Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Avoiding Antibiotics Whenever Possible: Less Is More

I work hard (as do most doctors) to avoid prescribing antibiotics when unnecessary. The reason? I’m concerned about both the short term effects (diarrhea, rash, allergies) and long term effects (drug resistance, altered normal bacteria and microbes on our bodies) of antibiotic use in children. As we learn more about health and about the role of “good” bacteria in wellness preservation, I suspect we will feel more and more compelled to avoid antibiotics in children. Less is often more.

There are certain medical conditions that benefit greatly from antibiotics (Strep throat, pneumonia from bacteria, kidney infections, some severe skin infections, for example). Hands down, antibiotics save lives and prevent terrible infections when bacteria are to blame. But antibiotics are not without risk. And, we know that antibiotics do no good for children when viruses are the cause of the infection. The use of antibiotics when unnecessary, contributes to “unnecessary [health care] costs, avoidable adverse events, and the development of antibiotic-resistant infections” a study published today reminds.

The hard part for parents (and pediatricians) is knowing when bacteria are to blame and when they are not. Read full post »

How To Dose Acetaminophen or Ibuprofen

Earlier this year, the FDA recommended the discontinuation of infant acetaminophen drops. The goal was to minimize confusion by only making acetaminophen (aka Tylenol) in one universal liquid strength for both babies and older children. However, because the FDA provided a recommendation and not a mandate, there are currently two different liquid acetaminophen preparations on the shelves marketed for babies. And another liquid marketed for older children. Ultimately, it may be more confusing than ever. Thank goodness I just got a little help from my friends…

The pharmacists at The Everett Clinic (where I practice) created a beautiful handout designed to clarify dosing for infant and children’s over-the-counter (OTC) fever reducers/pain relievers. See the dosing chart below along with the renderings of typical dosing devices (syringe, dropper, or cap). Print it out and put it in your medicine cabinet. Review it with Grandma or the sitter or your partner. And remember, the most important way to avoid a dosing error is to keep the original dosing device with the actual OTC medication. Resist the urge to grab a kitchen spoon!

Check out a video I made last year about common OTC medication dosing problems. The numbers will surprise you (hint: nearly all pediatric OTC meds in the US had inconsistencies, superfluous, or confusing dosing instructions). Dosing medications for our children can be more complicated than we’d like. So let me know what else you want to know about dosing acetaminophen or ibuprofen.

Halloween: Wicked Scary Tantrums

I like Halloween far more as an adult than I ever did as a child. At least that is how it feels now. Witnessing the excitement this year around casa Swanson has been a hoot. Not all easy though. Like I have mentioned before, holidays come with all sorts of novel stresses that our children experience differently. Then mix in a whole bunch of costumes and candy and…imagine.

On Friday, our little O had a mega-tantrum at the preschool parade. So loud, so ornery, so insistent that he never donned the costume and never got near walking in the parade. The tantrum ended only after arriving at home. I was feeling entirely terrible already as I was out of town and unable to make it to the parade, but when the husband called me at the airport and told me it was better that I wasn’t there after all, I felt even worse. The Mama-ache reached new heights. Although I mentioned that day one of preschool was a heroic moment, days 2 through 25 have been (typically) different.

Tantrums are wicked-scary-terribleness sometimes. The public grimaces, and then points and whispers and stares and judges. Our children’s friends and peers run the other way. And we parents look like out-of-control-bats. Tantrums can be very Halloween, actually. A post on the New York Times Motherlode blog yesterday couldn’t have come at a better time. Read full post »

How Much Milk? Seattle Mama Doc 101

We don’t need cows to survive but their milk sure does provide us with a convenient source of calcium. The amount of milk our children need varies with age. I outline needs in the video but know this, as your child ages from a preschooler to a school-age child to a teenager, their calcium needs increase. Of course, if your child doesn’t like milk or is allergic to milk products, you have plenty of ways to get them the calcium they need from other foods rich in calcium to fortified juices to calcium supplements and calcium-fortified bars.

