Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

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.

Why I Hate Sleep Positioners

I hate infant sleep positioners. They are not safe or helpful. If you have one or know a family/friend who uses one for their infant, throw it out. Trash compact it. Stomp on it. Cut it up in bits. This is one rare thing you should feel good about putting in landfill.

When I was first started in practice, I didn’t even know sleep positioners existed; I was shocked at how many parents told me they were using them. We are led to believe (by manufacturers) that positioners confer safety by keeping babies on their back. Since 1994, the Back to Sleep campaign has helped parents become vigilant (yes!) about putting babies to sleep on their backs. But after my sons were born, and while roaming the super-store aisles for bottles, crib sheets, overpriced silicon, and breast pads (oh the glory), I realized why parents get so confused.

In the infant sleep section, I found plenty of products designed for babies I would never recommend. Never. Sleep positioners, head positioners, comforter-like blankets for the crib, bumpers and stuffed animals. Many products went against what I was taught in my pediatric training and what I’ve learned thereafter. Like so many things in life and medicine, less is more. When asked about setting up a safe infant crib I say, “Boring, bare, basic.”

In 2005, the AAP (American Academy of Pediatrics) issued an updated guideline on the prevention of SIDS. Though the message has been effective, sleep positioners have persisted to sell. Two weeks ago, prompted by 12 deaths (over 13 yrs)  due to sleep positioners, the AAP reiterated their position citing the dangers from sleep positioners after the CPSC and FDA (photos seen here) sent out a warning. Even though these positioners go clearly against safety data and medical advice, companies have kept them on the market.

Why? Read full post »


I’m smoooooshed today. Underwater. Submerged. Trapped under my orange scarf (see image). Just back from two consecutive conferences and readying to speak at another. And, drumroll……the in-laws show up in 2 days. I’m in that state of near-paralysis-parenting where there is so much to do I feel incapable of completing any of it. Every parent, working or not, has been here. Right? Here’s to hoping I’m not alone… I nodded my head about 12 million times over the last week when other docs I met at the AAP conference talked about the juggle between work and parenting. One pediatrician, Dr Alanna Levine said, “There isn’t an instant of time left unscheduled.” Yes, and today I’m behind on that schedule.

I started sobbing at my computer this morning after our nanny came home to tell me that I had forgotten it was picture day at preschool. Of course, I wasn’t crying about the reality that F went to school in an old T shirt and a cock-a-doodle-doo hair style (he went straight to bed after family swim last night). No, this is not about vanity or being uptight. I was crying because it feels like failure sometimes when you forget details in your parenting life. F couldn’t care less about what shirt he wears for the photo, and I certainly need to think about that, too.

So as I scour the planet for a shovel big enough to dig me out of this hole, I wonder, what would you most like to hear about this week and next?

My Ideas:

  • Blog post on recent update on recommendations for preventing, treating, and caring for kids with concussion.
  • Blog post on a list of recommended booster seats. And the whys in using booster seats.
  • Why I hate infant sleep positioners and why I think they put kids at risk for SIDS. Don’t believe the advertising hype that they are good for your baby. Video or blog post.
  • The AAP published new recommendations for iron intake in infants and toddlers.  Want to hear about it?

Tell me what you want me to write about; vote below. Yes, I’m asking for audience participation. And, ummmm, do you have a sturdy shovel I can borrow, too?

The Chicken, The Egg, or The Dog?

Research in The American Journal of Public Health last month found that children who had a dog at home were more active compared with dogless ones (my word, not the researchers). Although dogless kids may ultimately be safer (no bites, no Salmonella-tainted food, no getting pulled across the street) they may also be more likely to be overweight. Having a dogless home is not a new risk factor for obesity, but this study may offer some insight into childrens’ lives.

Who knows why kids with a dog are more active. We can all certainly speculate. But, this may be a chicken or the egg type question. Or a dog or the kid one. Let me explain: Read full post »

Plugged In, Plentiful Air, Perspective

I read an incredible story this week; I think you should read it. It’s not enjoyable, per se, but eye-opening and provides perspective on parental love. Healthy days can be simply luxurious. Any parent who has endured/witnessed serious illness in children knows this. So do parents who have witnessed a scare.

