Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

Washington State Measles Outbreak: What To Do For Infants And Children

There is a measles outbreak unfolding in Washington. Unfortunately, there have been multiple outbreaks across the US in the past few months. Here’s info about outbreaks in 2018, as well.

The MMR vaccine is safe and effective. If you’ve hesitated or declined the vaccine in the past, please reconsider the science and risk to your child and their community now.

I haven’t written much about measles since 2015, but an outbreak in Washington State has prompted me to send out a few reminders. The first thing to know, which I know I already said, is that the MMR vaccine (protects children and adults against measles, mumps, and rubella) is safe & highly effective. If your children are immunized there is very little to worry about during a measles outbreak. The 1st dose (and 2nd dose for those infants and children who didn’t respond to the first) of the vaccine work to trigger lifelong immunity. Typically after the 1st dose (at 12 months old), 95% of people are protected for life. The 2nd dose (age 4) protects those not protected from the 1st dose and brings protection to 97-99%. If your child hasn’t had a 2nd dose of the MMR vaccine and you live where widespread measles infections are being reported, you can get the 2nd dose of MMR now as long as it’s been 1 month since the 1st dose. Call your pediatrician to inquire if you’re interested. The bottom line: immunized children can play and go to school and go to assemblies and even visit a clinic safely during an outbreak because the vaccine is so effective. Hurrah for science!

What To Know About Babies Too Young To Be Immunized For Measles(MMR):

I hate that I can’t completely say infants are perfectly safe during an outbreak. Infants are a vulnerable population during a measles outbreak. Measles is wildly contagious and during an outbreak, it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk of exposure outside of areas during an outbreak is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to your baby). Here’s an even more comprehensive post I wrote about this from 2015.

  1. For Babies Under 6 Months of Age: If a baby’s mother has had her MMR shots and/or had measles infection in her life she passed antibodies to her baby during fetal development while in-utero and continues to pass them passively while breastfeeding. Those antibodies provide protection for young infants and typically are thought to protect infants for up to 6 months or more. However, exactly how long for each baby is not ever known. Immunity wanes for these babies as they age and the mom’s antibodies fail to persist. The reason babies don’t get the MMR shot sooner than a year of age is because of the persistence of these maternal antibodies — if you put a vaccine in while maternal antibodies are still around the vaccine won’t stimulate the baby’s own immune system to respond, it will just get soaked up by the maternal antibodies doing their job.
  2. Okay To Go To The Grocery Or Have A Playdate With Your Infant?  Yes! With a few caveats, of course. If you’re in a county where multiple cases of active measles have been recently reported (Clark County reporting 62 cases) you may take more caution disallowing strangers to hold your baby and/or steering clear of anyone with a cough. Measles is infectious on surfaces and in the air for 2 hours after an infected individual has been in the space so it’s tricky to provide solid guidelines of how to avoid it if it’s around. If ever ANY concern for exposure, call your pediatrician to discuss a visit. Like everything in life we balance risk with benefit and being out and about in the world. If planning on visiting with guests or sharing in on a playdate, why not ask parents to children involved, “Is everyone here immunized against measles that can be? If you or your family live in Vancouver, Washington area or Portland area, look at the clinics and multiple schools that have had exposures. I would recommend being clear about how you access a clinic with an infant in these counties during this outbreak.
  3. Is my child’s school protected against a measles outbreak? In many states, you can track vaccination status for your child’s school because exemptions (those opting out of immunizations for medical or philosophical reasons) are tracked. In Washington State, parents can check to see what percent of children are up to date on immunizations in kindergarten by searching SchoolDigger. Because vaccination status is tracked at the state level, many other states provide this service (some are up on School Digger). To find your data, start at school digger or try a search on the state’s Department of Health website for more. If you’ve run into a roadblock or can’t find the information, it’s always your right to request the numbers from school administration or the school nurse. Outbreaks like this are one of the reasons California discontinued allowing children to attend school without up-to-date immunizations. Their non-protection puts other children at risk.
  4. As a parent, do I need another MMR shot? What If I’m pregnant? It’s unlikely you need more MMR shots if you were born after 1957 when vaccination was universal, most of us all got the shot as children. In 1989 we also started to do a 2nd dose of MMR to get more people protected (closer to 100% of the population). Only adults working with vulnerable populations and in health care need to go and get 2nd dose now. If you have ZERO written documentation anywhere that you’ve had MMR shot, talk with your doctor. In addition, if you’re pregnant now, no MMR shot until after the baby’s born. You can get an MMR shot safely while breastfeeding.
  5. Traveling internationally with infants: If you’re planning to travel abroad with your infant and they are between 6-12 months of age, it’s recommended they get an MMR shot before travel to protect against measles. They’ll need to repeat that MMR dose at 1 year of age, and the last shot at age 4 years, but they will be better protected during travel to higher-risk areas while still an infant.

What To Know For Children During A Measles Outbreak:

  1. If your child is up-to-date on MMR vaccination they can play and go to school and live life as they normally would during an outbreak! The MMR vaccine provides lifelong immunity for almost all who get it.
  2. If your child has had the 1st dose of the vaccination (usually given at age 1) and they haven’t yet had their 2nd dose, if you want to get the 2nd dose before age 4 years, especially if you live in or near areas of widespread outbreak or you’re planning travel, call your pediatrician or family practice office. The MMR dosing interval is 28 days meaning you can get the 2nd dose at any age as long as it’s been 4 weeks since the first.

