Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Smoking At The Movies: Even When It’s PG

This week, Paramount released a new animated film entitled Rango. A film full of reptiles with cowboy-type roles, strong voices and adult choices. It’s an animated film marketed to and geared for kids and families. It’s rated PG. In the television trailer I saw last night, they specifically dubbed it a “family movie.” The movie had a great opening weekend, it turns out, but not without some controversy.

The film is full of tobacco imagery, where many characters use and play with cigars and cigarettes. And as I hear it, the hero of the story swallows a cigar at one point and subsequently breathes fire in the face of a villain. Funny. Silly even, maybe. But potentially instructive, too.

As most parents know, many animated films contain content, language, jokes, and plays in plot that go right over kids’ heads. These are cleverly designed to keep parents, adolescents, grandparents, and chaperons “stuck” in the audience, entertained as well. And to keep us coming back.

Problem is, it turns out not every theme goes over childrens’ heads as we’d like to believe. Read full post »

A little Bit Unhappy: $15 Well Spent?

I’m increasingly understanding that the busier I get, the more I find myself a little bit unhappy. This afternoon, I unscheduled the nanny in hopes that I would carve out 4 hours to be with my son O before I picked his brother up from school. He’s still sleeping as of now, so I remain tethered to the computer.

Despite the best of efforts, my son is having a marathon nap this afternoon, something I would normally be ecstatic about. But today, I’m not. I wanted to see him, play with him, have some time. But like we all know, parenting doesn’t work this way. Children don’t follow the script.

So here I remain, entirely plugged in. I’d had a nice conversation at the beginning of my day with an accomplished writer who was thinking of blogging for a cancer center. I gave her words of welcome, encouragement, excitement, and hopefulness for her proposed blog. At one point I said, “You’re the perfect person to do this!” (Because I believe this). But I still gave her warnings, too: this will consume you, eat you up, take over your mind. As any blogger (writer?) knows, the world becomes framed by your blog and every experience you have seems to vie for a possible leading role in your writing. I told her how I basically sleep with my iPhone (not kidding) and approve comments whenever I can and as quickly I can. It allows me to know exactly what’s going on on my blog and hopefully improves the readers’ experiences. But it comes at great cost. I’ve had a total of about one week entirely unplugged since I started this blog November of 2009. I really can’t remember what life was like before that time.
Read full post »

What To Do About Fever

Fever is often a part of life as a parent, particularly with young children in the winter time (read: 6-10 colds a year is the norm). Although I sincerely don’t like it and do feel naturally uneasy when my boys have a fever, as a pediatrician I know to take fever as one of many symptoms they develop when responding to infection. I certainly use medications like Tylenol when my boys are feverish, refusing to eat, punked out, and exhausted. Thing is, it works! And often they respond beautifully, bouncing back, regaining energy and improving their fluid intake and appetite. But I don’t treat every fever they have and I don’t recommend you run for the medicine cabinet when you feel that warm forehead. It’s not necessary to treat every fever. And it’s certainly not ideal to treat the numbers, themselves. Fever is a natural response of the immune system. Fever ultimately can be productive and may assist your child’s body in fighting off infection.

Fever phobia is pervasive though; we pediatricians are partly to blame. This week the American Academy of Pediatrics published a report on fever (and fever phobia) and the use of fever-reducing medications like acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). Listen to my take in the video. The main take home is not to treat fever per se, but your child. There is no reason to make a fever disappear if your child is otherwise acting well, playful, and staying hydrated. But do know there are some fevers that do require a visit with the pediatricians. It’s important to seek care when fever persists after 3 days in infants and children, any fever in a baby 3 month old or less, and if fever is over 104 degrees. Furthermore, trust your instincts! If your child looks unwell in the face of fever and doesn’t seem to be improving as you would expect, call you pediatrician for help!

What do you think; does fever freak you out? Do you feel like you need to treat fever immediately? Does this information help you feel more at ease with temperature elevation and fever in infants and children?