Getting The Calcium Our Children Need:

  • Lowfat milk is an easy and affordable source of calcium, but it certainly isn’t the only one. Other calcium rich foods include soybeans (edamame), tofu, broccoli, spinach, and almonds. Click on that link for a comparison of how much calcium each food contains compared to a cup of lowfat milk.
  • Calcium needs increase by age. Here’s a chart that breaks it down by the milligrams of calcium kids need each day. If you’re not into counting milligrams of calcium, think of calcium needs by the glasses of milk need daily: about 2 cups for 2 to 3 year olds, 2 1/2 cups for 4 to 8 year olds, and 3 cups for rapid-growing 9 to 18 year olds.
  • You don’t need whole milk for proper nutrition after age 2. “Whole” only refers to the amount of dairy fats, not the amount of vitamins or protein. US Studies find that almost 1/3 of families still serve their older children whole milk. I recommend switching to lowfat milk once your child turns 2.
  • Fewer than 1 in 10 girls gets the calcium they need between the age of 9 and 13 years. Fewer than 1 in 4 boys in the same age gets what they need. I’m perplexed by the sex difference, but suspect it has to do with calorie restriction (read: dieting), cultural norms, and the vast array of alternative beverages marketed to teens. When I searched for an explanation, I found data on fur seals. If you know the answer, please leave a comment!
  • If you are concerned your child is lactose-intolerant (very rare prior to age 5 years) consider getting milk products that are lactose-free or getting pills from the doctor that help children digest the lactose (milk sugar).
  • If your child isn’t a milk-hound, consider finding ways to keep calcium-rich snacks within reach. For easy snacks consider a handful of almonds or a piece of low-fat string cheese. Leave them out and in arm’s reach after school.
  • And remember, the only two things your toddler to teen needs to drink on planet earth are milk & water. Everything else is an extra.

Speaking Up In The Exam Room

I was in a cab yesterday afternoon. I’m at another conference this week and as I made my way to San Diego, I had to count on many people to keep me safe. From the pilot to the air traffic controller to the cab driver. We do this all of the time, of course–step into a moving vehicle, sit down, inform another person where we’d like to go and then just trust. Trust that they know how to drive, that they’ll take care of us, that they’ll do their best to remain aware, responsive, and agile in the face of unexpected events. We trust that they’ll keep us alive and return us to our children. We do this at the clinic and at the hospital, too.

As I sat in the back of the car, I noticed a sticker on the window describing the bill of rights for passengers for San Diego Airport cabs. The list detailed things I was due: a safe car, a working seat belt, a music-free ride for example. And the kicker, a driver who doesn’t talk on the cell phone.

Read full post »

What Is The Tdap Shot? Seattle Mama Doc 101

Tdap is a shot necessary for all adults and children starting at age 11 that protects against infections caused by Tetanus, Diptheria, and Pertussis (Whooping Cough). Because of increasing reports of Whooping Cough and increased infant deaths in the last 2 years, we are working hard to protect infants, children, adolescents and adults from Whooping Cough (caused by Pertussis). Most importantly we want to protect our newborn babies from being exposed or contracting whooping cough. Whooping cough is most dangerous and most devastating (occasionally fatal) for newborn babies (under 2 months of age) and infants under the age of 6 months. If you are around a newborn baby it’s essential you’ve had a Tdap shot at least once as an adult. Watch the video for more.

Keep in mind, even fully vaccinated adults can get pertussis. If you are caring for infants or young children, check with your health care provider about what’s best for your situation.

What is Whooping Cough & How is it Treated (Link)?

WHEN TO CALL THE PEDIATRICIAN: Pertussis infection starts out acting like a cold. You should consider the possibility of whooping cough if the following conditions are present:

  • The child is a very young infant who has not been fully immunized and/or has had exposure to someone with a chronic cough or the disease.
  • The child’s cough becomes more severe and frequent, or her lips and fingertips become dark or blue.
  • She becomes exhausted after coughing episodes, eats poorly, vomits after coughing, and/or looks “sick.”

