Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

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 :-))

Dosing Liquid OTC Medications

Over the counter (OTC) liquid medications for children are packaged with a diverse set of various measuring tools. The dropper that comes with liquid acetaminophen (Tylenol) will look very different than the dropper that comes with liquid Vitamin D or infant multivitamins. Even more discrepant are all the various caps for medications used in older children like liquid Motrin or Benadryl. If your cabinet looks anything like mine, caps and syringes are scattered about and distant from the bottle with which they were originally packaged. Because of this, many of us get confused when dosing medications for children. It’s time OTC liquid medications for children were packaged with a universal dosing device. And….time that pediatricians and all physicians be required to use only one unit of measurement (whenever possible) to avoid ongoing confusion for prescription medications, too. A new study functions as a wake-up call for drug makers and pediatricians alike; we need to do a better job helping families learn how to safely dose OTC liquid medications for infants and children. Current practice isn’t going to cut it.

A recent study in JAMA found… Read full post »

A Living Mommy-Daddy Will

I’ve been struck by the death of Elizabeth Edwards. I keep coming back to thoughts about her. Like most Americans, on Monday I learned she was advancing to hospice care. After a long day in clinic on Tuesday, spent, I listened to NPR in the car on my commute home. It was dumping rain in Seattle, it was dark, the cars were moving slowly. NPR announced she’d passed away. What? Pause. Swallow. Take a right turn at the light…

I thought she had weeks. Tears welled up in my eyes; I felt caught off guard. I can only imagine the sadness of those who have known her.

I’ve been thinking of her, her children, and her life experience. I don’t know her, so of course my vantage point into her life is one similar to most–I only know what the media shared with me and what she chose to share with the public. I trust her texture is expansive and far more pronounced in person. I know so little about her, but I have heard her story and it is memorable. I am taken by her death likely because so often, she was identified as a mother.

Today in NYT’s Motherlode blog, Lisa Belkin writes about Ms Edward’s “Dying Letter,” a letter she composed for her children as she faced her mortality. People magazine reported on the letter while the Edwards family was on the campaign trail. I suspect like any letter from a mother, her letter is filled with story, memory, advice, wisdom, and legacy. Fortunately, we’ll never know. Only her children will.

But it got me thinking. Why don’t we all write this? Why don’t we all share, journal, and jot down our thoughts and ideas for our children before we face a mortal diagnosis or worse, an unexpected death. Why not collect thoughts/ideas/moments in time throughout our lives for our children. After I wrote a letter to F last year for his preschool emergency preparedness, I felt better. I know that if today an earthquake occurred while my son was at school, that while separated, he’d at least have my words and a photo. This task could function like a living will but not for our own end, rather for our childrens’ future. Today, a living-Mommy (or Daddy)-will makes a lot of sense to me, despite the onerous task of composing it.

Does it make sense to you to start an ongoing letter to your children? If you don’t feel like much a writer, how about a list of ideas/wishes/advice placed in bullet points? I suspect if any of us start this, we’ll never regret it. Neither will our children.

Will you do this?

Verbatim: Be A Dad

Recently I saw a patient for his 7 year old well child check. He was in the office with his entire family for an evening appointment. My medical assistant got his weight, height, blood pressure, and completed his screening exams. In the hall, she mentioned to me that he said he was going to be a scientist when he grew up. She was charmed (clearly) and I was weak in the knees when I entered the exam room. I mean, endearing and sweet, robust and proactive, his dreams exceeded the typical 7 year old. I suppose I thought this partly because of my path in life (science-y and full of many years of science education). Of course there is nothing ultimately graded about dreaming to be a scientist when compared to dreaming to be an astronaut, a carpenter, a designer, a gardener, a botanist, an artist, or a teacher (this list goes on and on). What we want for children is far wider than their title–what we want is contentment and enjoyment in their career.  Most of us often love when people tell us they want to be “us” when they grow up. It’s affirming, right? One reason you have to be careful from whom you seek career advice. For most, it will often sound a lot like a transcript of what they have done. I’ve been thinking about this since the visit because of what happened next… Read full post »

Do You Believe in Vaccines? (Part III: Experience)

Helping families make decisions about their child’s health takes training, expertise, and experience. The training is standardized (medical school, residency, fellowship), and the expertise confirmed by passing board examinations and maintaining yearly CME (continuing med education). But the experience piece is ultimately unique for each physician. With each day in clinical care, patients teach, instruct, and shape how we understand wellness and illness. Through individual experiences with patients, physicians ultimately become who they are in the exam room. In medicine, despite the huge push to standardization everything from centralized phone calls to how much (or little) time we get with patients, individual doctors will fortunately remain unique. As patients, we still get to enjoy our physicians as people helping us through illness and injury.

This week has been intense. Wednesday, I spent the morning as a patient in the care of my incredible doctor. (I’m fine). She’s entirely instructive for me as a patient and as a physician; her bedside manner astounds. I believe she’s just very good at her job, partly because she’s uniquely experienced. I believe her experience being a nurse for many years before becoming a doctor really colors how she provides care–she gets it.

The week has also been intense because of this series. I’ve been thinking about immunizations, reading comments here on the blog, writing, and witnessing my patients’ responses. I’ve received many e-mails. Yesterday, I was at clinic for over 10 hours and like most days, immunizations were a huge part of my day. But I said things I’ve never said before…True synergy between my clinical self (doctor) and my writer self (Mama Doc), this experience is shaping who I am, in and out of the exam room.