(Errata: The paper detailed above from the AAP this week isn’t a “Policy Statement” as I mistakenly said in the video. It’s a “Clinical Report.”…and well, that’s a different thing. I apologize if I caused any confusion.)

Tanning Bed Ban: 10 Tips on Tanning

I left the country, and went to a tanning bed, both for the first time while in 5th grade. I was 10 years old. Circa 1984, my parents had planned a trip to Mexico and my mom had been poorly-advised that it was a good idea to have my brother and me ready with a “base tan” prior to travel to prevent sunburn. This was unlikely to have come from a doctor, but who knows. It was the 80′s after all.

My mom took us to the local strip mall where I spent multiple 1/2 hour sessions in that warm, sweaty, purple glow encased between 2 rows of light bulbs, the grocery store to my left and the new VHS video store to my right. I remember the stomach sticker I used to obscure the UV light during tanning that marked the progress of our sessions. I remember how excited I got about traveling. I remember how this formed an initial groundwork for my skewed idea that getting a tan marked some sort of achievement. I remember how I used to get praised for my ability to tan when we’d return home to Minnesota.

I also remember that I got the only blistering sun burn in my life from a tanning bed while still under the age of 18. Not good.

I share this because tanning is a misinformation issue. Children and teens may have no idea what risk they take when getting a tan (or a burn) and some parents often have no idea the danger of these tanning beds pose. The argument for “this may cause cancer” often doesn’t resonate with a teen. It’s simply too remote, too far off, or too “grown up” a concern. I’ve found talking about the truth behind wrinkles may be a better angle…

This week the Academy of Pediatrics (AAP) stepped up. The AAP published a policy statement describing the effects of UV light exposure in children while pushing for a ban on tanning in children under age 18. The statement starts off by articulating that “sunlight sustains life on earth.” This time of year here in Seattle we’re particularly aware of this… Read full post »

An Amalgam In The Exam Room

This post is an amalgam. Not the kind that fits in your back molar, but the kind that exists in my head. I’m trusting you have this type of overlapping-quilt-like-consuming-idea-thread that resides in your head at times and ultimately becomes thematic. How one event in life opens a new window into others and then suddenly there is sense and commonality in different spaces and experiences. You know what I mean? Evolving wisdom or simply experience, I don’t know. But I mean how something persists in your every-moment and helps you define meaning  with each new space and time. I’ll explain…

On Monday, a blog post of mine from last summer was published on Dr Kevin Pho’s blog, KevinMD. The post detailed my mom finishing her chemo and 5 words that her oncologist spoke one sunny afternoon: “You’re the picture of health.” The post is about the power of a physician’s words and how words spoken in the exam room linger in our life. In this post, I spoke about words we hear as patients (and caregivers) and how it’s essential that doctors detail wellness when they see it (rather than always focusing on illness). But reading the post again brought me back to last summer. More than once this week (let’s be honest, maybe like 6 times) I’d think about the post and well-up with tears. Maybe it’s the reality that we all face mortality or that I’ve been ushered into a new moment with my mom in her current remission where I am not filled with worry every day. Or maybe it brought me back to the emotion that was in the exam room that day, too. The same emotion I’ve typically divorced myself from. But,

It got me thinking, how was it I was starting a blog, helping my mom through chemo, moving to a new home, and caring for two little boys while caring for a panel of patients during that time? Why wasn’t I in a puddle of tears? Well…see…we do this. Parents (and children) do this ALL THE TIME. They muster incredible courage. Parents face fears. They exceed expectations and bust through boundaries for their children. For example, in the exam room, I tell parents we’re admitting their child to the hospital and then they listen, they thank me, they discuss.  They rise up to what is asked of them without their heart falling out of their chest and landing on the floor. They endure. They “keep it together,” they advocate. They share. Yes, they break down sometimes, too. Yes, they tremble. But they always do what they need to. They endure.