When I forwarded the story to my husband while flying to a conference on Monday, he instantly said, “I just want to go home and hug the boys.” I felt the same way. But trapped at 30,000 feet, I had little choice. I was working while flying across the continent. I’ve mainly been traveling with the boys these past years, and on this trip I learned that the last bastion of the unplugged landscape is dead. I point my finger at airplane WiFi. Albeit fantastic from a productivity stand-point, WiFi in the sky is life-balance wrecking. For a working mom who fills up every square centimeter of time with work or time with the kids, the airplane trip (sans kids) was supposed to be a little luxury “me time.” No more.

By Colorado, back into work and entirely plugged in, I became slightly breathless. Read full post »

Crack The Code On Pediatric Flu Shot Recommendations

Flu shots have arrived to nearly every neighborhood in the US. Frustratingly, clinics often get the doses after the retail stores (seems silly) and doses for children under age 3 may not arrive at the same time. So if you’re reading all over the planet that shots are available and your pediatrician’s office can’t offer it to you today, have patience. Children under age 3 receive immunization doses without preservative, so if a store or pharmacy advertises that they have “flu shots” it doesn’t mean they offer them to all comers. Pediatric doses are not offered at many retail locations. Often, like so many things in medicine, the same rules don’t always apply to infants and children. But that being said, clinics expect to get all the doses needed for our high-risk (and low-risk) patients in time this year (no expected shortage) and can help you determine when, how, and why to get a flu shot for your child. This year, it is more confusing than ever. Read full post »

Mandatory Flu Shots: “Ethically Justified, Necessary, & Long Overdue”

This year, The AAP issued a statement urging pediatric hospitals and clinics to require mandatory immunization against influenza for all health care workers. They stated it’s “ethically justified, necessary, and long overdue.” The Advisory Committee on Immunization Practices (ACIP) began recommending influenza immunization (flu shots/mist) for health care workers back in the early 1980s. Even after 3 decades of the recommendation, overall immunization rates for health workers remain around only 40%. Evidence suggests a clinic or hospital unit needs an 80% immunization rate to protect themselves and their patients from the flu. In the US, we’re nowhere near it. Last year for example, the CDC estimated that for health care workers, only 61% got seasonal influenza shots, 37% got the HINI shot, and only 34.7% of workers received both.
Totally unimpressive for a group of people committed to protecting patients, curing illness, and preventing disease.

I believe the mandate is long overdue. No one likes to be told what to do, but there is reason behind this policy. For example, in the statement, The AAP used patient safety as part of their rationale, citing 2 studies: Read full post »

Similac Powdered Formula Recall: Gross But Not Dangerous

Worth mentioning: There is a large Similac powdered formula recall. It’s not dangerous, but gross. ICK. Ick, Ick, Ick.

The FDA announced today that Abbott (who makes the formula) voluntarily recalled formula due to concerns about bug contamination. Yup, bugs. Beetles and Beetle larvae in the powdered formula. The recall involves powdered formula made by Similac:

  • Certain Similac powder product lines offered in plastic containers.
  • Certain Similac powder product lines offered in sizes such as 8-ounce, 12.4-ounce and 12.9-ounce cans.

The recall states that babies could have a bit of tummy upset (GI distress) or refuse a bit of formula if they ate contaminated samples. I’m not worried at this point about harm or danger for infants drinking this formula. The stomach acid (& pH) and GI tract of a baby can likely handle this without any trouble.  Instead, it’s a disgusting reminder that when we don’t make food ourselves, we remain vulnerable to companies who do, to keep and hold high standards of safety and hygiene.

If more information unfolds that is alarming or worrisome, I will update this post.

I read lots of reports on Twitter and online proclaiming this is a great reminder to breastfeed. I agree, offering breast milk will never involve a recall. But I will say this (and loudly): some of us had or have a difficult time making enough milk for our babies. Sometimes parents offer formula because they need to, not because they choose to. THIS IS NOT ANOTHER REASON TO FEEL GUILTY. Just a reason to check your can of formula if you have Similac lying around and follow recall instructions. Don’t let this shake you.

Online sources of information about the formula recall:

Call your pediatrician with any further questions, although I doubt you’ll need to.