Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

5 Rules For Dosing Medicines For Colds And Ear Infections

In clinic the last couple of weeks I’ve been reviewing medicine doses with families for common over-the-counter (OTC) medicines repeatedly. It’s the time of year when goopy illness comes into our homes and is chased by fevers and aches and discomfort, screams and coughs, and overall gloom. Sometimes the goop turns to things that cause bigger pains (ear infections, strep throat & influenza) that have bigger solutions. But most of the time these gnarly colds just disrupt our lives and our holiday harmony and then go away thanks to the magic of our immune system. No question the holidays gather us together but those Whoville-Circles-of-Love also have us exchanging common colds like nobody’s business. We all wanna make the symptoms from colds go away, especially in our infants and toddlers who just can’t explain how they feel and seem to have their sleep disrupted in wildly unfortunate ways. Obviously, there aren’t a bunch of wonder drugs out there for these wintertime illnesses. But there are some lovely solutions that do help our children feel better (acetaminophen and ibuprofen — tah dah!)…

5 Things To Know When Using Medicine From The Drugstore:

  • Less Is More: My key takeaway for using OTC medicines is that often, you don’t need them. Don’t ever treat the thermometer. If your sweet human is bounding around the living room playing Twister and she feels warm to touch and you then confirm she has a fever with her sniffles (the thermometer reads 101.7 degrees) you don’t need to reach for acetaminophen. Keep her hydrated, have her cover her cough (yes, please!), make sure she gets rest so her body can do the dirty work of clearing out the infection. The acetaminophen should be used when she’s achy, not feeling well, or not wanting to be herself because of overall yuckiness. Treat your child, not the thermometer.
  • Pain Medicines For Ear Infections: Without question the most important medicine for most ear infections are the OTC medicines (acetaminophen and ibuprofen around the clock for the first 48 hours of an ear infection). After age 2 year, most children won’t need antibiotics — and most can avoid them and their side effects — if given time to heal. But the best bridge to getting there is making sure you take away the pain from those infections. More information about when to treat ear infections with antibiotics here.
  • Cough and Cold Medicines Only For School-Age: I think parents to infants and toddlers are desperate for solutions when their babes are unwell because of the profound amount of disruption a nasty cold virus brings to their life. Anyone who blows off the degree of ick of a 17 month-old with a bad cold and cough who isn’t sleeping nor eating and is coughing and choking and vomiting hasn’t parented one in a while. But quick reminder that not only are cough and cold meds not helpful in young children, they can be dangerous. Reach for a teaspoon of HONEY before anything in the medicine cabinet (as long as your little one is over 12 months of age). Research from 2007 found that honey has been found to help reduce nighttime cough better than OTC remedies.
  • Dosing Device: This time of year all sorts of people want to “baby” your baby. Grandma, Cousin Judy, whoever. Make sure someone isn’t dosing the medicines with the kitchen spoon. Use the dosing device that comes with the bottle of medicine always.
  • Weight Over Age Dosing: Always dose medicine by weight not age in young children. Here’s a dosing chart for acetaminophen and ibuprofen that includes doses for children under age 2 years. Here’s another version of acetaminophen and ibuprofen dosing that is easily downloadable! Print it out, keep it in the kitchen cabinet where you store your medicines. Call your pediatrician’s office if ever concern about how and when to dose. Those are never silly calls. Even if some jerky, tired, on-call provider makes you feel that way (I’m sorry if someone does). But it’s true, those are never silly calls if you’re confused or unsure.

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Mumps! What To Know During An Outbreak

There is a mumps outbreak here in Washington State, as well as various other outbreaks across the nation. The CDC reports that mumps infections are currently at a 10-year high. This post is a quick update on the outbreak and why they occur, an explanation about the mumps virus, the infection and symptoms that are typical, and what parents should know now to avoid mumps.