Which got me thinking, we really can be the balogne in the generational sandwich. Read full post »

Formula, Breast feeding, And Solids

Here’s a response to some of the comments about the post I wrote earlier this week. As I’ve said before, I support parents feeding with breast milk and with formula. Studies like this aren’t designed to alienate parents who feed with formula. Take a listen. Here’s a post I wrote about the juggle/struggle to breastfeed while working. Ultimately, the goal of the Pediatrics study on timing of solids was to illuminate ways to improve obesity prevention. Not divide us or cause us to doubt ourselves.

If It Were My Child: No Baby Food Before 4 Months

Last week news of a study evaluating the timing of solid food introduction for infants emerged. It got a ton of press because the study evaluated the timing of solids on the likelihood of obesity at 3 years of age. Researchers divided babies into 2 groups, those that received partial or full breast milk until 4 months, and those that were weaned from breast milk and received formula exclusively before 4 months of age. Researchers then determined when babies were given solid food (rice cereal, biscuit, pureed “baby” food, etc) of any kind.

The results proved notable. Babies who received exclusive formula and solid foods before 4 months of age were 6 times more likely to be obese as a 3 year-old (defined as BMI over 95%, sum of triceps and subscapular skinfolds). This however, was not true for the babies that were receiving breast milk of any kind. So this study may not be applicable to many babies; in the US for example, 25% of infants are never breastfed and approximately half are breastfed for less than 4 months. Yet still, this sheds light on what we can do to help. Use this data when Grandma Trudy is urging you to feed your infant cereal at 3 months. Or why it’s best to wait until 4 months when you get excited about starting solids. Those of you who didn’t wait? Before you spin your wheels with worry about that bite of rice cereal you gave your baby at 3 1/2 months, read on. Because although, if it were my child, I wouldn’t give baby food before 4 months, there may be more to consider when it comes to timing. Read full post »

Guest Blog: Dr. Ari Brown on Dr. Oz

Dr Ari Brown, a pediatrician and author (books in photo), was on Dr Oz yesterday. She was asked to join a discussion about autism. Dr Brown is a board-certified developmental pediatrician, a mom to two, and an advocate for science. She is passionate and clear about what she believes. She is speaking all over the country about how to protect children from illness, particularly when making decisions about vaccines. She contributed ideas in my series in late 2010 entitled, “Do You Believe in Vaccines: part I, part II, and part III.” On Dr Oz, she was asked to contribute to a discussion about autism that ultimately focused on fears about vaccines. I worry the discussion wasn’t a representation of most American families and even Autism Speaks refused to join the show.

She’s shared with me a blog post she wrote after being on the show. Many other pediatricians are writing about the show; read Dr Natasha Burgert’s post, too. On the show, Dr Brown sat next to Dr Bob Sears, a pediatrician who deviates from the recommended AAP schedule and had a chance to discuss her take. She sheds light on what we can do as parents to really understand. Thanks, Dr Brown.

I am thankful, Dr Oz, for the opportunity to participate in your autism show. Both the American Academy of Pediatrics and I hoped the show would help educate the public and move the conversation forward.
As a pediatrician who talks with families everyday in my office, I know parents want to know more about both vaccine safety and about autism. I’m also a mom. Like you, I need accurate information to protect my kids as best as I can.
I am concerned that viewers took away a very inaccurate view of vaccines. The most vocal audience members represent a small minority. Most parents of children with autism agree with the scientific evidence and do not believe that vaccines cause autism. Read full post »

Influenza: Still Time For A Flu Shot

It’s not too late to protect yourself and your family from influenza. Influenza peaks during February and March in the United States. Now is the time to be vigilant in protecting against and preventing the spread, of flu. Washing your hands, staying home from work/school, and covering your cough can be incredible steps. BUT:

The most effective way to prevent influenza is to get vaccinated. If you haven’t had a flu shot, get one this week. Your child can be immunized if over 6 months of age, and remember that many children under age 9 will need a second dose (booster shot). Read about how to determine if your child needs a second dose <—-here.

