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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?

Killing The TV Won’t Cut It

Even if you kill your TV, you’ll still have Hulu, iTunes, your DVDs, and your smart phone. Today we’re never separate from streaming entertainment. So the old slogan of killing the TV just isn’t going to cut it. “Turn off TV, turn on life.” Better…

Around here, we’re not big TV people so this TV Turnoff week (a week to go without “screen time”) isn’t as hard as it could be. F did, however, ask if he could watch a Thomas the Train DVD tonight as we drove home. And I must say, it took decent energy to deny him. It would have been great (for me) to let him plug in before bedtime after a series of haircuts and swim lessons late this afternoon. I was zonked. Instead, we walked around the block (3 times). I was mid-way through this post and felt obligated to comply.

Not surprisingly, of course, remaining unplugged was the right decision. We met a new neighbor and spent an additional 45 minutes outside playing and navigating the sidewalks. Everyone was happy about it. But… Read more »

A Spoonful of Bacteria For Baby?

I’m becoming more of a believer in giving children probiotics. Not for everything and not for everyone; I really don’t think we should put them in the water. Probiotics, essentially live “good” bacteria we use to supplement our diet (usually Lactobacillus Acidophilus in the US), are becoming more and more available and recommended by more and more physicians. The role microbes play in our health is a hot topic. Probiotics are thought to improve intestinal health by restoring/elevating levels of  helpful bacteria while concurrently diminishing the population of harmful ones. Bacteria in the intestine are a normal part of our digestive health, but population counts of  bacteria living in our gut may be altered by illness, antibiotic use, ingested/modified foods, or life circumstance. What we eat and where we travel to drink water, change what lives in our gut. Research also finds that which bacteria cohabitate on our bodies may impact other illnesses outside the gut like eczema, allergies, and/or asthma.

In children, probiotic supplements may promote recovery from acute diarrhea by decreasing the number of episodes of diarrhea & the number of days. They also may help prevent the development diarrhea when children are taking antibiotics. The reality is many decisions we make affect our populations of bacteria. This starts on the day of birth. We know for example that babies born by C-section have different populations of bacteria in their poop when compared with those babies born vaginally, within a week after birth. So from the very beginning, the choices we make (or our parents make) may change the environment in our bodies. This ultimately may change our wellness. A set of doctors studied the effect of probiotics on colicky babies… Read more »

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 more »