Of course, experiences in clinical care (and living on planet earth) shapes how all pediatricians discuss and listen to families when discussing immunizations. Here’s the final segment in my series on asking pediatricians if they “believe” in vaccines. The 20 or so pediatricians who responded, talked about their experiences in representing vaccines. Additional comments are included in part 1 (emotion) and part 2 (evidence).

Experience:

Dr Kronman, a pediatrician and infectious disease fellow:

We don’t see these diseases anymore. I work at a premier tertiary/quarternary care facility for children. I have seen children die of influenza (seasonal, H1N1), pneumococcus, meningococcus, the late sequelae of measles, pertussis; I have seen Hib meningitis, tetanus, severe debilitating outcomes with varicella, cervical cancer caused by HPV, and severe rotavirus. This list goes on. But most people haven’t seen these things anymore. People don’t have to panic about their children in the summer becoming permanently paralyzed from polio, because we don’t see it anymore. And the reason? Vaccines. Read full post »

Do You Believe in Vaccines: (Part II: Evidence)

I asked a group of 33 pediatricians what they would say to the question, “Do you believe in vaccines?” while standing in line for coffee. I asked for their help in thinking about an effective, 2 minute answer.

This is part 2 in a series. For detailed information behind the why, read part I (emotional responses) or watch the video explaining how this came to be. As I said, I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. Part of the reason I started this blog was that in practice, I realized when I told families what I knew and learned in training, they listened. When I told them what I did for my own children and how I felt, they made decisions. Telling my story seemed essential.

(This is going to sound familiar) I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

Today I’ve included responses from pediatricians that mentioned things that I experienced as “evidenced.” But rather than talk to you about numbers, causality, rates of autism, and the absence of thimerisol in all childhood vaccines (except multi-dose flu shots), these comments focus on the evidence that helps physicians discuss immunizations with families. There was a paucity of numbers in the responses from these physicians.

Dr Gayle Smith (@MDPartner), a general pediatrician in Richmond, VA says it best:

I’d say how much I wished pediatricians were better ‘rock stars’ with our message of prevention so we could be more effective in the media limelight.  I’d speak my own willingness to touch the hearts of the families I care for, to carry the bag of fear and worry for them, perhaps lessening their load a bit. Read full post »

Do You Believe In Vaccines? (Part I: Emotion)

I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.”  I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought.  I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?

I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well.  I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.

But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

We are all so similar.

We all want to do what is right for our children.  That’s why everyone is so nuts about this. Simply stated, we all care immensely.

This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.

I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:

  • Emotional
  • Evidenced
  • Experienced

These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.

As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.

Emotional:

Most of these doctors wrote me about listening more than about talking.  But here’s some of what they said:

Dr David Hill, a pediatrician in North Carolina wrote:

Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’

Gulp. His response to that parent’s viewpoint: Read full post »

Wednesday Before Thanksgiving

Be safe today. With travel defining many of our days, this is a day I think about safety every year. Now more than ever because of my kids. Motor vehicle injuries are the leading cause of death for children in the United States. The CDC statistics on child passenger safety state that child safety seats reduce the risk of death in passenger cars by 71% for infants and 54% of toddlers age 1 to  4 year of age. Car and booster seats are an awesome way to protect our kids.

Wednesday before Thanksgiving was changed for me forever while training in pediatrics.

Wait, a warning: this is a slightly morbid thought. So if it will do you no good, don’t read on. I share this only to show you how and why pediatric training and the profession of caring for ill children shapes how and why we pediatricians believe so strongly in preventing illness and injury. Terrible stories are instructive.

One year in residency, I rotated into the pediatric ICU during November. I was on-call the Wednesday before Thanksgiving until middle of the day Thursday. I was taking care of critically ill patients, some who were on the transplant list waiting for organs. I remember as colleagues left for the day on Wednesday afternoon and evening, one doctor mentioned she wasn’t worried. She knew the patients in the ICU were going to get the organs they needed shortly. It was the biggest travel day of the year, she explained, and organs were going to be much more available.

Entirely morbid, and then entirely hopeful, too. Yes, the organs did arrive over the weekend…

The memory of that conversation really stuck with me. I don’t know if it’s true that more organs are available soon after the Wednesday before Thanksgiving (biggest travel day defined) because of travel related accidents, but it comes into my head every year. Makes me double check the car seats, re-examine the buckles, and drive a bit more slowly.

Be safe today, all. Don’t take risks you don’t need to take, and buckle up. Ensure the carseats are properly installed, particularly if you’re putting a seat in a relative’s or a rented car while you travel away from home.

I like this USA Today article with tips about traveling with infants and children, too.

And here’s my take on why I don’t recommend using Benadryl on the plane if you were thinking about throwing it in the travel bag.

Be well. Enjoy time with friends, family, and your Thanksgiving traditions. I am so thankful for all of you…

Good Decision: Cough And Cold Medications Off The Market In 2007

Over the counter (OTC) cough and cold medications do very little for cough in infants and young children. There is a pile of research that supports this. Parents often agree after they try these tinctures. Because of the lack of effectiveness and concern for side effects (or worse: over-dose), makers of OTC cough and cold medications voluntarily took them off the market in 2007. This was an incredible step in protecting children. In getting rid of unnecessary (and ineffective) medication marketed for young children, we’ve improved pediatric care in this country. Today, some data backs this up. Read full post »