Mumps Outbreaks In 2016

  • Numbers This Year: For the calendar year 2016 through early December, 46 states and the District of Columbia have reported a total of 4,528 mumps infections — well more than double the mumps cases reported in 2015 and creeping up in ways similar to 2006 when we had the last big mumps year. That outbreak was primarily housed in the midwest among college students.
  • Mumps In College Students: In general, we often hear more about outbreaks on college campuses in part because of students living in close quarters. Mumps is easily spread when those are in close contact who share cups, talk closely together and share respiratory droplets more readily. The intensity of these environments allows mumps to spread more rapidly and it’s also possible that during college some students have lost immunity from the vaccine they received as a child. In general college students are at higher risk because of how they relate. I love how CDC details the conditions, “certain behaviors that result in exchanging saliva, such as kissing or sharing utensils, cups, lipstick or cigarettes, might increase spread of the virus.”
  • Washington State Outbreak: As of 12/23/16 there have been 101 cases in King County (cases updated here by the Public Health Dept). In total, 32 cases are confirmed and 69 probable with additional cases under investigation. The majority of cases are in children under age 18. Some 65% of those cases are in people who are reported as up-to-date on Measles Mumps & Rubella (MMR) vaccine. This occurs in part because although the MMR vaccine works well, it still will leave some vulnerable to an infection if exposed. The MMR vaccine provides protection against mumps to about 88% of us after we get two shots, so it consequently leaves more than 1 in 10 of us vulnerable during outbreaks. We typically don’t know who is in that 12% so during outbreaks we make sure students are up-to-date in immunizations and those with suspicious symptoms are seen, diagnosed, and while infectious, they stay home.
  • Schools Send Children Home If No MMR Shots: The outbreak has been of big enough concern that The Auburn School District told more than 200 non-immunized students to stay home so they wouldn’t get the virus and go on to infect others. Public health officials sent letters to the students’ homes saying kids would only be allowed back once they had proof they’ve received the MMR vaccine. Otherwise, the students will be kept from school for at least 25 days after the last mumps case in the Auburn district.

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One Mom Shares Her Story: It’s Not Just the Flu

serese-families-fighting-fluThanks to Serese Marotta, Chief Operating Officer, Families Fighting Flu for sharing this vulnerable and truthful story about losing her son to influenza. Talk about gorgeous peer-to-peer health care. I hate that this story exists and yet I’m so thankful for Serese’s bravery in sharing it. May we all benefit from her experience and her wisdom ~ Dr. WSS

So often we hear “it’s just the flu”, but we need to take the flu seriously. How do I know this? Because my healthy, 5-year-old son, Joseph, lost his life to H1N1 flu in October 2009. I have always been pro-vaccination and Joseph and his sister received their annual flu vaccinations in September 2009, but H1N1 wasn’t in the vaccine that year. Sadly, the H1N1 vaccine didn’t become available in our community until two weeks after Joseph’s death.

Joseph’s Story

Joseph’s story began innocently enough. He was attending kindergarten in the fall of 2009 and threw up on the school bus. Later that day, Joseph continued to throw up and became increasingly lethargic. We called our pediatrician who suggested we take Joseph to the local urgent care. Upon arrival, they found Joseph’s blood oxygen level to be very low and immediately transported him to the local children’s hospital. The rapid flu test came back negative and Joseph was eventually diagnosed with pneumonia.

Several days into his hospital stay, the doctors informed us that Joseph’s culture was growing influenza, which was likely H1N1, but not to worry—it was “just the flu” and they’d start him on antiviral medications. Joseph’s condition over the next several days was relatively stable. Various specialists came and went; all of Joseph’s tests appeared normal and we were even discussing his discharge with the doctors. All of that changed on the ninth day of our hospital stay. Joseph’s blood pressure suddenly plummeted, and we were sent back to the ICU. The doctors couldn’t really figure out what was causing Joseph’s low blood pressure, but they didn’t seem overly alarmed. More testing went on throughout the night, while I tried to distract Joseph with cartoons and discussions about his Halloween costume.

