Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Too Much Salt? More Bad News

Salt is back in the news. Not surprisingly, salt continues to get a bad name because eating too much salt can put us at risk. This is a bummer for those of us who prefer a salt lick to a popsicle. And it’s especially bad if we developed a salt-eating habit in childhood. An article published today found that increases in salt intake are correlated with the finding of high blood pressure. Not news, exactly. But the article asserted that for each increase in 1000mg of sodium intake each day, the risk of elevated BP increased significantly. Every little grain of salt seems to count. This was especially true among children who were of unhealthy weight (over 1/3 of the children studied). Thing is, the longer we have high blood pressure, the more damage our bodies sustain. So if high pressures start in childhood, risks increase throughout our lifetime.

Blood Pressure In Children:

  • Normal blood pressure for children shifts and changes as they grow. Normal BP varies based on age, gender, and height. Your child should have their blood pressure routinely checked starting at 3 years of age. Ask the nurse, medical assistant, or doctor to report  your child’s blood pressure and confirm the numbers are normal for their age and height.
  • Salt may increase blood pressure by causing the body to retain more water, giving our blood more volume. When blood volume and pressure increases, the changes can load stress on our heart and our blood vessels. Over time, those longstanding increases can cause damage to our organs putting us at higher risk for heart problems and/or stroke. You should know however, there are many people who develop high blood pressure as they get older who don’t eat excess salt, for unknown reasons. Medically significant high blood pressure requiring treatment is rare in childhood but can start at any age. Even so, anyone who eats excess salt is at risk for elevating their pressures at any age.
  • Many children with high blood pressure don’t know it. The article reported that 15% of the 6000 children evaluated had high blood pressure. Boys were more likely to have high pressures.

Below is a video I published previously on where salt comes from in our diet, how much salt children can consume by age, and ways to help reduce our cravings for salt as a family. Number one thing to do in any household to reduce salt intake is to reduce processed food sources–canned and processed foods account for the majority of salt in our diets. Read full post »

Whooping Cough Shot: Does It Last?

A study published today in The New England Journal of Medicine evaluated the duration of protection against whooping cough after children get the DTaP shot.  Researchers wanted to find out how long the shot lasts. DTaP shots are given to infants, toddlers, and kindergarteners (schedule below) to protect them from three infections (Diptheria, Tetanus, and Pertussis –whooping cough). After these childhood vaccines, we give a “booster” shot at age 11. Because we know that many babies who get whooping cough are infected by teens and adults, all teens and adults are now recommended to get a Tdap shot to protect themselves and those vulnerable against whooping cough.

As researchers seek to understand the recent epidemics of whooping cough in the US, they have found more and more that the causes of these epidemics are multifactorial. Not only is it unvaccinated populations that allow epidemics, it may be waning immunity from shots given previously and waning immunity to natural infection, as well. Previously, it’s been estimated that our immunity to whooping cough wanes anywhere between 4 and 20 years after we get whooping cough, and that it may wane 4 to 12 years after the shot.

A little history: back in the 1990’s we switched from using the “whole cell pertussis” shot to using a vaccine that is “acellular.” Some health officials have had concerns that this “acellular vaccine” may not protect children as long. Although it does a great job protecting infants and toddlers, it may not last as long as previous immunizations. Some have wondered how long the kindergarten shot protects our children…

Physicians at Kaiser Permanente reviewed information about children in California during the 2010 whooping cough outbreak. What they found may have significant effects on how to protect our children going forward: Read full post »

Eye Candy: PODS And Capsules

Laundry and dishwashing capsules & “PODS” are all the rage. Frankly, I love them. They’re less messy, take up far less space in the cabinet, and enticing to use. Throw them in the washer without a single errant drop. They’re pretty to look at, too.

That’s the trouble though.

These PODS and capsules look more like Halloween candy than laundry detergent. But this soap [eye candy] poses a unique and dangerous risk. The film that forms the capsule is designed to dissolve quickly. Toddlers are at risk, as small children explore with their mouths not only their hands. Toddlers and preschoolers may be both drawn to the visual appeal of these concentrated capsules and to their balloon-like texture and squishy feel. I wrote (did a video) about this earlier, when WA State issued a warning to all ER doctors.

Concerns for ingestions are continuing here (nearly 3000 injuries were reported in US children between January and August, 2012) and around the world. Highly concentrated laundry detergent can erode tissues, cause swelling, and cause burns to the mouth, throat, airway, and eyes of children who touch, break open or ingest them. The majority of injuries from PODS and capsules have been due to ingestion, but there are reports of many eye injuries as well.

Curiosity rules a toddler’s exploration. Judgment lags way behind.

