Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

6 Tips For Successful Shot Visits

Getting shots, or the pain and fear associated with them, is one frustrating association children have with seeing their doctor. There are some ways to make this better. Diminishing shot anxiety is a huge goal for parents and pediatricians. If expectations are clear, everyone can leave a visit after shots feeling more successful.

  1. Prepare: Do your best to prepare yourself for a visit where there will be shots. Bring your husband/wife/partner, friend, or relative with you for support. If you act or feel nervous, your child may pick up on this. Even infants pick up on nervous cues. It is well known that parental behavior influences the amount of pain and distress from shots. In one 1995 study, 53% of the variance in child distress during immunizations was accounted for by maternal behavior. Geesh! So, if you’re freaking out, your child may be influenced. A Pediatrics review article in 2007 found that excessive parental reassurance, criticism, or apology seems to increase distress, whereas humor and distraction tend to decrease distress. First shots for new parents are often nerve-wracking. Layer your support and tell your pediatrician you’re nervous so they can provide reassurance and support. Bring a new toy for your child, plan a joke ahead of time. Scripting may truly help.
  2. Distraction: Use distraction whenever possible. Squeeze your child’s hand during shots, sing songs together, blow on your baby’s face, or talk about plans you have later in the day during the injection. Discuss your favorite spots or places you’ve been together. Also, consider the “cough trick.”  A study in Pediatrics out earlier this year found that children (age 4-6 and age 11-13) who were coached to cough during the injection experienced less pain from the shot. Read full post »

Understanding Immunizations

It’s my true fortune that I spend the majority of my days with children–my patients and my own. But as a mom in the year 2010, I find I worry a lot. As a pediatrician, my job is to reassure. My experiences with these divergent, and then entirely interwoven roles, converge at one issue in particular: immunizations.

The reality is, we live in a vaccine-hesitant world. With my patients, my friends, and even my family, I hear many myths about vaccines. I hear truths, too. Mostly, I feel and witness worry. When it comes to getting shots, most everyone wants to know a little more. There’s no doubt that the things we read online and in the paper, or the mutterings we hear on the news and in line at the grocery store, have left us frightened about immunizations. I remember the fearful stories more than the reassuring ones. Don’t you?

Despite this worry, I believe that alongside the challenge of overweight/obesity, hesitancy about shots may be the biggest issues facing children, parents, and pediatricians today. I spend more minutes (hours) per day with vaccine-hesitant families than I ever imagined I would. So this is a part of my every day. But hold on a minute, this is not a post about the “rights” of doctors or vaccines or the “wrongs” of another group. This is a blog post to help illuminate your right to earnest, research-based information regarding immunizations. You need to have compassionate care rooted in scientific evidence; you need to know what science holds. What I mean is, you have a right to really understand why doctors recommend immunizations.

Vaccines are discussed nearly everywhere by nearly everyone. As a parent, be selective about what you read and with whom you discuss these issues. Not everyone at the water cooler has expertise in this area. And not everyone understands the enormity of the issue, let alone the repercussions of their advice. As the wise say, “Don’t believe everything you think,” either. Read full post »

Traditions (At Halloween)

I’m big on creating traditions. Wish I had more of them, actually. If Halloween was a day to make resolutions, I would pledge to increase my family traditions. But I’m mixing holidays like metaphors…

Children thrive when expectations are fulfilled (think routine, routine, routine); and traditions can be cement in the routine mold. There is something lovely about repeating an activity to mark the importance of a particular day or particular time of year. I mean, this is what birthday celebrations are all about.

Both of the boys’ birthdays are coming up in the next few weeks. Because of Maryann’s (see her comment) contribution to the blog a couple weeks ago, I’m starting the new tradition of kissing the boys at just the moment they were born. A virtual stamp of time and place. Driving to and from work this week (my down time), my head kept returning to thoughts about the new tradition. A big, wet smoooch that I’m giddy about it; it seems an entirely intimate tradition. Now I’m just sitting around waiting for 1:18pm and 3:11pm to roll around. Maryann, thank you for the idea of this symbolic tradition. I figure his tradition can also serve as an insurance plan, too. I will be exactly where I want to be in those birthday moments: with my boys. Read full post »

Faltering

So we don’t have our nanny today. This was intentional, a way to carve out some time with my boys. Our nanny hasn’t had a week day off in months and months. All well and good except I needed to finish a blog post and a letter I’m writing for an advocacy effort. F is at school. O went to music this morning with Grandma. And nap time (now) was supposed to be used for writing. Oh how I expect the plans to work….I am working on finishing a blog post on traditions, and the one I keep promising on booster seats.