The doctor came to me early on the morning of Oct. 18 to say she wanted to put Joseph on a ventilator because his heart and respiration rates were so high and his little body needed a rest. The doctor emphasized it was not a big deal, but Joseph would be unconscious while on the ventilator. I calmly called my husband, who was at home with our young daughter, and asked him to come to the hospital. Minutes later, while I was standing next to Joseph’s bed, he suddenly coded. The next scene was like something on a TV show—doctors and nurses rushing into Joseph’s room. I backed into the hallway so they could do their job, but honestly, I had no idea what was happening. As the minutes ticked away, I began to realize that something was seriously wrong. I continued to wait outside Joseph’s hospital room and finally, the attending doctor came to me, sobbing, and asked me to follow her into Joseph’s room because she needed me to talk to him. Looking back, I think she thought if modern medicine couldn’t save this child, perhaps the sound of his mother’s voice could. I entered Joseph’s room and held his hand as the doctors and nurses continued to work on him. Finally, the doctor turned to me and said “I’m so sorry.” My precious son lost his life to influenza that day, and my life was irrevocably changed as a result.

My story is not unique. I have met many parents who’ve lost a child to the flu or had a child suffer serious medical complications as a result of the flu. I want parents to understand how critically important it is for all children and their families to get their flu vaccinations each and every year. The flu vaccine is the best protection we have in our fight against influenza. The Centers for Disease Control and Prevention (CDC) recommends annual flu vaccination for everyone six months of age and older. I also want people to understand that getting an annual flu vaccination not only protects you and your family, but it also helps protect others in your community by limiting the potential for an outbreak. Read full post »

Vaccination Nation: How Healthy Is Your School?

aap-vax-mapFrom the moment we become parents, we work to keep our children’s environment safe. We child-proof our homes and make sure poisons and dangerous objects are secured wherever our kids spend time. But we aren’t always as diligent about making sure the community spaces where our children learn and play are protected from threats we can’t see, like infectious diseases.

Just this fall there was a vaccine-preventable disease reported in my son’s 2nd grade cohort. When he started kindergarten a couple years ago we were told the class was 100 percent up-to-date on immunizations, so I got done worrying about things like exposures to chicken pox, measles and mumps from his classmates. We know vaccines aren’t 100 percent protective, of course, but I took stock in knowing that his class of children was protected as best they could be.

So, when I heard about the case of chicken pox, it reminded me I needed to check back in. Read full post »

That Could Have Been Me: When An 8 Year-Old Knows She Belongs

harry-potterDuring carpool recently I witnessed an 8-year-old realize her relevance and her sense of belonging even more than before. What a total profundity. It happened by accident and this involves J.K. Rowling…

It’s my belief that getting a child to understand their import is a hope housed in almost every parent, teacher, auntie, or grandfather. When those of us, even peripherally involved in a child’s life, witness a child discovering their capacity, import, potential, and connectedness the moment can be immense. I don’t think I’m overstating this.

Everyone wants to feel they are capable. Everyone wants to feel they belong. We learn and see and feel our connection in infinite ways.

You’ve probably read a lot about parenting your children more with a focus on “grit” than with a focus on accomplishment. I think most of us can all agree that perseverance and a steadiness in keeping a “can-do” attitude is far more important for survival and for joy in life than any accomplishment we’ll ever have. In fact it’s in our failure that we perhaps find ourselves feeling more connected and less alone.

The best moments we have with our children are therefore neither about grit nor honing success — they are typically about presence. Being aware of the sincere vitality in being alive together and a part of when our children grow, delight, see, or be seen is a thunderous thing. The moments when it happens are hard to contain in our heart, no matter how big it is.

Working to cultivate grit is certainly a meme in the perfect-parenthood swirl of advice this decade. Working to extend yourself so you fail is something all of us want to do when we think about tapping into our true potential as workers, mothers, fathers, sisters, brothers, and community members. But it’s hard to push to fail and sometimes, as odd as it sounds, it’s hard to fail well.

Sometimes failure happens because we’ve stretched ourselves too far. Sometimes, of course, it is the external factors that bring failure. Most of the time it’s a combination of the two. Sometimes we learn about failure through our own experiences as we stumble and then heal our own scars.

