Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Little Boy = Violent Play?

So parenting news is aflutter with research talking about little boys, their genetic make-up, and their aggressive and violent make believe play. New writing posits that this violent and aggressive play may be needed, that boys will process their aggression via this play. But the jury is still out for some educators and parents. The debate is timely for me after a recent weekend with my two little boys and their 4 year old cousin. I must say, I have the experience in observation part down pat. I’ve seen this behavior, yes.

Boys Need Aggressive Make Believe Play

From how I see it, boys may gravitate to aggressive play but as parents, we never have to condone their violent or aggressive actions. I really believe the lines between imagination, play, and the “real world” are often blurred. There are countless examples of children not understanding the consequences of their actions precisely because they are children. If I let my son pretend to kill/shoot/fight, aren’t I somehow complicit in equating a violent response as an okay one?

What do you think? Do you think aggressive, violent play is an essential part of boyhood?

Don’t Make Promises

Don’t make a promise you can’t keep. Probably something your mother told you. I’m not pointing my finger, but I often tell this to families in anticipation of a pediatrician’s visit, too. Do your best not to promise “no shots” prior to a visit. Although you may think your child is “up to date” on shots, they may not be. Or, the pediatrician may order a blood study (seems like a shot to a child) or injection that you’re not anticipating. And then we’re all in a sticky situation. Trust broken.

Well the same goes for your pediatrician (or for this one), at least. Unfortunately, I’ve been making promises I can’t keep, too.

Recommendations for Prevnar, a vaccine used in infants and toddlers to protect against pneumococcal disesase, have recently changed. The vaccine is given at 2,4,6, and 12 to 15 months of age to protect infants and children from serious infections like bloodstream infections, pneumonia, or meningitis. Prevnar prevents some more minor infections like ear infections, as well. The vaccine previously (Prevnar 7) covered 7 strains of the bacteria that are most likely to cause serious or invasive disease. This year, the vaccine grew up. Now instead of just 7 strains, the vaccine contains 13 strains of the bacteria to improve protection to infants and children. All infants and toddlers getting their routine shots will get Prevnar 13. But if your child is under age 5 and previously completed their Prevnar series, it’s recommended they get one more catch-up dose. Therefore, don’t be surprised when your pediatrician mentions an additional dose for your preschooler at the next visit.

Clearly, no one likes to get shots, but pediatricians often spend a large part of their day writing orders for them. Prevention is one of the best things we do for children; immunizations are a major pillar. I’ve said to many people, “Outside of connecting and listening to family’s concerns, writing orders for shots is the most important thing I do when I go to work.”

No matter what your profession or job, delivering good news is a cherished part of the work day. I loved telling the parents to 18 month olds, “After shots today, no routine immunizations other than yearly flu shots until the pre-kindergarten shots at age 4.” But I was making promises I can’t keep. So I’m changing my ways. Will you?

The Sound Of Music In Seattle

I’m about to pull the curtains off the wall and make some shorts. Or a dress, handkerchief, and a set of lederhosen. If only I had a sewing machine…

F and O have been singing “Do-Re-Mi” all weekend. We’re nailing our knowledge of the octave (kind of). It’s been the theme song to our move even though they’ve never seen the movie. But the greatest little thing evolved over the weekend (via repetition) that I don’t have the heart to correct. It’s just too delicious. A little like O adding “eeee” to the end of his words. (He’s still doing it, thankfully.)

Here’s what it sounds like when F sings Do-Re-Me:

“Do, a deer, a female deer. Hur-ray! a drop of golden sun. Me, a name I call myself. Faaaaw, a long long way to run. Sew, a needle……”

Is this what happens when you grow up in Seattle?

I’m ready to sing and spin around on the top of a hill with my arms out. We know a drop of golden sun will come again; Happy Labor Day.

Moving Day: Double Take

Baby eating a popsicleDoes this photo look familiar? We moved again today. Yup, we moved homes just 10 months ago. Crazy or stupid, you decide.

I’m just home from a late night in clinic. The boys are in their new spaces while the boxes tower amidst the palpable tired. But the night still swells with possibility. I can see the stars from the back yard. And the bare walls blended with the smell of cardboard boxes, makes me feel like I just turned the page in a new hard-covered book. Moving, albeit chaotic and uniquely stressful, can feel like hope. Optimism prevails tonight.