But O isn’t napping today. I think it’s the first day in the history of time that he has skipped his nap. He has a crummy cold, he’s markedly congested, and has a barky cough. He is mouth breathing because he has so much snot in his nose. Subsequently, he keeps awkening and then screams and cries. I’m back up in my office just now after my third attempt to rock him back to sleep. But I’m faltering. I know, I mean I know, that if I gave him that pacifier back, he’d konk out and sleep. Despite the effort to keep him as comfortable as possible: 1/2 tsp of honey before nap (to dimish cough), the humidifier running (dimish cough/humidify his nasal airway), and his comfy jammies for nap, I am missing something. In the puzzle of life, I know that pacifier would fit perfectly.

Of course, it’s the small picture solution and a wreck for the big picture (successfully weaned pacifier). Doing my best to take my own advice. But it got me wondering, have any of you gone back on your pacifier plan and given it back to your child in a moment of “weakness” for care or comfort? What happened? Am I right when I say it will be harder to wean the next time? Share.

I need some support before I go rummaging through the shelves/garbage/pockets in search of that pacifier…

If It Were My Child: No Teething Tablets

On Saturday, the FDA released a recall of Hyland’s teething tablets. The recall stems from concerns for increased and varying amounts of belladonna, a toxic substance that could cause serious systemic effects to babies. It’s unclear how much belladonna is found in these tablets normally although it is well known it’s in them. Recently, infants have developed symptoms consistent with belladonna toxicity after using the tablets (change in consciousness, constipation, skin flushing, dry mouth). Homeopathic supplements and medications are unregulated and therefore it’s hard to know what is in them, how consistent one bottle is from the next, and how different brands of the same products compare. Local and national poison control previously deemed teething tablets safe even though it is known that they have trace amounts of belladonna (and possible caffeine). The FDA states it is “unaware of any proven clinical benefit from the product.” Because of safety concerns and no known benefit, I’ve always recommended against using teething tablets. If it were my child, I didn’t, and would not use teething tablets. If you have these at home, throw them out. Here’s some FDA tips of safe disposal of unwanted medications. If your child has had these tablets in the past, there is no reason to worry. Ill effects would have been seen soon after using them.

Some Teething Truths:

Sitting In A Circle

Working-mom-struggle bubbling up. Work life balance. Feels like I’m sitting in a circle; there’s no corners to hide out in. Problem is, this circular spot happens about every 7 days. It’s Thursdays I’m talking about.

This Thursday I was away from home for 14 hours. I left for a talk before the boys awoke, and arrived home well after bed time. During those 14 hours, I was able to hear an incredible talk by Perri Klass on reading & advocacy via the Reach out and Read program, I completed a long day of clinic and saw over 25 patients, I completed an interview with a potential medical assistant, and I had two 30 minute commutes. I am really glad I had those opportunities. For one patient and his mother, I wouldn’t have missed the day. Hands down, good decision to go to work. But these long Thursdays eat away at me. Intellectually I understand trade-offs in life exist (duh). I understand with opportunity comes losses (duh). Despite this acknowledgment, I seem to go through an emotional evaluation every week. Something about Thursdays seems an utter failure on a personal level. A day starting and ending with zero time with my children seems simply preposterous. Outside the scope of travel, having a day go by on planet earth without a glimpse of my children, while coexisting in the same home, seems a minus. My motherhood isn’t supposed to look this way. Yes, I know mothers leave and travel; I know children divide time between parents. I know plenty of parents work harder and longer hours than I do. I know many other mothers and fathers carry more than one job. I remember my co-residents with children (while in training) left their homes for upwards of 30 hours at a time, every week. Yet every Thursday I feel this 14 hours-ish toll. Even though I know my kids endure these long days well, I don’t. The balance between our time at work and our time enjoying our personal lives remains tricky. Read full post »

Coffee

Iron For Babies & Toddlers


This month, the AAP published a clinical report representing the committee on nutrition, urging pediatricians and parents to work together to improve rates of iron deficiency in this country. The reason: iron deficiency is one of the more common problems among children but it frequently goes undetected. We can’t see it, smell it, or detect it easily on exam or with one simple blood study. Oddly enough, it’s complicated to determine an infant/child’s iron status.