Connectedness, togetherness, and the capacity to contribute to things greater than ourselves will always be foundational for humans. Every day should be about building more and more of this entanglement with each other, with those that we love, as best we can.

So back to that day carpooling. On the way to school, my car full of delightful school children, we got talking about about the Harry Potter series and specifically J.K. Rowling. I mentioned that I remembered hearing she’d submitted her book, “about 7 times before a publisher had accepted it” and now she’s the author that has sold books faster than any other human on earth. When I realized I wasn’t certain about my facts, I did something I DON’T typically do. I asked my 10 year-old to grab my cellphone (!!) and look up the real story of J.K. Rowling and her attempts to publish her first Harry Potter book.

He used wiki, then he used a search engine and landed on a version of the story. At this point we’d parked at school and so an 8 year-old now was leaning over his shoulder helping interpret what he was reading online. Curiosity was abloom.  The children found this explanation: Read full post »

HPV Vaccine On Time: Only 2 Doses

hpv-2-doseWelcomed news out this fall about immunizations. If children and teens get their HPV vaccine on-time between the age of 11 and 14 years, they won’t need to do 3 doses as previously recommended. HPV vaccine given, starting at age 11, can be just 2 doses now, spaced 6 months apart! Celebration.

This new HPV shot recommendation from the CDC is based on research that has found when younger children are immunized, their immune response is greater at younger ages (age 11 versus age 16, for example). It’s also based on data on durability of the vaccine response — data has found teens immunized in the “tween” years continue to be protected years and years after the vaccine is given. So don’t wait to get teens immunized! In fact, waiting isn’t safer in any way, just leaves your child open to exposure for a longer period of time and the vaccine has the same side effects (most notably pain at the injection site!). Plus, you’re now reducing the amount of shots your child needs from 3 –> 2. Huge win!

The hope in this new recommendation is three-fold: more teens will get immunized on-time, they’ll be better protected from HPV infections and cancer risks early, and it will be easier to complete the entire series. Last year, for example, about half of boys ages 13 to 17 had gotten at least one of the recommended three doses, while about 63 percent of girls had gotten at least one dose, according to the CDC. However, not all teens finish the series and the new recommendation may help. In some areas only about 1/3 complete it.

HPV vaccine is an anti-cancer vaccine.

If your child has started the HPV series but not completed it, there is no reason to re-start the series — those shots still count. Just schedule a visit to finish what they started. If your child is between age 11 and 15 and there has been 6 months since their last HPV shot, under the new recs they will only need one more dose.
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5 Ways To Fight Loneliness

img_1673It seems to me that some of the greatest suffering in life comes with loss. Loss has all sorts of shapes and various hues of intensity. Comparing one loss to another in unlikely to ever do anyone any good. What feels big to someone you love IS big. For you, for your children, for your mom, or for your friend. Perspective shaping is important at times but acknowledging pain in loss is tantamount. Losses we feel can be immense (the loss of a person’s life) or obscure (the loss of personal direction) or even simply burdensome (where are those *&$#-ing keys?!?!?). We humans, including our little ones, feel worst when we’re disconnected, when we feel we’re somehow disorganized with our community and don’t belong, or when we are enveloped with a sense of loneliness.

Bullies know this well, of course, in part because of their own isolation. But so does everyone who has ever felt love. Being lonesome is agonizing.

Loneliness is bad for your health. In some research it’s on par with the effects of obesity and heart disease, injuries or violence.

For some, holidays are like blood-letting when it comes to loneliness. When any single one of us suffers we all lose a little. Those of us who are feeling disconnected will only sense and experience solitude with greater fervor as families, groups, friends and co-workers join hands to celebrate this time of year. Look around and imagine.

Or think about a starling murmuration and its beauty. It’s the choreography that makes it a thing of elegance but it’s also the intimacy in knowing that all those birds fit — all of them have a dependence and place with each other. Those little birds feed on both the single bird next to them but the group, en mass, too. I have to think they feel they belong as they twirl in the sky and progress across it. They give to and take from the group. And it reminds me that those outside of the murmurations typically want in.

