Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Evidence for Vicks VapoRub?

A Pediatrics study this past week starts out stating that, “Upper respiratory infections (URIs) are the most common acute illness in the world.” Wowza, that seems like a show stopper right there. But it’s true, anyone who works with kids or has kids or knows kids (let’s be honest) also knows that winter brings snot to little noses. And lots of it. I really believe that snot and mucus are a part of being a kid in the wintertime.

Kids typically have 6-10 colds a year, mainly between October and May, so if your child is snot-free today this mid-November, consider yourself lucky. Kids get upper respiratory infections (“a cold”) one after another after another and its often difficult to know when one cold ends and a new one begins. The far majority of these colds are caused by viruses. And because we don’t have treatments to impair the virus or kill the viruses that cause colds, we recommend supporting the machine that does: the body. Support your child as they fight off infections. Immune systems are amazingly efficient. Feed these immune systems the proper fuel: rest, hydration/liquids, energy, and most important, time.

We see many children in clinic with colds when families come in concerned about fever, cough, sore throat, congestion, or possible ear infections. Fortunately we rarely have to use antibiotics or other medication interventions. And although it’s nice not to have to prescribe medications for well children with uncomplicated colds, I hate not having much in my tool box to help a family. After a terrible sleepless night of coughing, hacking, fever, and snottiness, families come in absolutely exhausted. Pediatricians really do get this and we do want to do “something.” But often our advice comes off as “The doctor did nothing.” I look at it this way, we ruled our bacterial infection, provided ideas for improving cough (humidifier in the room, honey before sleep for kids over 1 year of age, nasal suction [love NoseFrida], and upright positioning to let the snot drip the right way) and gave guidance about why or when to return. But I do want more tools in my toolbox. This study may help.

As I mentioned last week, sleep is a major commodity while raising children (duh). The study on Vicks VapoRub surprised me. Read full post »

Happy Birthday, Blog

It’s crazy when people talk about themselves in the third person. Also crazy, when virtual projects take on lives of their own. Personification- isn’t that the term? You and me blog, we’ve been inseparable this past year. A proud mama, I am. Drained and exhausted, yup, that too. But to you, today, I say the most sincere, Happy Birthday.

Today marks 1 year for Seattle Mama Doc. It’s been wild– something akin to piloting a plane, taming a wild dog, starting a new business? For me, this last year has been the most rigorous of my life: raising my boys, seeing patients in clinic, writing, creating, and speaking about what I believe to be true in health care. All the corners of my brain are being accessed though, and on most days it feels really good. And today, I must say, I’m a bit teary eyed as I mark all the 1’s in the calendar (11/11/10 for a 1st birthday ain’t bad). In celebration, at the end of my long day in clinic, I’ll bake a cake. Sit at the counter in my kitchen and eat. Should be a nice way to mark the huge milestone for me. In lieu of gifts, will you please leave comments? What have you liked, what can I do better, and of what would you like to see more?

I’m so thankful for the success, the support from others, and the change I believe we are making in improving communication around children and health. Thank you for reading (silently) and for commenting (loudly). You truly feed me, too.

A Year In Review

Am I right? Do you remember this differently?

Here’s to another year. But wait…a day of clinic, and then a bite of cake, first.

Breast Feeding vs Formula: Mommy Sleep

Loved a study published today in Pediatrics. Researchers sought to determine if mothers who breastfed slept less than those who formula fed their babies. I hear lots of talk (at birthday parties to office visits) about how formula or rice cereal creates better infant sleepers. So far, science doesn’t back up these claims. But as every new mom (and dad) knows, sleep is the major commodity during your infant’s first 6-12 months. We really want our babies to sleep through the night. Desperately. Six weeks in, crying is at a peak for infants and mothers are utterly exhausted after a pregnancy, a labor/delivery, and a month or so of very fragmented and dwindling sleep. Not only are we at peace when our babies sleep, we often rest, too. Maternal rest is essential for familial functioning, enjoyment of a baby’s infancy, and simple recovery. Sleep is not just about feeling rested or perceiving that you get more (or less) sleep than the other baby’s mothers on the block. It is about wellness, too. The study asserts that, “a growing body of evidence shows that mothers may not, in fact, do fine with less sleep.” Maternal sleep may affect rates of postpartum depression and an infant’s emotional and cognitive outcome. Getting rest is something we actually CRAVE in the first few months of our baby’s lives. Sleep, at some point, has to be a priority.

Researchers in West Virginia wanted to figure out if mothers of formula fed babies got a better night of sleep compared to those who breast fed or partially breast fed. The motivation behind the study was to dispel any perceived disadvantage of breastfeeding. Before you get up in arms about how bad your night sleep was while breast feeding compared to baby Jane next door who was chugging formula, look at what they did. Sometimes understanding how a study was performed helps you interpret how much weight you put into the results. Read full post »

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