But I’m still thinking of the last time around.

Here’s my moving day post from last year. Read about our terrible misfortune and improper planning. Learn from our mistakes. Especially if you’re about to do a moving-double-take, too.
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My story of 9 stitches, 2 parents who feel as deflated, flat and small as the bottom of your worn shoe, a near 3-year-old boy, and 1 orange Popsicle. This is about our mistakes and the dangers of the events that followed moving day in my world, October 31, 2009.

But let’s go back in time; history is supposed to be one of our most sage instructors.

Circa 2003. I took care of a 3-year-old girl in the ER when I was an intern (my first year as a physician, while training in pediatrics) after medical school. In medical training, there are certain patients that stick out, jump off the exam-room-pages, of the hundreds of patients you can see in a month’s time. I know some will stay with me forever. Read full post »

Wonderfully Un-Wired

I returned home from the mountains yesterday. We spent the majority of the weekend in a cabin with my brother’s family, my mom, and our dog Luna. There was sunshine. A bike. Lots of little boys. And loud wind in the trees. The best kind of noise…

The owners of the cabin had advertised WiFi in the cabin, so I made no preparations for my time away. I was gone Saturday noon until mid-day Monday. Not a long trip by normal human standards. Yet it felt like a huge voyage.

As fortune had it, the WiFi didn’t work. I got a signal on my phone for only a few minutes, twice, during the 48 hour respite. Not surprisingly, I was transformed. And rapidly. By Sunday morning, I’d tossed the iPhone in the corner, hid the computer, and stepped away from my responsibilities with work. This isn’t the norm for me since I started this blog back in November; I’ve been plugged in nearly every waking hour of every day. I haven’t taken a full day away from technology since last fall. Not requisite per se, but the way I’ve lived through the evolution of this blog and my time in social media. Part necessity to feel thorough, part insanity, and possibly part-addiction; social media can squeeze into any space. Maybe, a little like a bedbug. Read full post »

Spanking: 65% Of Parents Say “Yes.” Do You?

Life is a blur this week. But something stopped me in my tracks. A study published in Pediatrics on Monday found that 65% of parents to 3 year-olds said they had spanked their child within the last month. Sixty five percent? The number surprised me. If you’d asked me to guess, I would have said 20-25%. Talk about way off. Another reminder of how much I have to learn.

The study evaluated risk factors, including domestic violence and intimate partner aggression & violence, on spanking and corporal punishment. The researchers are trying to understand/describe that while most child advocacy groups condemn spanking, in the US, the reality remains that nearly 2/3 of families continue to use spanking as a form of discipline. They found that parents who experienced aggression and violence between each other were twice as likely to be in the group that spanked their children. Having been spanked as a child increased the odds, too. Not surprising.

But the 65%; that was surprising.

I don’t talk about spanking in clinic (I can’t think of a time I did); no one asks my opinion about it. I talk about setting limits, behavior, tantrums, obedience, discipline, but no one asks me about spanking. I wonder, do parents feel it’s taboo? Do they feel I would judge them?

My position on spanking may be irrelevant, really. What I say as one mother or pediatrician doesn’t change the reality that more than half of the parents in this study are spanking children. I’ve always thought of spanking as illogical. If I’m trying to model behavior against aggression, why would I hit my child modeling just the opposite? But I’ll tell you this: I was spanked as a child and I certainly remember it. Clarity in fear. Further, there have been moments of desperation (think: major-tantrum-melt-down-disaster-ness) where I thought about it, too. So, I think the instinct to spank (particularly when you’ve seen it, or experienced it) in a moment of utter overwhelm may be the norm when raising kids. But 1/3 of us choose not to spank,and about 2/3 of us choose to spank our children. Why?

What pediatricians ultimately need to figure out for families is how to help parents improve their lives with their children. We need to support families in times of frustrations. Groups like the AAP discourage using spanking or corporal punishment of any kind. But their statement may not make much of a difference.

So I wonder, does 65% surprise you? Do you spank your children? Do you think it works? Do you feel spanking is corporal punishment? If you don’t spank your child, why not? So curious. Please share, even anonymously if need be.