We can all make this better for ourselves and for those around us. As we ready to step earnestly into December, I say we do more for each other this month. Counteract the forces and gravitational pulls of loneliness and isolation around us. Teach our children they can help, too. At dinner tonight and tomorrow maybe bring it up?

5 Ways To Fight Loneliness

  1. ONE: We can talk with our families about who we could invite to our homes, to our parties, and to our celebrations. Just imagine making a goal to invite one person into your fold you may not have thought to include. Just one person to one day or one event you wouldn’t have thought to include before. Even if they don’t typically don’t “celebrate” what you do. Make an invitation to someone by Friday, December 2nd.
  2. TWO: If loneliness seeps into you on any of these days, grab your bearings by turning off the noise of the murmurations around you. I think of this in terms of making sure you don’t stare at the masses. Turn off social media for 12 hours (or 3 days!) and immerse yourself in something you love. Be fastidious with yourself — put the devices down or turn them OFF if they lead you only to those murmurations and inclusions you don’t feel a part.
  3. THREE: Practice gratitude. This can be brisk and powerful in the face of loneliness. Write a quick thank-you note this week or jot down in a journal 3 things for which you’re thankful every day, for a week. The minute you elevate those around you in import is the same minute we feel truthfully happier.
  4. FOUR: If you sense someone around you is lonely, call. Don’t just text. If they don’t pick up the phone, call again. Invite them to a quick walking meeting, coffee, or lunch. Just do it.
  5. FIVE: Get a good night’s sleep. However banal that sounds we know sleep deprivation has us look at the world with cloudy lenses. We also know it even has us remember improperly (we color our memories negatively when sleep deprived). I seriously believe we all feel less alone after 7 to 8 hours (more for children!) of sleep.

Get Rid Of Constipation In Children

Children's legs hanging down from a chamber-potConstipation is really, very truly, no fun for anyone. No fun for baby or child, no fun for the parent who worries and watches and cleans the clogged toilet, and clearly nothing wonderful for the sister or brother who waits while a family supports a child in the room next door. In general, constipation is a frustrating, sometimes hugely embarrassing, and often a chronic problem for young children. In my experience, parents worry a lot about hard infant or toddler poop in the diaper (goal is always peanut butter consistency or softer) but it’s when constipation sneaks up on many families in school-aged children that BIG suffering ensues.

I can’t say this loud enough: if you’re worried about constipation in your child do consider seeing your pediatrician, nurse, family doc or physician assistant to make a long-term plan. Constipation DOES get better but do know it’s over weeks to months. When your child’s intestinal tubing is stretched out for weeks it takes weeks to re-configure sometimes — quick fixes won’t be long term solutions. More below on which remedies to use and how.

Constipation sneaks up because after children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl so gone are the days of tracking daily poops. Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop (below). I usually break this down for children (and parents) in visual terms. I talk about things you find outside:

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet? Or at least a report?

Lots of foods, hydration and OTC medicines can quickly change the game with constipation. Before I detail more specifics on constipation and highlight some remedies, I do want to call attention to some potential concerns of polyethylene glycol (PEG 3350). The medicine PEG 3350 is an odorless, tasteless laxative that can be easily diluted in juice or water. It’s a big polymer and can’t be absorbed by the intestine so it works by binding to water so that water ingested can’t leave the intestines, colon, and rectum. The great news is it doesn’t cause cramping or more pain and isn’t addictive. Used daily (often for days or weeks) the powder binds to water and disallows the colon to dehydrate the poop so it just doesn’t get hard. Therefore the poop that comes out is soft and often helps produce less painful pooping — and often it comes out more often! It’s commonly sold under both brand (Miralax) and various generic names. However, the Food and Drug Administration (FDA) has only approved its use in adults, not children. Currently, PEG 3350 is being studied as well as the bi-products of PEG 3350, specifically ethylene glycol (EG) and diethylene glycol (DEG), to determine whether it might be absorbed by children and whether use of the laxatives is linked to development of psychiatric or neurodevelopmental problems. The New York Times has done 2 stories on this topic: one in 2012 and one more recently in 2015, both worth a read if you are debating giving your child PEG3350. For children and families with severe constipation often the benefits of using it far outweigh the concerns.

