Seattle Mama Doc™

A blog by Dr. Wendy Sue Swanson.

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

Spring Cleaning: How To Dispose Old Medicines

April 29, 2016  |  Parenting Post Comment

PharmacySpring has sprung and many of us are feeling that familiar itch to tidy and purge our homes & closets. One more chore to add to the spring cleaning list: clean out your household supply of over-the-counter (OTC) medicines.

Just like the dosing instructions and additional information on the label, the expiration date on the packaging is there for reason. Once a medicine has reached its expiration date, it may not provide the treatment that you need. Smart to refresh the cabinet annually. Now is the time and this weekend, ideal!

To ensure the medicines you take are both safe and effective, keep an eye on the expiration dates and safely dispose of any expired or unwanted medicines. I talked with my friend and colleague, Dr. Suzan Mazor who is an expert in toxicology and emergency medicine about expiration dates and here’s what she had to say:

Drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.”

Traditionally, I counsel families to be really careful with life-saving medicines. Injected epinephrine (for life-threatening allergies) is a perfect example — after expiration it’s less effective. So it’s a MUST to replace those injectors at home and school after expiration as they are used in acute/urgent/life-saving situations (and I’m not exaggerating). Other products like sunscreen are less effective after expiration, too. Not life-threatening but what chore to use it wisely and well and then be using an inferior product. Read full post »

Tips On Avoiding Arsenic In Baby Rice Cereal

April 28, 2016  |  Infant, Parenting 1 Comment

rice cerealWhat we feed our babies matters. No question one delightful and soulful part of raising our babies is introducing the world of solid food. I mean really, it’s hard to describe a competing parenting moment with feeding our children healthy food, at any age. For decades, rice cereal as a first food seemed to make sense but major groups reporting out on only feeding rice with caution. The Food and Drug Administration (FDA) recently proposed new limits for inorganic arsenic in rice cereals (think: potentially cancer causing toxin that is increasingly known to cause harm early in life). Many families start their transition from breastmilk/formula to solid foods by adding in rice cereal. Doing so is convenient, makes for great consistency, but rice cereal is a leading source of exposure to the toxin. Arsenic is an abundant element in the earth’s crust, coming in two forms (organic, inorganic), the inorganic form being tied to bad health outcomes. The reason rice has more arsenic compared with other foods is how rice is grown (in watery fields) and its unique tendency as a crop to absorb the arsenic while growing. Here’s what the World Health Organization (WHO) says about inorganic arsenic:

  • Arsenic is naturally present at high levels in the groundwater of a number of countries.
  • Arsenic is highly toxic in its inorganic form.
  • Contaminated water used for drinking, food preparation and irrigation of food crops poses the greatest threat to public health from arsenic.
  • Long-term exposure to arsenic from drinking-water and food can cause cancer and skin lesions. It has also been associated with developmental effects, cardiovascular disease, neurotoxicity and diabetes.
  • The most important action in affected communities is the prevention of further exposure to arsenic by provision of a safe water supply.

Why are infants particularly vulnerable to arsenic in rice? The FDA says: “relative to body weight, rice intake for infants is about three times greater than for adults.” In their evaluation, they tested 76 different rice cereals and found that 1/2 exceeded the inorganic arsenic limit. Some companies and products are advertising for safety — for example Gerber rice cereal manufacturers announced that their products already meet the FDA’s proposed limits but it will be with time that the food source is changed for good in all products packaged and marketed for babies.

Knowledge about what exactly rice cereal does to babies and their developing bodies continues to unfold but infancy is a time of profound growth and development. Also a time we really want to limit toxins that could change risks. Researchers in JAMA Pediatrics explain: Read full post »

Join In On The Seattle Mama Doc Podcast?

