Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

2011 Immunization Schedule Recommendations

This week, Pediatrics published their yearly update to the recommended immunization schedule. Each year, the immunization schedule is reviewed, and when necessary, guidelines are changed to improve protection for children. Changes stem from new studies that provide insight into immunization spacing, infectious disease experts’ analysis of data from new trends in infection, or epidemics, like that from H1N1 or Whooping Cough. All of this data changes our understanding of how and who we need to protect as time unfolds.

Some of the new recommendations announced this week may require your child to get an additional shot when at the office next. Often we think our kids are up to date when they aren’t. We’re often wrong because of changes made to the recommendations or because our child has missed a dose at some point along the way. Or the records at the office aren’t complete…

Recommendations change yearly to define and hone the best practice for preventing infection in children and in our communities at large. The full recommendations are available in Pediatrics with a nice summary in Health Day geared more for parents.

If you have any questions about your child’s immunization status and their protection from infection, contact the physician’s office.

Talk with your child’s physician about these recommendations to clarify rationale and get their take and opinion. And, bring the immunization record with you! Keeping the book has been shown to protect your child and improves the likelihood of accurate records and thus, staying up to date.

The Tiger Mom

I really didn’t want to write a post about Tiger Mom. I didn’t want to lend credit to her media bonanza. And truthfully, I’ve been intimidated by the exceptional writing in response to her words. At first, I didn’t think I had anything unique to add. I don’t like her message (tough/conditional love, tyranny and insults, achievement=happiness) but she probably doesn’t like mine, either. I have high expectations for myself, my friends, my family, and my co-workers. I expect my children to challenge themselves, to learn to communicate, to learn to love, and to work hard to make their conditions good enough so that they can enjoy their lives. I expect them to contribute. I may roar but I really don’t bite. I don’t hit, spank, grab, or insult either. I expect, at particular points in life, many people won’t meet my expectations just like I won’t meet theirs. I believe in forgiveness. My love and adoration doesn’t waver based on performance.

We don’t tolerate aggression in our children, why would we tolerate it in ourselves? Abuse is far more complicated than that which comes from the force of a fist. Just to be clear, I’ll never call my children, “Garbage.”

I’ve read somewhere over 40-50 reviews of the Tiger Mom. If for some reason you’ve not heard of her (who are you??? They’re looking for you to sit on a jury somewhere), Amy Chua is a self-declared Tiger Mom. She wrote a piece entitled “Why Chinese Mothers are Superior” in The Wall Street Journal, January 8th. It marks the beginning of the Amy-Chua era. Since then, buzz around her book, Battle Hymn of the Tiger Mother, hasn’t diminished. A pulse on her perspectives remains one month later.

I don’t want to read her book. The more I read about her, the less I want to know about what she says. I’d rather read something by Peggy Orenstein. I do, however, remain drawn to read what other people think about what this Tiger says. There is an unequivocal sociology brewing. Clearly Amy Chua did more than strike a chord. What’s interesting is not Chua’s idea (that one privileged, hyper-educated, heavily-connected, wealthy, Chinese American mom believes her parenting is superior) but rather, the response of our nation. I mean, EVERYONE has something to say about this. Why would we care that some mom, in one corner of our country, thinks she is doing a better job raising her kids? Why would we care that she equates happiness with achievement or “Westerners” with weakness? Why would we care that she believes intellect is only captured in music capability/competitions and SAT scores? She misses so much about humanity. So much about what defines our connection to others. We care, I suspect, because she was strong enough to state she believed she was right. And that she’s better.

She’s a bully. And a lucky one. Her kids have the wealth of good health.

Read the most memorable response I’ve read, to keep any fascination with Amy Chua’s words in check:

Battle Hymn of A Bereaved Mother

Really, stop reading what I wrote. Go and read what Ben and Ryan’s mom wrote (above).

I’ll tell you, I won plenty of music competitions (oboe), I went to an Ivy league medical school, I have a good job and an innovative career, I married a fantastic partner, and have the fortune of raising two darling boys. I didn’t come anywhere close to perfecting the SATs, I made mistakes, I quit lots of things along the way. Clearly I don’t think my accomplishments (or failures) define my worth, my happiness, or my sense of purpose. I agree more with David Brooks when he said “Amy Chua is a Wimp.” Brooks points out that, “Practicing a piece of music for four hours requires focused attention, but it is nowhere near as cognitively demanding as a sleepover with 14-year-old girls.” Emotional intellect means something. We test for it, just not inside the classroom. And it’s far more difficult to measure than math. Read full post »

Changing The World: Gates’s 36 Cents

Bill Gates recently said, “Not everyone can go into the field or donate. But every one of us can be an advocate for people whose voices are not heard.”