New research finds that deficiency of iron, particularly at young ages (0-3 years)–when the brain is forming and growing rapidly–may have irreversible effects on cognitive and behavioral development. Although the majority of infants and children are not deficient in iron, between 5% to 15% of toddlers are deficient. There are no great studies (believe it or not) telling us exactly what percent of infants are truly deficient.

Don’t go nuts about this and don’t let this scare you. You only need to make changes now, not look back and worry. First of all, let me put this in perspective: iron deficiency used to be a bigger problem than it is now. Prior to the 1970’s (when iron was added to infant formula) rates of deficiency were around 30-40% of babies. Breast-fed infants are at higher risk (versus formula fed babes) of being iron deficient if there is delay in introducing solid foods. So when the pediatrician has mentioned waiting until 6 months for solids, we neglected to prioritize iron.

We care about iron deficiency because it can cause two major problems:

  1. Iron deficiency anemia (small, pale red blood cells)
  2. Slowed or depressed cognitive and behavioral development. The first 3 years of life are critical for brain development and there is new research that iron status, starting in infancy, is essential for later cognitive performance. Think of “cognitive performance” as seeing well, reasoning, remembering, and interacting with others. So this stuff matters.

My biggest hesitation when I read the report the first time was that we were sending yet another message to breast-feeding moms that their milk wasn’t enough (ie your baby may need a supplement of iron in addition to that vitamin D). Furthermore the recommendations are filled with testing, re-testing, and follow-up evaluations that may be confusing and scary for families. Yet after numerous conversations with other doctors who were initially skeptical, and about 4 personal reads of the report, I have come to the same conclusion as those with who I spoke: We need to protect infants from deficiency of iron and we need to do more comprehensive screening of those babies graduating into toddlerhood. So some facts and explanations: Read full post »

Pacifier Free

This morning, casually, while at the breakfast table with the boys, I mentioned to O that big boys don’t use pacifiers. I said, “Babies use them, but big boys don’t. You’re soon to be 2 (years) and no longer a baby. You’re a big boy now.”

He asked to get down from the table where his pacifier was sitting. He marched into his room and grabbed his two lovies and came back to the breakfast table. It was as if he instantly knew he needed to look elsewhere for comfort. I didn’t take the pacifier away from the table and he didn’t ask for it again. When I left for clinic a bit later, I asked our nanny to try his nap without it today. Not wanting to set her up, I said, just explain that he’s a big boy (no mean, you’re-no-baby messiness) and see what happens. “If it doesn’t work,” I said, “I’ll do it next week.” But something seemed right about it.

I often tell parents in clinic that they are the experts of their children. Because although as their doctor I may know more about the physical exam, I’ll never understand or trump the instinct of a parent. As one mom mentioned to me in clinic today, we parents simply know who our kids “are” and what is about to happen. Read full post »

Minus One

O lost his front tooth this weekend. This was not one of those tooth fairy glory moments. No wiggling the tooth in the bathroom. No anticipation. No stuffing of dollar bills under the pillow. O is 23 months old, so losing a tooth right now is not only precocious, it’s 5 years premature.

Every time I think of it, I get a pit in my stomach. Maybe it’s my memory of the scream (mid-tooth-flying) or the fact that I was planning on calling the dentist this week for an opinion on how to preserve the tooth. O had fallen a number of times (while learning to walk on planet earth), rendering his front tooth dangerously loose. Sunday night the tooth got caught on a T-shirt as it was being pulled over his head. You can imagine the rest of the story.

Feels like a #mommyfail on some level. I should of made that call.

I was upstairs getting ready for a dinner to celebrate my father-in-law’s 75th birthday when it happened. Last time we tried to celebrate a birthday (mine) with my in-laws, O broke his leg. Doing my best not to read into this.

When the tooth fell out, we didn’t go to the ER. Dentists don’t put primary (baby) teeth back in when they fall out traumatically. And although dentists recommend you bring your child in for follow up after this sort of thing, if there is no other injury to the mouth or gums, there is no need to head to the ER.

Heart in my hand and the tooth on the counter, we celebrated my FIL’s birthday out for dinner. But I remained distracted throughout the night. My boy’s smile altered for 1/2 of a decade and that audiofile of the scream playing and re-playing in my head. Although O doesn’t show any signs of missing that tooth, I do.

There is nothing comparable to the heart-pull-tug-shread we feel when our babies get hurt. We are connected in inseparable ways. And pain travels faster than anything I know.