April 22, 2016  |  Doctoring & Healthcare, Mama Doc Philosophies, Podcast 7 Comments

Always a work in progress here — trying to think on ways to share new data, expert advice & enjoy the journey of parenthood. I’m excited to announce we’re going to pilot a Seattle Mama Doc Podcast early next month. Since this blog’s inception in 2009 we’ve covered nearly 650 standard blog posts, vlogs, guest contributors, interviews and now I’m going to test out a podcast. I am a huge fan of crowd sourcing and co-design, so will you help create the look, feel and content of the podcast alongside me? I would love to know what topics you’re interested in, which you’re tired of hearing about, who you want me to interview and frankly, anything else you’d like to share.

My hope is to interview experts and researchers here at Children’s, parents, and patients when there’s interest in sharing the experience of raising children. We’ll include the smarts of friends and peers across the country working on preventing and preventing illness while raising children. We’ll highlight all the tips and tools we learn along the way, new evidence, expert opinion and ideas to feel better about our decisions while raising our children.

I’ve recorded 3 options for the introduction of my podcast (I’m well aware of kind of bootleg smartphone audio quality for these little demos — promise to record high quality content in studio for the actual podcast).

Which resonates and makes you want to tune in?

Tell me what to cover. And also, would you want to join me on the podcast? SAY SO, PLEASE!

Option #1

 

Option #2

 

Option #3

 

Take Me Out To The (Peanut-Controlled) Ball Game!

April 18, 2016  |  Parenting, School Age 2 Comments

ThinkstockPhotos-508446509Having food allergies (specifically to peanuts) might prevent you and your family from attending certain events, but baseball in Seattle hopefully won’t be one of them. The Seattle Mariners are offering 5 “peanut-controlled” games this season at Safeco Field. No peanuts will be allowed in sections 313, 314 and 315 in the view box level during these games. And although fans should note that peanut-controlled does not mean the game will be entirely peanut-free, this does offer a new way to improve safety for children with serious allergies. The Mariners certainly deserve an “Atta Boy!” for this one. (More game information below).

While peanut allergies have doubled in the past decades and are reported to have tripled between 1997 and 2008, they are just one food allergy of the nearly 400,000 school-aged children who suffer from mild to severe reactions if exposed to an allergen. Some food allergies are serious and life-threatening.

One in every 13 children has a food allergy so this isn’t a rare experience for children or their families. How we support our own children and children in the environment, at school, in sports, and at our homes is also changing. We really are perhaps becoming more compassionate and sophisticated (peanut-free tables, thoughtful policies for birthday treats, more open discussions about how best to include children with dietary restrictions). The Mariners games are just a lovely example of how to do things better at scale.

When To Introduce Peanuts To Babies?

Data is still evolving for recommendations for all babies, but about a year ago (March, 2015), new recommendations (comprehensive blog post) were given regarding introducing certain foods to babies. The New England Journal of Medicine found if allergy-prone infants were introduced to peanuts early in life (between 4 and 11 months of age) their risk of peanut allergy at age 5 years significantly decreased. The current American Academy of Pediatrics policy on food allergy introduction (revised in 2008) states there is insufficient evidence to support delayed introduction of potential food allergens to reduce the risk of developing allergies. This means holding back on foods during infancy isn’t recommended! Try introducing things like wheat, egg, soy & fish before 12 months. We’re moving towards not waiting on any foods in late infancy and this data on peanuts is the beginning of understanding creating recommendations to start foods early. More data will help make these recommendations for all babies. Check in with your baby’s doctor with any questions or concerns, especially if food allergies run in the family. Read full post »

Your Children Not Sleeping? It Might Be YOU

April 6, 2016  |  Parenting, The Value Of Sleep 1 Comment

parent sleep

No question sleep — the good and restorative kind of sleep — changes our day. Sleep is tied to our outlook, our mood, our performance, our safety, and our sense of stress/anxiety. We’re nicer people after we sleep. I often say that after a good night of sleep I get to be more of the mom I earnestly want to be. Sleep is magical that way.