Ditto to what he said.

Watch Gates’s annual letter (below). This modality for telling stories is delicious and the message here is simple yet full of heart. However, like most things in life, it is not without controversy or a difference of opinion. As reported today in The New York Times, some feel Gates is off target.

I got a boost of energy listening to Gates today. It’s good to hear about progress. And even better to feel hope in the war-torn-rioting world in which we live.
Mr Gates describes efforts needed to complete polio eradication around the globe. He also points out the value of 36 (18+18) cents. Most vaccines are cheap. And although you can’t protect a child from measles for 36 cents in the United States (think co-payments and/or administrative fees), you can elsewhere. Particularly when Bill and Melinda Gates are picking up the tab.

I love to witness those with big dreams and lofty goals; it’s how and why our world progresses.

This video is worth the 4 minutes it takes to view. Both for its message and for the enjoyment that comes in watching the pictures unfold.

Baby Elephants & The Working Mom

Working-mommy crisis ensued again last night at the typical quarterly interval, yet in the most unusual form. It was my regular Thursday, a 14-hour work day away from my boys. I left the house before 7 and didn’t return home until nearly 9pm. I didn’t see the boys all day. But that wasn’t it. I was doing just fine with my day; I’d seen over 25 patients in clinic, made some inroads on work in social media and sincerely enjoyed the opportunities I had to help. The shift occurred after I decided to watch the first disc in The Planet Earth series. Have you seen it? I’d planned on finishing a post on Amy Chua (writing it feels like putting hot pokers in my eyes at this point) but realized my brain was fried. Decided to give in and stop working around 10. We got a new television for our basement this week; I popped in the DVD.

The show has nothing to do with women in the workforce. I don’t think the BBC producers thought once about inspiring a post on work-life-balance. Yet the series has everything to do with parenting, our connection to community, our space in nature, and our commitment to our children. The future of the health of our planet is dependent on our care now (of course). Our task in helping preserve the earth is really about more than the quantity of plastic that ends up in landfill. It’s really about how we learn to love and enjoy the woods and the wilderness, how we learn to live and travel without leaving large marks, and how our children understand what matters outside the walls of their home. And how they come to understand decision-making.

The BBC series highlights the earth from every contour and perspective while chronicling animals of all forms in their process of incubation (penguins=amazing), rearing, surviving, and dying.

I just kept watching the mothers. My stomach flipped at points as I watched a mother elephant help her young bull who’d walked right into a tree because he’d been blinded in a dust storm. Or the polar bear teaching her young cub to walk. These animals flanked their mothers. The babies would get tired during migration and sit down. Their mother urged them on… Even after the room was dark and I plopped into bed, I was eyes-wide-open thinking about those mothers. Read full post »

500 Words on a $5M Fine

No photo for this post. You can imagine why.

I’m a little stunned by the news that a politician in Florida is trying to stifle pediatricians from asking questions about guns in the home. My reaction is utterly predictable. Should I YELL IT or write it down or leave it up to your genius (and imagination)?

(silence)

The Skinny on the Florida Proposal:

  • Florida Rep. Jason Brodeur said “he has heard about a number of cases in which doctors asked about guns. He thinks the topic should be off-limits.”
  • Brodeur says he’s concerned about doctors asking patients about guns in the home. He’s concerned that information could get into the hands of the government or insurance companies.
  • Under the proposed legislation, a doctor could face a fine of up to $5 million or be sent to prison for up to five years for asking about guns in the home.

The idea of blocking the right to advocate for children is preposterous. Clearly pediatricians don’t like censorship, particularly when it gets in the way of protecting the lives of children. We don’t even like censorship from our patients; we like it when adolescents tell us the truth about having sex, doing drugs, and self-tattooing. We like it when parents tell us what truly keeps them up at night. Really. Transparency and a lack of censorship is an imperative ingredient in the doctor-patient relationship. The exam room is a space and place where you’re not faulted for telling the truth. Read full post »

An Extra Wince In The Exam Room

Yesterday, results of a survey on beliefs about vaccines circulated on the internet. The survey conducted last week, asked over 2000 adults if they believed vaccines, or the MMR shot, caused autism. I’m not an expert on surveys and I don’t know how reproducible these results are to all parents in the US. But the news caught my eye (along with many others) when they reported: “Just a slim majority of Americans — 52 percent — think vaccines don’t cause autism” That’s a kind-of-odd-double-negative-type way to look at it, I suppose. Or maybe a hopeful one. The results reflect that nearly half of adults in America may suspect or worry that vaccines cause autism; 18% saying they believe a connection exists.