How To Protect Your Family From Whooping Cough

  • The best way to prevent Pertussis (Whooping Cough) is to get vaccinated.
  • Children 7 to 10 years old who did not have their full DTP/DTaP series (2,4,6, and 15 months shots) need a Tdap shot.
  • Children with either an unknown or incomplete shot record/history before age 7 years of age need a Tdap shot.
  • All adolescents with an up-to-date record need the Tdap shot at the 11 year old well child check-up/visit.
  • Anyone over age 11 who has not previously received Tdap – when indicated.
  • There’s no minimum interval between Td and Tdap vaccines. Meaning, if you for some reason had a Td (“tetanus booster”) in the last few years, you still need a Tdap now to protect against whooping cough(Pertussis). No 5-10 year interval is required between the shot.
  • Vaccine protection for pertussis, tetanus and diphtheria fades with time, so adults need a booster shot. Experts recommend adults receive a Td booster every 10 years and substitute a Tdap vaccine for one of the boosters.
  • Getting vaccinated with Tdap is especially important for adults who are around infants – new parents, grandparents, babysitters, nannies, and health care providers.

AAP Policy Statement on Using Tdap to prevent Pertussis

CDC: Protecting your family from whooping cough (Pertussis)

Traveling For Work

I’ve been traveling for a week. Please forgive the silences here. As you can imagine, I’ve been making lots of noise elsewhere. Since I left my little boys and husband early morning last Friday, I’ve been at the AAP national meeting in Boston where I met with many friends and peers, gave a talk at a big conference at Mayo Clinic in Rochester, MN, had the honor to participate in the Mayo Clinic Center For Social Media board meeting, and today I’m speaking about immunizations at the Minnesota Dept of Health’s Got Your Shots conference in Minneapolis. All very exciting and this work and time feels productive on many levels but the leave-taking last Friday left me gutted.

O had been up all Thursday night last week vomiting and we spent the night in the frenzy of clean-up (how many back-up sheets do you have?) and comforting. As the sun rose, I knew I was leaving them for the longest stretch ever. I vividly remember the sound of the car door closing just as I drove away and it wasn’t until about North Dakota, mid-flight, that the ridiculous ache (heart) and nausea associated with leaving started to regress. It’s been busy since I left. The work serves as a very good distraction. But like many of you have heard, I often feel like I’m missing a limb or two when I’m away from my boys.

It was last night when I knew I needed to head home. The Husband mentioned that F had proclaimed it made no sense to travel to the farm (that we usually do) to get a pumpkin when he could simply get one at the grocery store. Clearly logical for a near 5 year-old. But the reason I knew it was time to head home was that my husband agreed.

I’m honored to work and entirely blessed to share my stories and my ideas about working as a pediatrician and writer and working to change health care. But it will never ever take away the role I cherish and hold most dear. That is, my commitment and love for my children and my family. The busier I get, the more clarity I hold. As I speak about striving for balance and making sense of the different hats we wear and batons we pass in our lives as parents and clinicians and children and community members, I must say that never once while away did I worry that I don’t understand priorities. The boys thrive as I do because I am surrounded by committed family and friends who share a similar vision. And they love and hold and care for the boys beautifully while I’m away. As I woke this morning across the street from The Mayo Clinic, what I knew was this: I can’t wait to get home to see those boys and travel to that farm for a beautiful pumpkin, but I really am thrilled to be here in Minnesota and just so happy to help.


Limited Time At Well Baby Checks: Seattle Mama Doc 101

A recent study confirmed that there is limited time with pediatricians for well baby care. The Pediatrics study surveyed parents retrospectively about their well-baby visits with pediatricians; 1/3 of parents reported having less than 10 minutes with the doctor! I say this can still be a great place for partnership, reassurance, diagnosis, and care even if time is limited. As a parent, you have to be a pro, too. Plan ahead, prioritize questions for the doctor, and help set the agenda for the visit when the pediatrician walks in the room. It’s always okay to ask (anything) and it’s always okay to return for follow-up visit, too.

