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Do You Believe in Vaccines: (Part II: Evidence)

I asked a group of 33 pediatricians what they would say to the question, “Do you believe in vaccines?” while standing in line for coffee. I asked for their help in thinking about an effective, 2 minute answer.

This is part 2 in a series. For detailed information behind the why, read part I (emotional responses) or watch the video explaining how this came to be. As I said, I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. Part of the reason I started this blog was that in practice, I realized when I told families what I knew and learned in training, they listened. When I told them what I did for my own children and how I felt, they made decisions. Telling my story seemed essential.

(This is going to sound familiar) I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

Today I’ve included responses from pediatricians that mentioned things that I experienced as “evidenced.” But rather than talk to you about numbers, causality, rates of autism, and the absence of thimerisol in all childhood vaccines (except multi-dose flu shots), these comments focus on the evidence that helps physicians discuss immunizations with families. There was a paucity of numbers in the responses from these physicians.

Dr Gayle Smith (@MDPartner), a general pediatrician in Richmond, VA says it best:

I’d say how much I wished pediatricians were better ‘rock stars’ with our message of prevention so we could be more effective in the media limelight.  I’d speak my own willingness to touch the hearts of the families I care for, to carry the bag of fear and worry for them, perhaps lessening their load a bit. Read more »

Do You Believe In Vaccines? (Part I: Emotion)

I wrote 33 pediatricians an e-mail asking what they would say, while in line for coffee, to the parent of a newborn when asked if they “believed in vaccines.”  I wrote the e-mail not as a gimmick or a way to frame the issue of vaccine hesitancy, but because this happened to me. Rather, this happens to me. Often. When a new father asked me this question while carrying his newborn baby 2 weeks ago, I told him what I thought.  I then ruminated about my response for 24+ hours and wrote a group of colleagues. How do we talk with parents we don’t know, outside of the exam room, to help them understand why we feel so strongly about protecting children with vaccines?

I’m not a believer in scripts. I’m not attempting to suggest there is one, 2 minute segment for every family that will help. I wanted to hear what these expert pediatricians would say to get a sense of their collective insight. I wanted you to see it, as well.  I want to be really good at my job as a pediatrician when helping families understand the science, the evidence, and the emotion behind raising healthy kids and preventing illness with vaccines.

But I also really want families to understand why pediatricians work so hard to vaccinate children. I don’t want to increase the divide between those parents who are worried or skeptical of the possible harms of immunization, and those parents, doctors, and experts and who believe in the benefits. Rather, I want to regain our similarities.

We are all so similar.

We all want to do what is right for our children.  That’s why everyone is so nuts about this. Simply stated, we all care immensely.

This was confirmed when I wrote docs from all parts of the US. I got over 20 responses.

I’ve arranged these pediatricians’ thoughts based on how I experienced their comments:

  • Emotional
  • Evidenced
  • Experienced

These thoughts are not mutually exclusive; you’ll hear evidence in the emotional comments, experience in the evidenced ones, and emotion in the experienced ones. Today’s post includes responses that felt emotional.

As I said in the video, it isn’t just parents who are emotional about vaccines. Read the comments to that post and you’ll see—some 30+ comments, mostly written by pediatricians, full of energy, data, and emotion. Pediatricians (and scientists/public health experts) are ultimately responsible for improving the way families understand immunizations. So this is weighty.

Emotional:

Most of these doctors wrote me about listening more than about talking.  But here’s some of what they said:

Dr David Hill, a pediatrician in North Carolina wrote:

Boy is this an issue on all of our minds! For me this question has particular poignancy, as we all watched our partner’s (a pediatrician) 22-year-old daughter die of H1N1 last year. To see her face-down on a ventilator, bloated and pale and then to have a parent tell me, as one did last week, ‘Everyone knows the flu vaccine causes just as much disease as it prevents.’

Gulp. His response to that parent’s viewpoint: Read more »

Work-Life-Balance

I did a live radio show for the the AAP’s Healthy Children radio show last week.

Click the above link if you’d like to take a listen or below for individual segments (each about 15 minutes).

My favorite part of the first interview is when I mention magic. Of course, the hard work of raising young kids is simply so worth it. We get so much more than we give. Nothing about this is easy of course, and nothing about this static, either. Take a listen and let me know if what you think.

Work-Life-Balance Issues for Working Parents

Breast Feeding, Working, and Being a Working Moms

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 more »

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.

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 more »

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:

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 more »

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 more »

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.

Thoughts?