I was in Costa Rica, I really felt like a mom. Singularly at times. We were devoid of deadlines and while in the middle of the rain forest, the distance from technology was vast. Big trees, humid thick breeze, and the bazillions of bugs reminded me that there really was a time before my iPhone, Twitter, and e-mail. There can be time that is slow and uninterrupted.

Let me be clear, travel with children isn’t all rosy and relaxed. Travel with children is just that, travel. It’s not technically vacation. There remains little “down-time.” The diapers still get filled, the tantrums remain rampant, the sicknesses can still appear, and the room is usually crammed. And although travel through the eyes of children enlightens, it also exhausts. Which leads me to these 5 things. Read full post »

2011 Hopes, Dreams, Predictions

One year ago, I published a post about hopes, dreams, and predictions for 2010. Click on that link, there’s a 7 second video worth watching.

While we determined our hopes and predictions, a friend helped me determine the mathematical equation for ranking the likelihood of each coming true. We figured it went something like this: Predictions>hopes>dreams. That is, predictions are most likely to come true, dreams the least.

Here’s the 2010 list of predictions from a night one year ago with friends and neighbors. The results listed thereafter.

2010 PREDICTIONS: “2010 will be easier on all of us than 2009,” “Obama’s reputation will be saved by climate legislation,” “I’ll paint the trim in the house white.”

(No, I don’t think 2010 was easier. I don’t think Obama’s reputation was saved. Instead of painting the trim, we sold the house)

2010 HOPES: “Good health,” “My Dad can retire by 12/31/10,” “My mother-in-law’s cancer treatment is successful.”

(Good health, yes, thank goodness. Yes, her dad retired. Yes, my mom’s treatment has put her into remission for the time being).

2010 DREAMS: “F will be potty trained,” “Obama is as good of a man as we think he is,” “I work less,” “The Chevy Volt will save GM.”

(Yes, F potty trained in January of 2010 (YAHOO). I believe Obama is an amazing man. I worked more, not less. I don’t know about the Volt; the jury is still out. Thoughts?)

We were on, we were off. I do believe we all continued to dream big.

As I ended the year 2010, I was directed to a blog post entitled, “The Myth Of Work Life Balance” by Mitch Joel. I read it more than a week ago and have returned to it in my head many times. I agree with parts, disagree with others.

First things first, anyone who writes about work life balance doesn’t have it. Read full post »

Happy New Year!

Greatest “Hits” of 2010

2010 was good to me. See the picture; see my boys? Was it good to you? Life was out of balance, but full, vibrant, meaty, and dynamic. I met amazing people. Work and time with family has been very textured; I feel saturated. Writing and maintaining this blog has ultimately caused me to pause and think about medicine, and my choices, quite a bit more than I used to. I chew on the things people say in comments and in response to what I write over and over again. I’ve learned a lot.

I’m indebted to many. Primarily, to my husband, who has read e-v-e-r-y-s-i-n-g-l-e-p-o-s-t. And for all but about 5 of them, he’s read them prior to them being published. It turns out he is incredibly committed to communicating about pediatric health as well, but goes about things quietly. Clearly, we’re very different (thank goodness). I remain so thankful that someone believes in what I say like he does. My mom also reads nearly every post. She’s been known to scold me about typos and grammatical errors yet ultimately keeps me in check. When an older relative watched a television interview I did recently on obesity, he said, “Well, she speaks too quickly.” My mom apparently responded, “You need to learn to listen more rapidly.” So genuine support abounds at home and at work. I’m entirely indebted to those with whom I work at Children’s, my peers, and my friends in medicine. You’ve all bolstered me this past year. As I said in an interview today, “I am just so lucky to partner with an organization that believes in innovation.” Thank you, all.