Whew.

The survey reminds us of some of the Why. It seems on some level, it’s a breakdown in our education. While only “69 percent of respondents said they had heard about the autism-vaccination theory — only half (47 percent) knew that the original Lancet study [that linked vaccines and autism] had been retracted, and that some of that research is now alleged to be fraudulent.” And, the details of all the research finding no link between autism and MMR is even more deeply buried, I suspect.

Even so, the numbers surprised me. In light of all the writing in the British Medical Journal this month on the scam behind Andrew Wakefield’s original paper in 1998 making the claim, I’ve been thinking about where we all stand in our understanding of immunizations, science, and trust. More on that next week. But I really wouldn’t have said 1/2 of my patient’s parents believed or suspected in a connection between autism and vaccines. What percentage would you have guessed? Read full post »

The Injustice of Immunization Interviews

When Dr Wakefield interviewed on Good Morning America today, an injustice occurred. For children, I mean. And it occurred inadvertently I suspect. But I believe this injustice happens all the time when it comes to childrens’ health and wellness. What the media covers really changes how we think and feel about protecting and parenting our children. The media’s effort to inform and educate, just like that of physicians and nurses, social workers and ancillary staff, researchers and students, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr Andrew Wakefield with a 2 minute introduction by Dr Richard Besser, a pediatrician and medical editor/correspondent. Yet when the interview was over, I was left remembering the myth.

Today I awoke to the boys asking for breakfast. After getting them to the table with a bowl of Life (always strange to offer a cereal named after our existence), I poured milk in my own bowl. Suddenly I realized that I needed to get the recycling and garbage to the curb. I donned my boots and a coat, ready to haul the can and a number of collapsed boxes to the curb. But just as I headed out of the door, the phone rang. It’s when the day went from the typical day (“making” breakfast and moving garbage) to a day steeped in really trying to understand. My mom was calling, she said Andrew Wakefield was about to be on Good Morning America. I hit my personal fast forward button, flew to the curb with the garbage, and got back inside with enough time to hear the complete interview.

Dr Wakefield interviewed on GMA with George Stephanopoulos who later labeled the interview “combative.” Mr Stephanopoulos was given a terribly difficult task: he was interviewing Wakefield on one of the most complex, emotional, and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefields’s purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research that refutes his own work, Mr Stephanopoulos had to defend science. Alone. George Stephanopoulos isn’t gaining popularity (read the comments) with the anti-vaccine crowd and even some who doubt what Dr Wakefield claims. Yet ultimately, the 7 minute interview with Stephanopoulos and Wakefield simply stirs the pot. I trust it will have huge viewership. I worry that this is, in part, why it was done. Read full post »

Dirty Laundry

Obama said, “Our hearts have reason for fullness,” this week in Tucson. Yes, they do. Hope and love are always here. And although this sense of fullness can be buried or obscured by our sadness, each day offers a new chance at finding lightness. Understanding, insight, forgiveness, and love, too.

Recently I returned to an incredible article I read during the summer of 2009, What Makes Us Happy, in the Atlantic Monthly. The article highlights the work of Dr. George Vaillant, director of a 72-year Harvard study on aging and happiness, who explains “what makes people strive for fame and why dirty laundry symbolizes a perfect life,” (watch his interview). You have to read it to believe it (the laundry part), but the study follows men from the 1930’s during their college years until their death, determining ultimately what defines and exemplifies their happiness. JFK was one of the research subjects (wow). Dr Vaillant discovers, like most seem to, that happiness is neither rooted in money or fame, achievement or reward, cars or vacation homes. Ultimately, happiness comes from love. And the many piles of laundry that result from time together with the ones for whom we care the most.

I’m sharing this because today my mother-in-law turns 75. And well, she is blessed with wisdom and patience unmatched by many. And she is happy. She often speaks to me about happiness. And while once describing her sixth, as the most happy decade of her life, she gives us young-ens all hope! She is an uncommon model in maintaining incredible relationships with her children and by having 4 of them (and 8 grandchildren), she’s managed to form quite a tall pile of dirty laundry…

Happy Birthday, dear Lois. Thanks for doing the wash. We are so much happier because of you.

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 »