New information released last week in the UK helps categorize the concerns. The National Poison Information Center shared a brief where they detailed that capsules and PODS were the most commonly reported ingestions in young children over a 14-month period. A group of physicians at The Royal Hospital For Sick Children in Glasgow also authored an academic letter detailing their concerns, reporting on 5 children who had been admitted and cared for in the hospital after ingesting (eating) the PODS/capsules. Their letter highlighted:

Ingestion Injury From Detergent PODS & Capsules:

  • 5 children, between 10 and 22 months of age, were admitted to the hospital with serious injuries.
  • Injuries for the 5 children included serious swelling and damage to the throat and airway (arytenoids, glottis, supraglottis, esophagus, gastro-esophageal junction). Children demanding hospitalization varied in the care needed. One was managed with steroids and antibiotics alone, while the other 4 children demanded intensive care. Four of the 5 children needed breathing tubes, 2 of whom were on the ventilator for a week.
  • Fortunately, all children recovered from their ingestions.

Protecting Children From Detergent PODS/Capsules:

  • Young children are ruled by curiosity. Make sure that capsules and PODS are up and out of reach.
  • Don’t display them due to their visual appeal.
  • Don’t allow young children to help use the laundry or dishwashing capsules. Becoming familiar will likely cause them to want to touch, explore, and possibly gnaw on these capsules.
  • Until containers selling these products have a child safety lock/top, inform your friends and caregivers about the risk to young children.
  • With any ingestion, no matter what the size, call poison control immediately 1-800-222-1222.
  • Read more about it (including my interview) at US News & World Report or here at WebMD.
  • Print out this Poison Control fact sheet for your daycare or pediatricians’ office.

 

Circumcision For Newborn Baby Boys

Last week, the American Academy of Pediatrics (AAP) issued an update to their circumcision policy statement that attracted significant attention. In it, the task force clarified the previous neutral policy for boys’ circumcision. The AAP stated that research has advanced since it’s most recent report in 2005 to conclude the health benefits of circumcision outweigh the procedure risks. Like any medical test or procedure, circumcision carries both benefit and risk. With global data expanding about benefits of circumcision and protection against sexually transmitted diseases, the AAP changed its stance. Risks from circumcision are reported to be very unlikely and happen less than 1% of the time. Most common side effects can be a small chance of bleeding or a need for antibiotic ointment. The most frequently reported adverse event from parents is a concern not enough foreskin was removed. Fortunately, circumcision revisions are very rare.

The statement doesn’t go so far as to recommend that boys undergo circumcision, rather the task force stated that the procedure should be done under sterile technique by a trained, experienced clinician. Importantly, they stated for the first time that it should be covered by Medicaid and insurance. This with the hope that every family ought to have the right to make a choice for or against circumcision, not just those with private insurance.

Clearly, the decision to circumcise a newborn baby boy isn’t made simply in the content of medical data. Families weigh religious traditions, cultural practices, family history, and medical information when choosing to circumcise or not. The AAP statement maintains and honors this belief. Ultimately, the decision is a private one for families to make. A pediatrician, family doctor, or ARNP should help you go over medical benefits/risks as needed. As a parent, you go over the rest. Read full post »

First Day Of School: 6 Tips For Sleep

We know children are sleeping less now than they did 30 years ago. Research studies are piling up that assimilate the ill effects of our lack of shut-eye. When children don’t get the sleep they need they suffer. And not only in the ways we may expect. Sure, they are grumpy and irritable but research also shows children who create a sleep debt also have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible while having difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Further, tired teens who are on the road driving in the early morning are at more risk for motor vehicle accidents. Data shows that more than 1/2 of all early morning accidents attributed to drowsiness occurred in drivers between 16 and 25 years of age.

Teens are potentially at the greatest risk for drowsiness because they tend to naturally fall asleep later and school start times get shifted earlier and earlier. Here in the Seattle area, many schools start at 7:30 am (school bell times). And multiple students in clinic this past week have shared with me that they are attending extra classes during “zero period” that begins at 6:30am! That means, many teens are responding to a 5:00am alarm clock. If these teens aren’t to bed until near-midnight, come October they are going be exhausted.

Typical Sleep Needs For Children And Teens

  • Preschoolers: 10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
  • School-age children: 10-11 hours total sleep. Most children get to bed around 8pmbut as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm.  Puberty brings on changes to their sleep cycle and thus shifts them later.
  • 12 year-old to teens: 8 1/2-9 1/2 hours total sleep. Most teens aren’t tired until 9pm or later. To get the amount of sleep they need, you really have to help them prioritize bedtime. Between the lure of Facebook, the average of >100 text messages sent daily (!), and the academic demands of school, coupled with extra-curricular activities,  it can be tough. Learning to value sleep is life skill. If you’re having trouble getting these hours in, you’ll see your teen catch up on sleep during the weekend. This is sleep debt. They can fill the bank and replenish the sleep debt by sleeping in on weekends, but it’s imperfect. Allow them to sleep in, but help them also keep the same bedtime Friday and Saturday as best they can.