Thing is, sleep has a profound effect on our perspectives and attitudes about life. In fact research has found that sleep loss causes bias in our memory — the less sleep we have the more we focus on negative events and the more our memory builds space for memories of the negative details in our life. Yikes.

You know how it is…we all do. You start the day exhausted or you head into work tired, clutching your coffee, trying to rev up for the day. Your child didn’t sleep well through the night and therefore neither did you. Happens all the time, of course and to some parents more than others. You’re wondering (and likely doing some research online) what you can do to improve their sleep. What tricks haven’t you tried? What schedule should you be following? The hidden answer might be the last thing you’d think of …your own sleep.

Thing is, if we didn’t sleep well last night we may be misrepresenting the facts of the night.

A new sleep study published in Pediatrics showed that parents who don’t sleep well may mistakenly believe their children didn’t either. The researchers studied the sleep of 100 2- to 6-year-olds in Finland and their parents. Children wore bracelets (devices called actigraphs that track movement and quantify sleep) for a week to estimate sleep duration and quality while parents kept a sleep diary for their children and filled out a sleep questionnaire. Parents’ age and education were included as relevant variables in a the study as well as the child’s age, gender, chronic illnesses, medications, and number of siblings.

People who sleep poorly overestimate their children’s sleep problems.” ~Marko Elovainio, author of Pediatrics study

Read full post »

New Zika Advice: Sex And Ways To Protect Yourself

March 30, 2016  |  Infant, News Worthy, Pregnancy Post Comment

Zika Test Tube

I’ll continue to monitor and track Zika news to share with you as I learn about it. My inboxes keep filling up with Zika questions even though I think the risks to our families, if you’re not pregnant or not thinking of getting pregnant, is low. That being said, if you’re thinking of having a baby now or in the next 6 months or if you are not using contraception and are sexually active, listen up.

Last Friday, the Centers for Disease Control and Prevention (CDC) presented new guidelines for preventing the sexual transmission of the Zika virus. The news and recommendations regarding transmission and our behavior is evolving and changing rapidly as researchers, doctors and medical experts learn more about Zika. This science is not complete, but these guidelines best attempt to keep our population the safest it can be with the information we have. Here is a short rundown on the new guidelines.

New CDC Updates And Reminders About Zika:

Number one reason for this is that although daytime-biting mosquitos are the primary transmission of Zika virus (in areas with Zika — click here for info and world maps) sexual transmission of Zika has been documented here in the United States after travel/exposure —> infection). As of March 23rd, of the 273 travel-associated Zika infections documented in the US, 19 cases are in pregnant women and 6 were sexually transmitted.

The below info helps shape ways to protect yourself:

  • WOMEN: If a woman has been diagnosed with Zika (or has symptoms of Zika after possible exposure) it’s recommended she wait at least 8 weeks after her symptoms first appear before trying to get pregnant. As a reminder, symptoms of Zika include rash, red eyes, joint aches, overall feeling of being unwell. Secondary reminder, and one that makes this advice a bit of a challenge to interpret, only 1 in 5 who get Zika virus will have symptoms in the first place. Therefore, if we want to be really careful consider this: if you’ve traveled to a Zika-affected area you may want to wait 8 weeks after returning home before attempting to get pregnant, with or without symptoms.
  • MEN: If a man has been diagnosed with Zika (or has symptoms of the illness), he should wait at least 6 months from those first signs of the illness before having unprotected sex. This recommendation comes off news that the virus has been found live in semen 62 days. The 6 months is a conservative calculation.The CDC took the longest known risk period (about 2 months) and then multiplied that by 3 for conservative recommendations to ensure no transmission.
  • MEN WHO TRAVEL AND HAVE PREGNANT PARTNERS: Men who travel to areas with Zika outbreaks need to prevent transmission to pregnant partners for the rest of the pregnancy. CDC recommends: “Men who have traveled to or reside in an area with active Zika virus transmission and their pregnant sex partners should consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) or abstain from sex for the duration of the pregnancy. This course is the best way to avoid even a minimal risk of sexual transmission of Zika virus, which could have adverse fetal effects when contracted during pregnancy. Pregnant women should discuss their male sex partner’s history of travel to areas with active Zika virus transmission and history of illness consistent with Zika virus disease with their health care provider; providers can consult CDC’s guidance for evaluation and testing of pregnant women“
  • The CDC is NOT recommending that that men and women living in Zika-affected regions postpone pregnancy all-together like other countries (think Ecuador).
  • Infectious Disease experts feel that a Zika virus infection in a woman who is not pregnant would not pose a risk for birth defects in future pregnancies after the virus has cleared from her blood (roughly about a week after infection is over).
  • They have also updated their Question/Answer page that is chalk full of helpful information.