So a quick greatest hits. Here’s a breakdown, strictly by the data (pageviews), of the posts that were read most frequently in 2010. Read full post »

Lice Infestation

I’m not trying to ruin your holidays (or your appetite). I really couldn’t and wouldn’t make this stuff up. But yes, we have had a lice infestation for the holidays. Last Thursday we flew to California to be with family for Christmas. Before that, I was in the midst of typical holiday madness, but I also felt this year, in particular, I’d managed not to get stressed. While in clinic on Wednesday, I made a conscious decision that I wasn’t going to stress about the to-do list awaiting me at home. The perspective I get while seeing patients often helps me frame my own stress. Compared to a broken arm or a bout of RSV, a packing list is really nothing. My husband was on call on Wednesday, so when I returned home from clinic around 6:30pm, the to-do list was mine alone. I needed to pack the family for the holiday, finish off some writing, wrap some gifts, and find something for dinner while completing the Christmas cards. I had about 12 hours before we needed to leave for the airport. But this is the life of nearly every parent at one time or another, particularly around the holidays. Then it hit.

Just before our nanny left, she mentioned F was complaining of an itchy scalp. The rest goes something like this:

Me: “Really? F, Lovie, come here, let me look at your head.” Pause. Gulp…….wait for it……..”You’ve got to be kidding me, lice for Christmas.”

F had lice. Yes, we’d received a letter the week prior that a “sibling” of one of the preschoolers had lice. The letter seriously sounded like the stories we hear from others about a “friend” with an STD or a “neighbor’s child” who bites. I figured one of the kids in school really did have lice and yes, the threat was there, but then blew it off and went on with life. New recommendations from the AAP this past fall encouraged schools not to send children home with lice or keep them away from school. I tend to agree with the recommendations as having families leave work and sending kids home seems an enormous interruption for a “non-health issue.” Maybe because of this, I was just about to have a front row seat in a major infestation.

Just then, the doorbell rang. Does this sound like a sitcom? One of our new neighbors was at the door, huge warm smile on her face. She was inviting us to a quick impromptu holiday party next door. Would I like to come? One of the older children had been offered up to watch the kids so I could head over and have a glass of wine. Pâté. Meet the neighbors, embrace the holidays.

I faked it; I smiled. I don’t eat pâté, but the wine sure sounded good. I didn’t tell this holiday-cheer-infused welcoming neighbor what was going on. I mean, when someone is standing in your home, for the first time, meeting your family and offering pâté and wine, do you tell them your child is covered in bugs?

I shut the door, said I would try to make it (that was the truth), and planned my attack. Read full post »

Getting

Getting is an important part of our holiday tradition, too, even though most of us over age 18 naturally subscribe to the insight that, “We get far more when giving than when getting gifts.” Children feel differently, of course; when you’re young, holidays and celebrations are all about the getting. Part innocence, part their time and space, part their developmental stage (it’s normal for preschoolers to believe everything is about them); the recipe for being a child includes wanting more toys. But using Santa (or his elves) as a behavioral tool is never going to work. Naughty or nice is a total hoax.

Our maturation from focusing on getting to focusing on giving is the sustenance in this cycle. All in balance, most of us seem to want less material goods as we grow old. Wisdom, aging, or idiocy–you decide. As I age, my Christmas list has started to sound more and more like my mother’s :”time with my children,” towels for the bathroom, and appliances for the kitchen. It all used to sound so lame. Is it my simple understanding of the bank account, the distillation of my limited free time, or something else? Like most, no longer does gift receiving highlight my holiday; what I like most about this time of year is the ultimate sense of anticipation and the giving. As one friend recently said, “It’s hard not to want to spoil your kids.” It’s just so fun to give them things they like and want. Read full post »

Giving

I’ve been slightly dented by the bad news I’ve heard this year. In 2010, more parents have told me about losing their jobs, having a hard time paying the bills, losing their health insurance (this makes me insane/incensed!!), and losing their homes while I’ve been in clinic than I ever imagined. I’ve always had the fortune of financial support, either from my family as a child and young adult, or through loans for college and med school. My entire life, I’ve always had a place to sleep. In this down market, I’ve thought more about my good luck than ever before. I still have plenty of educational debt (like most doctors), but previously while living on educational loans or in medical training, I lived paycheck to paycheck. Therefore I didn’t have the luxury to give to charity. Or I didn’t choose to (that’s another way to look at it). Now as I get farther away from my training, I have more opportunity to give.