6 Tips To Help Your Child Prioritize Sleep For School

  1. Work to design and agree upon (as a family) a reasonable bed time for your child or teen. Eight o’clock for school age children and 9:30pm-10pm for teens may be most reasonable. Read full post »

First Day Of School: An Interview?

September is upon us. I’m back to blogging after my August pause. Life has been very busy and peppered with bits of flurry, but more on that later. School is about to start.

As we all return back to the routine of the fall and ready ourselves for winter, it’s a good time to check in on where we stand. This month really can feel like packing our cheeks with acorns. The transition to school brings on all sorts of stress, anxiety, sleep changes, and anticipation. Of course, it also brings great joy. So many parents, friends, and families relay sadness they feel on the first day of school (particularly Kindergarten). We shed a layer of innocence it seems when our kids advance. However, one good friend recently described his son’s first day of Kindergarten as one of the happiest of his life. He mentioned he could tell me, unlike other days, what his son was wearing, the pace of his son’s stride that morning as they walked to school, and how he remembers clearly the huge sense of pride both he and his son felt when they landed in the classroom. It was by all accounts, “Marvelous and immensely joyful,” he said. It’s his description that is allowing me to keep my chin up.

We flew kites with friends in celebration of the last night of summer tonight. I teared up at bedtime. It isn’t going to be pretty. Not only does F start Kindergarten this week, he also just announced a wiggly tooth. Be still my Mama-heart…

The beginning of the academic calendar marks a perfect time to pen in milestones for the memory books. Utilizing my coping mechanism for the school start this week, I did an impromptu interview with F on Friday. It wasn’t premeditated so it’s not entirely sophisticated and therefore, very reproducible. I’m hoping to make it an annual tradition to help me both mark transitions but also celebrate his incredible journey growing up. Here’s the 20-question interview with his verbatim responses. Please feel free to provide added suggestions for questions and I’ll do a a follow-up interview!

5 Year-Old Interview, 5 Days Prior To Kindergarten Start

  • What is your favorite color? “Yellow”
  • Favorite number? “5”
  • Favorite food?: “Strawberries”
  • Favorite toy?: “This is going to be a tiny bit hard……airplanes.”
  • What are you most happy about this summer? “I got to spend more time with Mommy and Daddy” (be still my heart, again)
  • Favorite memory from the summer? “Going through the Costco carwash.” (you can’t make this stuff up) Read full post »

Striving For “Polygamy” In The Digital Age

Dr Stephen Ludwig, one of my most treasured mentors from medical school gave a speech last year that he entitled, “Striving For Polygamy.”  I didn’t get to hear it live but I’ve read the speech many times since then. He wasn’t talking about polygamy like you’d expect. Rather, he spoke to the goal of balancing a set of  marriages described by the poet David Whyte in his book, The Three Marriages. The goal for all of us might be balancing 3 essential marriages in our lives: a marriage to our family, a marriage to our work, and a marriage to ourselves. Where social and digital media fit into this “polygamy” remains unknown. That’s where we’re all working hard to find harmony with our devices, as seemingly technology lives in all 3 of these spheres.

Think about it. How often do we take the time to put all three of these marriages on the table? I certainly don’t balance these well all the time. Although I believe in compartmentalization, the act of prioritizing ourselves amidst our deadlines while in the presence of our beautiful children is a challenge. Often when we’re raising young children we fall out of balance–the necessary daily tasks in raising children to adulthood take over while pushing other commitments asunder. When coupled with work, our personal care suffers. This imbalance creates a work-family frenzy for so many of us where we’re left with a dearth of time for personal reflection and much less silence.

In a quest for silence, I’m taking a 1 month sabbatical from the blog. Last August I took a sabbatical away from social tools to create more space and time with my children and more time in search of reflection and quiet. Stillness.

Technology and ever-available networks, communities, work inboxes, and devices have incredible and essential utility in improving our lives and our health. But so does the real, quiet world. I’ll be back in September. In the meantime, I’ll be with my family and friends, my patients, and the ever-elusive silence that surrounds us.

Swim Lessons Before School

New data around the world has found that early swim lessons (between age 1 and 4) may confer added protection against drowning. Maybe a new rule should be swim lessons before the start of school?