Blood Testing For Suspected Zika Virus:

For Men, at this time, CDC advises that testing of exposed, asymptomatic men (men with no Zika symptoms but who have traveled) for the purpose of assessing risk for sexual transmission is not recommended.

For men and for women, regardless of pregnancy status, get tested if you develop two or more of the following symptoms during or within two weeks of travel to an area of active Zika virus transmission OR within two weeks of unprotected sex with a man who tested positive for Zika virus or had symptoms of Zika infection during or within two weeks of return from travel to an area with Zika transmission: Read full post »

No Controversy, No Censorship — When Tribeca Got It Right

March 28, 2016  |  Doctoring & Healthcare, Vaccines 2 Comments

Screenshot 2015-02-01 12.30.40We don’t know what causes all autism but we do know vaccines don’t. Continuing to elevate myth does NO ONE any good. That’s why the Tribeca Film Festival got it right when pulling a documentary written and co-directed by vaccine science villain, Dr. Andrew Wakefield. Giving him another platform and more voice just isn’t insightful. To me it’s more noise and less what we need. There isn’t controversy here and there isn’t anything new to uncover. Allowing Wakefield more air time and the catapult generated by a film festival just ISN’T going to help us perfect parenthood and it won’t improve our jobs protecting our families, our children, and our communities. The Injustice of Immunization Interviews continues…

Tribeca Film Festival And Vaccines:

Wakefield is a doctor whose work connecting vaccines to autism was retracted from a medical journal (this is nearly UNHEARD of) and a doctor who lost his license to actually practice medicine. He’s not respected nor is his work something for us to learn from. His work may go down as one of the biggest frauds in medical history. Read: Wakefield’s article linking MMR to autism was fraudulent.

The science, on the other hand, is clear and well established. Vaccines have repeatedly and repeatedly been studied with respect to development of neurodevelopment changes and diagnoses on the autism spectrum. Don’t believe the preposterous things the politicians say. The 2011 comprehensive and enormous report from The Institute of Medicine analyzed over 1,000 studies on adverse side effects from vaccines. They concluded, “the evidence shows there are no links between immunization and some serious conditions that have raised concerns, including Type 1 diabetes and autism.” (read more here)

Ongoing research, motivated primarily because of the distrust and fear for vaccine safety propagated in movies, media, and documentaries alike continue to find the very same thing. Science continues to come out on the side of vaccines. Vaccines have adverse effects (fever, pain, seizure, and fainting, for example) but not autism. Read full post »

Candy Or Medicine? Safe Medicine Storage

March 25, 2016  |  Parenting, Toddler 1 Comment
candy or medicine

Image c/o Strong Health

The role parents play in poison prevention is paramount. The above image shows just how easy it is to confuse medicine with candy. Especially if we message this improperly. When my boys were young I started calling liquid medicines “yum-yums” in an effort to get them to take acetaminophen or other medicine easily only to realize as I was doing it I was advertising the wrong thing…totally novice move as a mom and pediatrician. Clearly as parents we’re always a work in progress.