An utter privilege. Dent remover.

When my husband and I discussed giving to charity this month, we were slightly clueless about how to proceed. With our busy careers and with two young children this year, we haven’t had (or taken) time to volunteer outside of the institutions in which we work. We don’t have any new experiences to help guide where we should give. I’ve given to my schools previously and to organizations that I listen to regularly or have affected my own life. But others–those who reach out to children I don’t know? It dawned on me I should survey the Twitterscape. Lots of communities (read: medicine) remain skeptical about Twitter. I find it an irreplaceable tool in medicine, and in life. My list for its utility flourishes. And I’m not alone; a recent Pew research survey suggests 8% of all Americans use Twitter…

Twitter can offer an incredible marketplace of thought, emotion, opinion, and fact. For those skeptical, yes, it does offer falsehoods, inflation, myth, and blatant un-truths. Just like any other situation–on the street, in the hallway, or at the water cooler–you still have to use your brain when consuming on Twitter. But one great thing about Twitter is that it’s a perfect place to crowdsource. That is, aggregating peoples’ minds and experience to answer a question easily. When I grab my partners in clinic to “eye-ball” a rash or discuss a patient case where I have some indecision, I often tell families “Four eyes are better than two” because most often, it’s true. Even if those two sets of eyes don’t agree, the reasoning for disagreement is entirely useful in making clinical decisions and in guiding families in a plan. Collective insight, wisdom, and experience will always improve advice in health care. And in solving everyday-type problems. Hence crowd-sourcing on Twitter to determine where best to give…

I sent out a tweet a little over a week ago: Read full post »

Crib Climbing: 4 Reasons To Leave The Crib

Speaking of cribs, I started this post on November 17th. I quickly abandoned it for no good reason. I realized tonight it was due to an unbelievable heap of procrastination. No, I wasn’t procrastinating about the writing. It was the act of moving O from crib to toddler bed. We’ve done this before, about 2 years ago. It wasn’t pretty. F had climbed out of the crib one day during his nap and greeted our nanny. I was on strict bed-rest with O. 3 weeks later I delivered and we had a newborn at home in concert with daily 2 hour stand-offs with F at bedtime. Staying in bed wasn’t his plan. He’d empty his entire closet, climb on top the chairs, look out the window, ask for water. Sing his repertoire of songs. Repeat his repertoire of songs. Consequently, for about 6 months we agonized in the reality that we’d moved F to a “big” boy bed prior to him transitioning into a “big” boy. Toddler-two’s-torture. Crib jail had been so nice.

For O, I knew it was time to move him to a bed back in November. Just couldn’t bring myself to follow through. Toooooooo, tired. A fairly lame and indefensible (yet understandable?) excuse. We got away with it. Sans a trip to the ER, we took off the front of the crib today. He’s been out of his bed all evening tonight. Let the games begin.

We still shouldn’t have waited. I wasn’t taking my own advice. I’m here to confess… Read full post »

Ban on Drop-Side Cribs

The Consumer Product Safety Commission (CPSC) officially banned manufacturing, sale, and resale on all drop-side cribs today. Laws will go in place June 2011. These cribs, with movable sides that come down to make it easier to place your baby or toddler in the crib, have been under scrutiny for years due to safety concerns. Previous CPSC warnings and recalls have been loudly amplified in the media. Many parents have had concerns.

Here is a nice summary of the announcement. If you have a crib with moving or drop-sides, check out these suggestions for ensuring your crib is safe by doing routine checks. Ensure the crib isn’t wobbly, that joints for the sides of the crib are secure, that there is not excess space between the mattress and the side of the crib (no more than 2 fingers should fit), and that parts are intact and unbroken. If any parts are broken, replace parts by following manufacturer recommendations by looking online at their site or calling the company who made the crib.

This is another great step in protecting our children. What’s your experience with drop-side cribs? Have any of you had experiences raising concerns while using them?

Here’s additional tips from the AAP on choosing a crib (hasn’t been updated to include today’s information).

(And yes, I look like I’m attacking the screen or eager to eat a large drumstick in the still above; I know. No comments necessary :-))