10 Things To Know About Influenza:

  1. Influenza peaks in February and March in the United States. Look at the CDC data that reflects ongoing influenza activity
  2. Vaccination is the best way to protect you, your family, and your community from the flu.
  3. Children under age 5 are at higher risk from complications from the flu. Children under age 2 are at even higher risk. Children with asthma and with some underlying medical conditions are at high risk as well.
  4. Pregnant women are at exceptionally high risk from influenza and complications from the infection due to changes in their immune, cardiac, and pulmonary (lungs) systems. While pregnant women make up only 1% of the US population, they accounted for 5% of the country’s deaths from H1N1 (Swine flu) in 2009. All pregnant women are recommended to get a flu shot. However we know that only about 30% of moms are immunized at the time of delivery. The bonus of protecting themselves? New research shows how vaccinating pregnant women protects babies. When moms protect themselves by getting flu shot, they also prevent spreading flu to their babies. Babies born to vaccinated moms have a lower risk of flu (and hospitalization) under 6 months of age when they are too young to get the flu vaccine.
  5. The best way to protect a newborn baby from the flu is to have all caregivers (parents, grandparents, nannies) get the flu shot.
  6. People can spread the flu to others before they even now they’re sick. People also spread the infection after they have had it; they can continue to spread flu for 5-7 days in mucus, sneezes, and cough. The best way to protect yourself is to get a flu shot, and second to that: wash you hands, cover your cough, and stay home from school or work when sick with fever and cold symptoms.
  7. Each year 20,000 children under age 5 are hospitalized with flu or complications of the flu. 11 children died from influenza during the week of January 30-Feb 5th in the United states.
  8. Although flu is reported as widespread in 37 states, nearly all areas have circulating flu right now. See the most recent CDC data on influenza around the country.
  9. Overall flu vaccination rates are less than 50% for people under 65 years of age. To best protect our communities, vaccination coverage rates should be about 90%. We’re not there. Immunizing yourself and your family protects those who are too sick (or too young) to get the flu shot and are also at higher risk of complications.
  10. Flu shots for children under age 3 do not have thimerosal. Nasal Flumist doesn’t have thimeroal. Read National Network for Immunization Information (NNii) page on mercury in vaccines. I don’t believe you need to find a thimerosal-free flu shot.

Love: Unequal And Incomparable

When I was pregnant with my second son, I had no idea how much I would love him. It didn’t seem possible that I could love him like I did my first. As I awaited his arrival (on bedrest), my expectations for him grew but my projected love and feelings remained very measured. I imagined having a blueprint for love, a near duplicate map of that with my first son. I was imagining a replica; I had no other schema for having a baby of my own. In this space, I expected it would all feel very familiar in my heart. And although this hope and anticipation fueled my pregnancy, I remember housing doubt that I would have the capacity to love another like I loved my first son. In some moments, it didn’t seem possible; the love already felt immense and unconstrained. As any parent knows, it’s simply insurmountable to quantify or govern love for your child.

If anything, I think I expected my love to feel equal for each boy, despite not understanding the mechanics of how it would happen. Part of that came from my mother telling me that she loved my brother and me equally when we were growing up. This often came up at incredibly sentimental times (note: sarcasm) like epic battles in sharing or when choosing which one of us needed to take the garbage out.

Of course, I’m sure my mom’s feelings are more complex, but her assertion of equality was the foundation in my thinking.

Out popped O in November of 2008. And just like everyone said, I fell in love with him…Desperately.

But my love wasn’t simple; it wasn’t the same. My heart didn’t mimic any pattern I’d developed for F. O was an entirely unique person in my life. And I generated an entirely new sense of connection.

My love for my boys isn’t “equal” in height, weight, or circumference. The love I feel for O is absolutely incomparable to the love I feel for F. As if it’s a different color, a different language, a different texture, or a different tonality. The space they occupy in me is immense and limitless, separate, and only occasionally overlapping. I don’t love one more than the other, but I can’t articulate how I love them in unequal ways. But I do.

Does the love you feel for your child equal that for anything else?