Safe medicine storage is one of those obvious things we feel we have under control. But numbers for accidental ingestion in the US prove we don’t. Young children are earnestly dependent on us doing this better.

Check out the above image — the packaging of medication earnestly isn’t any different to most of us than the packaging for candy. Imagine a 3 year-old trying to differentiate between the two in a moment of discovery. Pretty easy to imagine a 4 year-old stumbling upon a skittle and seriously impossible to imagine them over-riding their curiosity to explore/enjoy with their mouth. Chances are, that medication/skittle is going into their mouth.

Medication storage isn’t just for your typical over-the-counter (OTC) medications. With our households changing and many people coming though them, we have to think about prescription medications, liquid nicotine, marijuana and household products that all need to be up and out of reach. To that end, safe medicine storage is an important part of family and household safety. This week is National Poison Prevention Week so the perfect time to perfect our homes a little more. This includes any home your child plays in or stays in. Read full post »

One Image Of Parenthood

March 9, 2016  |  Mama Doc Philosophies, Parenting 1 Comment

Usually I arrive here to write and share things that might help. I mean, my hope as a mom and pediatrician is to elevate research, share vulnerability, toss out the irony in the isolation of ideas trapped in an ivory tower and bring in hope for more understanding. I’m usually here to share because I believe if we swap ideas through narrative we all move towards calm and confidence or knowledge and skill as parents, caregivers, adults, children, and partners.

But today I’m just here at my kitchen counter wanting to share an incredible image. Just wanting to make sure you’ve beheld it, too. I haven’t read a single word about the image and I will keep it that way. I don’t want others’ ideas or personal narratives or their agendas to taint what I see. And my hope here is to do the same for you.

All I can say is that for me the image is a triumphant, loud reminder of the immense privilege, the singular honor, and the wired intuition we hold when we get to parent a child. I mean life happens. In all its messy truths and horrific pains, mistakes and brilliant saves, and in our jubilant discoveries and the small gifts given every…single…day. But there was moment this past Saturday, captured by a lens, that explains so much about what and how we fear, what comes flying at all of us on Planet Earth, and what we can truly handle.

Enjoy this photo worthy of a long stare. I get lost in it.

HPV Vaccine Decreases HPV Infections!

March 1, 2016  |  Teens, Vaccines 4 Comments

Great news about reducing cancer risk. Nothing controversial here…

There is early evidence from a recent Pediatrics study that the HPV vaccine is doing what it was intended to do: decrease the rates of HPV infection in teens and young adults. The study compared HPV in two groups of teen girls and young women–one group during a time prior to the vaccine being used (pre-vaccine era 2003-2006) and another group of similar girls and young women after the vaccine’s introduction (vaccine era 2009-2012). They evaluated prevalence of HPV infection in both groups (from cervicovaginal swabs) to see the effects of the vaccine on the population. The DNA tests from those swabs identified evidence of HPV infection from HPV strains that have been included in the vaccine and also additional strains of HPV infections not previously in the vaccine. Researchers also had information about the girls’ self-reported vaccine status and behavior (sexual activity).

The results are exciting and hopeful when it comes to protection from HPV vaccine.

The study shows a 64% decrease in HPV strains found within the vaccine in immunized girls ages 14-19 and a 34% decrease in HPV in girls ages 20-24 who had received the HPV shot. In my opinion, there are 2 big takeaways to this progress and learning:

  1. The vaccine is effective in protecting teens from acquiring HPV, especially so during teen years. When the shot was given in younger teens they were more likely to have better protection — likely because they are immunized early and thus if/when exposed to HPV infections during their life, they were already protected.
  2. The earlier the HPV vaccine is given, the better the hope for protection against HPV during teen and young adult years. No safety benefit in waiting to be immunized — the risks are the same from the injection but waiting allows more time when a teen could be exposed to HPV. The data out last month may also reflect previous research that the immune response is better when the immunization is given to younger girls and boys (age 11 for example, over age 16 years).

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