What Is Constipation And Why?

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Give Children Probiotics When Taking Antibiotics

Probiotics are a little bit the rage these days. The more we learn about the microbiome (all the bacteria that happily live in and on us to support digestion and immune function), the more we learn we want to preserve them. Probiotics are supplements (not medicines) so the data on their use is in the early stages but taking probiotics while taking antibiotics really does make medical sense. New data out in JAMA Pediatrics makes this more compelling. Taken orally, probiotics re-populate your gastrointestinal tract with “good” bacteria to help aid in digestion — so using them at the time you are taking antibiotics for an infection may help alleviate side effects like diarrhea that result after the “good” bacteria are killed off.

Antibiotics are the most commonly prescribed medication to children yet estimates show that 1 in 3 to half of antibiotics prescribed are unnecessary. Typically that means that antibiotics are prescribed when they won’t do any good for a viral infection or when a child will recover from an infection without intervention. Trouble is, antibiotics kill BOTH the good and bad bacteria in our bodies. Sometimes this is necessary when it comes to treating things like whooping cough, strep throat and urinary tract infections, while others it is not (colds, bronchitis and fluid in the ear). Of course in addition to using antibiotics more than we’d like to, antibiotics also cause side effects like: diarrhea, abdominal cramping, hives and nausea.

The estimated incidence of antibiotic-associated diarrhea among children is 11%  among outpatients and 21% among inpatients — Probiotics and Prevention of Antibiotic Associated Diarrhea in Infants and Children, JAMA Pediatrics

The recent JAMA Pediatrics  clinical synopsis (summary of a larger Cochrane review) provides us new insights on how we can help children who may be struggling with side effects caused by antibiotics. The study found that providing children with probiotics during antibiotic use can reduce both the chance of diarrhea and the number of days it lasts. Probiotics are live bacteria and yeasts that can help replenish the bacteria in our guts that antibiotics kill. Probiotics often come in capsules you can open up in your children’s food or bottle or they come in packets you can sprinkle.

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New Data And 10 Ways To Reduce SIDS And Suffocation Risk In Babies

Mommy-copy-e1273260009105Any parent to a newborn worries about Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID) and what they can do to prevent it. SIDS deaths are unexplained while SUID deaths in infants are secondary to things like suffocation, entrapment, infections, or trauma. The new recommendations take research on all of these risks into account and are specific to guide parents to reduce risks for SIDS and sleep-related suffocation, asphyxia, and entrapment among infants in the general population.

I’ve been interviewed a lot lately about all the fancy new baby trackers, monitors and even smart cribs available to the public being marketed as SIDS reducers. These are not the answer to safer sleep — no data to prove it. I’m a digital enthusiast but it doesn’t change my concern that these devices are entering the market out of the place of fear, not science for improved safety. I think we have to acknowledge that these trackers might amp and rev up anxiety more than they will decrease it in some parents.

What we CAN do to decrease risk of SIDS is follow new research-based guidelines published this month from the American Academy of Pediatrics (AAP) to reduce the likelihood of SIDS and suffocation. This new set of guidelines are updates to the 2011 recommendations, some being similar, and others a bit different. Big changes from my perspective are the stronger recommendations for pacifier use in infants, the strong recommendation against feeding babies in the nursing chair at night, and the ongoing urging to have your babies in BARE, BORING, BASIC sleeping environments in a parents room. Pillows, blankets, bumpers, and stuffed animals are cute but not safe for infants under 1 year of age. Where we feed our hungry babies in the middle of the night matters, too. The recs out this month help define ways to do this with more confidence you’re reducing risk.

“Parents should never place the baby on a sofa, couch, or cushioned chair, either alone or sleeping with another person. We know that these surfaces are extremely hazardous.” ~Rachel Moon, the lead author of the new guidelines and professor of pediatrics at University of Virginia School of Medicine

10 Ways To Reduce Risk Of SIDS And Suffocation

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