Maximizing Time With Your Baby’s Pediatrician:

  • Set an agenda. The minute the pediatrician walks in the room, tell them what you want to learn during the visit and what worries or stumps you most about your baby or your parenting. If you help shape the agenda, you’ll avoid those painful “door-handle” conversations where the doc tries to leave (because there are other patients waiting and there is no more time) and you feel rushed and dejected. No one likes those conversations. If your doctor isn’t good at agenda-setting, you can be. Remember this is a partnership, not a dictatorship…
  • Because time is unfortunately always limited, prioritize your questions. You may have 15 questions, but list them out in order of concern/preference. As your pediatrician asks their own questions and completes a comprehensive physical exam of your baby, it’s possible to ask others and you may find yourself surprised that they addressed concerns you had without prompting. But prioritize so you don’t forget the last (and possibly most important) question of all.
  • It’s always okay to ask. ANYTHING. Don’t shy away from questions because your doc has limited time. If necessary come back a week or month later if you’re still wondering about something you need to clarify.
  • It’s okay to schedule a follow-up visit. One of the pitfalls in well baby care is that many parent want to squeeze 2 or 3 visits into one. During a well baby visit, there is a lot to accomplish (some studies find that docs are supposed to cover over 50 topics). So if you are also concerned about an acute or new illness/behavior problem, consider scheduling a separate visit. You’ll likely all be more satisfied with how you can get what you need and how you can partner to protect and prevent illness and injury for your baby or child.
  • Don’t leave empty handed! Ask the doctor what websites or online references you should read for more information after the visit.


California Bans Indoor Tanning

Atta girl, California. This week Governor Brown signed a law making it illegal for children under age 18 to use tanning beds. No doctor note, no parent note, or any other paperwork necessary. It’s a real ban and it’s the strictest law in our nation. While 30 some other states have laws limiting indoor tanning use by minors, no other state has banned the use of indoor tanning for minors entirely. Although many professional groups have urged for a tanning bed ban, it has taken some time to get this trend started. Only 49 states to go.

I see patients in clinic nearly every week who visit indoor tanning beds. Their parents go sometimes, too. And we know that’s a huge reason some teens start tanning. So why the rule and why the necessary seemingly rigid law? Watch the video above and put it on your Facebook account. Show it to your children or your nieces, nephews, or neighbors. Read my take:

Teens and Tanning:

A study back in 2002 surveyed kids from all 50 states to determine (risky) behaviors increasing the odds of skin cancer. The findings were fairly grim. Over 80% of teens reported having a sunburn in the prior year and over 1/3 of them had experienced 3 or more burns. We know one bad sunburn in childhood dramatically increases the likelihood of a skin cancer later in life. Further, one out of every 4 teen girls between 15 and 18 years of age reported indoor tanning bed use. And worse, as teens get older, they use indoor tanning more: the rate of indoor tanning doubles between age 12 and 17. The reality is, teens won’t prioritize skin health so you may have to help. Some suggest using the argument for preserving beauty (“Sun damage gives you wrinkles”) is more powerful than using the argument for preserving life (“Sun damage may give you a skin cancer that kills you”). Read full post »

How To Stop A Nosebleed: Seattle Mama Doc 101

Nosebleeds are a common frustration during childhood. Although finger-nose-picking is a common cause, other climate changes (dry), medication use (nasal sprays), and other medical problems (rarely) can be the cause. The best advice? Don’t panic. And do your best to help prevent nosebleeds: stop the picking (GOOD LUCK), use humidifiers in children’s rooms, nasal saline spray, or Vaseline. And, keep a towel handy. One of the best ways to calm down when the blood is gushing is to sop it all up.

My quick tips:

Don’t Panic.

Don’t stick anything up your child’s nose to stop the bleeding.

Don’t have your child lean back, rather apply pressure to the nose for 10 complete minutes while your child is tipped slightly forwards.

Healthy Children’s Tips on Stopping nosebleeds

Nosebleeds, See A Doctor If:

  • Bleeding does not stop in 20 minutes, after you’ve applied pressure.
  • If you think your child may have put something in their nose or something is stuck there (like a bead).
  • Your child has more than 3 nosebleeds in 24 hours
  • Your child gets frequent (weekly or even monthly), heavy or hard-to-stop nosebleeds
  • The nosebleed is a result of a blow to the head or serious fall
  • If your child is dizzy or is weak with the nosebleed