Many parents tell me in clinic that they are terrified about their children drowning. If you’re one of those, arm yourself with information: read some of the links (below) and consider signing up for lessons. However, don’t use swim lessons as an excuse to decrease vigilance around the pool or lake or riverside. Young children between age 1 and 4 years of age drown the most. Drowning happens quickly, and sometimes it’s very quiet or even silent.

Information, Myths, Truths, And Opinion About Swimming Lessons And Water Safety

  • Never let an infant or toddler out of arm’s reach when swimming or playing in water. There is good data stemming from an article published in March of 2009 to suggest swimming lessons may prove to be protective against drowning. Drowning is the second most common cause of death from injury in kids less 14 or younger.
  • 6 myths about water safety  Read full post »

Katie Couric’s Biggest Accomplishment

Without question, for nearly all of us, parenthood is the center, the privilege, and the highlight of our lives. Like a glowing pin at the center of a large target in the middle of the night, our children are really our focus points. We often see that very clearly, even with dark glasses.

That’s why it’s not surprising that when Katie Couric interviewed this morning in Seattle at KING5 News, she responded that it was her motherhood she was most proud of:

 

I think I did a pretty good job

She meant raising what she described as her “nice girls with good values.” Her daughter is just 21 years and her younger girl is 16 years old. But out of all of her opportunities in the media, all of her fame and celebrity, all of her fundraising and initiatives in cancer prevention, and her very public life on the news, she is most proud of her motherhood.

I’m not surprised. The complexity of raising children draws upon our instinct, our wisdom, our decision-making, our education, our communities, our families, and our values. Getting our children to adulthood with judgment, respect, vision, and compassion is a enormous task. This job we parents hold demands extraordinary things–and success here is more respectable than any other accomplishment we complete. Parenthood is that important. Parenthood is that precious of a resource.

Katie listed her work to improve cancer screening and raise hundreds of millions of dollars for cancer research “dream teams” as her second biggest accomplishment.

After I did my live colonoscopy we saw colon cancer screening go up by 20%

She briefly discussed the role of epigenetics in cancer prevention and the exciting time to improve health. When asked about all of the work that we see–that public work like reigning on the Today Show for years and the CBS evening news–she said: Read full post »

Aurora Shooting: What We Can Do

It’s almost a relief that it’s summer vacation. For the sake of our children, I mean. The buzz about the horrific, deadening, jaw-dropping news regarding the massacre in Colorado may be slightly less focused at the center of their lives–they’re not congregating in the hall or at recess. Well, maybe. That’s the difference between 1999 and 2012–back when Columbine happened we all watched as television detailed the horrific events of a school shooting and the radio reported on the lockdown and a mourning community—but our children and teens weren’t on Facebook or Twitter or Youtube then. The stories weren’t quite as accessible–they weren’t in our pockets. Now we’re texting and streaming one video after another.

All this bad news takes its toll on us. It endorses the curiosity we have about tragedy and violence and it can trickle into present repeatedly. At some point, part of how we help our children and teens cope is by facilitating digital breaks. Unplug the phone, log off Facebook, and help your children mourn offline, understand how it may affect their plans, and encourage them to reach out for face-to-face support networks.

I agree with the American Academy of Child and Adolescent Psychiatry:

 There are no ‘right’ or ‘wrong’ ways to talk with children about such traumatic events.

The 24-news cycle is amped-up, accessible, and ever-present. It fills us with information by the second & minute, not the hour. Our children and teens learn, hear, and spread responses with unparalleled rapidity. Never before did we consume media and news like we do today. Even daily hours of television viewing are increasing. We’ve also piled our digital time on top of it.  This tragedy seeps into our centers.

After a cafe shooting here in Seattle in June and ongoing mass shootings throughout our country, I think we’re profoundly scared. Our culture encourages and enjoys violence in movies and video games. Shootings are glorified and little babies and children bear witness to death (at early ages) via digital & traditional media and advertising. The NRA fights to keep guns accessible. Politicians have attempted (and failed) to censor conversations about gun safety in the pediatrician’s office. Even today, influential leadership avoids discussions about gun control. All this and then we chat, talk, tweet, stream, and absorb violence with a hunger. It’s just so horrifying that sometimes it’s hard not to watch. We follow along in bed, on the bus, in our cars (!), and during our face to face time with loved ones and family. This news is upsetting and torrential. Many of us are left feeling a bit helpless or vulnerable. So are our children.

Now is the time to be assertive with your children. Listen more than you talk. And maybe commit to turn off your phones as much as you can.

7 Tips To Support Your Children After The Aurora Shooting

  • Hearing about events like the massacre in Colorado makes us feel increasingly vulnerable. Read full post »