Don’t Let The Bed Bugs Bite

A friend called yesterday and asked if I thought her daughter had bed bugs. Her toddler had woken up with welts over her face, chest, back and trunk. She was itchy. Her mom was worried about bed bugs. I tried to reassure her, telling her what I knew about bed bugs &  how young children react to insect bites (not just bed bugs), I asked:

  • Does the bed have copper colored stains on it?
  • Is the mattress new or borrowed?
  • Any other babies or children nap in her crib recently?
  • Any one else at home with bites or itching?
  • Any travel to a hotel recently?

But I got to thinking, what do I know about bed bugs? Not that much, actually. A good friend of mine caught bed bugs from a famous San Francisco hotel about 3 years ago. I’d read up on it at that time to help her; she’d been diagnosed by a SF dermatologist while traveling for work. The hotel apologized, placed all her things (suitcase) in their walk-in freezer overnight and sent her home with some “points” to return to their hotels for free. She left with her frost encrusted “baggage.” She did just fine (easy for me to say), but I’ve certainly remembered the story and I’ll never stay at that hotel. There is something uber-creepy about the thought of bugs chewing on our toes while we sleep.

So I get the overwhelming response to media reports about bed bugs. When my mom mentioned a local NPR interview about bed bugs she heard yesterday, in combination with the phone call, I thought, “Oh no, people are starting to freak out.”  It ‘s all over the media. Then, I opened the NYT this morning and saw the cover article about bed bug infestations in New York City that ends likening bed bugs to the H1N1 scare. Closed movie theaters, infested dressing rooms, you name it.  Bed bugs appear to be teeming around the internet, and as we all start to scratch ourselves and wonder if it’s worth leaving the house (or if we’re surrounded at home), I did a little research: Read full post »

Only One Decision

When becoming a parent, we make a big choice. One enormous decision. Hello, understatement of the century. I remember my father-in-law saying, “There’s a freight train coming,” just before F was born. Yes, thunderous and steamy, I was ushered into a new world December of 2006, when my first freight train hit. And although I now may be billowing steam and coal, motherhood is the most astounding segment of my life thus far.

This weekend I read a blog post written by an OB I don’t know. She calls herself The Skeptical OB. We may hum on the same wavelength. She says that “Mothering is about choosing motherhood, and not about mothering choices.”

When I read her post, I nearly held my breath. Then I re-read it again a few times. So much of what she says makes sense to me and hits on my recurring theme about parenting in the world of opinion–the reality that there is no manual, no right or correct way to parent. There is no needed judgment and guilt about our choices. Love and commitment to our children may be the only pre-requisites for success. I found Dr Amy Tuteur’s blog post about choosing parenting on a popular medical blog this past weekend.

I felt like she was channeling my thoughts.

At one point she says, “My fundamental objection to the philosophies of natural childbirth and attachment parenting is not the emphasis that they place on mothering; I object to the fact that they privilege specific mothering choices over others.”

Hallelujah. Read her entire post.

3 Things That Won’t Help Babies Sleep

There is a lot of information (and opinion) about how to get your infant to sleep through the night. Cry it out/don’t cry it out, rocking/no rocking, co-sleeping/crib sleeping, white noise/no noise, breastfeeding or bottle-feeding. Everyone has an idea about what works. Like I said earlier, there is very little data to support one technique over another.

Auspiciously, there is new data that may help us know what NOT to do. Researchers found 3 things to avoid while helping your baby learn to sleep through the night.

A study (summary in Journal Watch) refutes an urban legend: feeding rice cereal keeps babies asleep.

Read full post »

Stammina

That’s no typo. I meant Stammina.

Dr Stanley Stamm is retiring this month after a 57 year clinical practice at Seattle Children’s. F-i-f-t-y-s-e-v-e-n year career. His wonderful nurse, Marlene, is retiring, as well. They have been caring for children together for decades. Yesterday I had the privilege to attend one of their retirement parties. Lovely, inspiring, humbling. I was silenced by it all; I was among giants. Working in medicine has granted me a unique window to witness exceptionally compassionate people who devote their lives to care for children. Dr Stamm and Marlene exceed the margins as they shine brightly through the window panes.

Dr Stamm has done incredible things for children: Read full post »