Washington State Outbreak Information January 2019:

As of February 19, 2019, Clark County reports 62 confirmed cases of measles in the state of Washington. 1 confirmed case now in King County. The 62 confirmed cases include two cases who traveled to Hawaii and another case who traveled to Bend, Ore.

Age:

  • 1 to 10 years: 44 cases
  • 11 to 18 years: 15 cases
  • 19 to 29 years: one case
  • 30 to 39 years: two cases

Immunization Status:

  • Unverified: 6 cases
  • Unimmunized: 54 cases — the data here is proof that it’s those without the vaccine that are most susceptible! 
  • 1 MMR vaccine: 2 cases
  • In Clark County, 7.9% of children entering kindergarten had vaccine exemptions during the 2017-18 school year, according to the Washington State Department of Health. During the same school year, 7.5% of children in all grades in the county had vaccine exemptions. The county is working with teachers and families to ensure children at risk do not attend until they are immunized and/or this outbreak is under control.

Resources:

Teens, Technology, And Parenting in 2019

Happy Friday all! As promised, here’s a quick recap of last night’s event with Common Sense Media on tweens, teens, and technology and the effects it’s having on their developing brains. I learned so much participating on the panel alongside Dr. Mike Robb & Dr. Pat Kuhl and hearing from parents and educators who attended. I think we are all feeling a lot of anguish and overwhelm when it comes to deciding how much time we let our children use devices, what types of content we let them access, when they should have a smartphone, digital peer pressure, the list goes on and on. My goal for this post is to aggregate the best takeaways and tips that were shared last night in the hopes that it brings you some clarity and actionable steps to set your family up for digital success.

You can view the entire event online, at your convenience, on the Seattle Mama Doc Facebook page.

Tips For Parents – The Event’s Top 15 Takeaways:

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Devices, Gaming, And Smartphones Are Changing How We Live And Who We Are

I’m speaking tonight on a panel about tweens, teens, and technology and the impact it’s having on our children’s developing brains and well-being with Common Sense Media’s lead researcher, Dr. Mike Robb and University of Washington brain researcher, Dr. Pat Kuhl. The event is sold out because I think we’re all overwhelmed about the challenge of growing up digital. AND what is happening to our children. So if you haven’t registered- no worries – you can watch live on the Seattle Children’s Facebook page from 6:00 – 7:30 PM PST tonight. I will also share the video on my Facebook page tomorrow if that timeline doesn’t work for your schedule. The reality is, we are living in a new time where our tween and teens are exploring video games, smartphones, and screen time en masse. Just shy of 90% of teens have smartphones so this really is a everyone-issue. Fortnight has 200M users and people literally sit around on Youtube watching people play. Further, this isn’t just about being strict or employing numeric rules for devices. Many of us know that the challenge is more nuanced than “screen time” and just setting time limits. These smartphones are changing how we all live and ultimately who we all are. What does this mean for our children and their brains as they grow themselves into adulthood? And what does it mean for their mental health and connection? Their sense of belonging and their sense of safety…and what does it mean for our relationships with them? Read full post »

Bounty

It’s been a really long time since I blogged here about the comings and goings of life with two little boys. When the blog began (9+ years ago) I journeyed much more of the day-to-day raising, the emotional swings and glories, the experience practicing pediatrics, and the maneuvers it took to endure it all. And to enjoy it. I shared so much with the public then because I was learning that it could both be beautiful and meaningful for me to do so as a writer and pediatrician, but also could position the relevance of new science and bring the importance of believing it when making decisions (hint: vaccinate) into scope.

Work and life and my mind have gotten busier. The boys have gotten bigger. I’ve more fiercely protected their privacy in not sharing as many stories here. I’ve moved ideas and storytelling to other more constrained channels (TV, Instagram, Twitter, Alexa, speaking, new work). In the beginning, there were loyal readers and commenters; I would think about them when moments happened and I’d sit down to write in part because I wanted to share with them how I felt and why it mattered. So we could raise our children as best we could, together. And I know we haven’t grown the blog up over time, in fact, the way it looks today is exactly the way it looked when I wrote the first post in 2009. So in some ways it’s slowed down as my efforts at work and in digital health have really picked up.

But this morning there was a moment that swept me sideways a little. It was just so pretty. All of the sudden I wanted to share it here with you. And some of those long-ago loyal readers. So if this reaches you Viki, please enjoy.

Like a twinkle you see in a dark sky, the one you can sometimes feel might have traveled through the universe at the speed of light just for you to notice the change of light, my little boy did something he’s always done. And it felt as big as that kind of twinkle in a far-off sky. I know I’m possibly the only one on the planet, maybe the universe, who could see the history in it. Who could feel gravity in it. The bounty in knowing it’s just he who it belonged to. A fingerprint of who he is and who he has always been. And it was one of those triumphant moments in being alive. I’m not overstating that, I know you know them. One of the moments in being a parent that is so big and yet so undetectable to anyone else it’s hard to hold in your mind. Or even share with someone else. It could look trivial at first glance. It could feel small or irrelevant to another when spoken. But when you raise a child this is something you know….that regular life, regular little moments, can fuel the empire of your soul. Read full post »

Which Flu Vaccine Is Best For Children?

Injected flu shots or nasal flu spray?  The short answer, like so many things in life: it depends.

Data out this week summarizing the effectiveness of influenza vaccination for children over the past few seasons. The study published online was a meta-analysis –meaning it was a study of previously published studies — looking for the aggregate effect. Researchers wanted to evaluate the effectiveness of the flu shot compared to the nasal flu mist in protecting children. This year, the American Academy of Pediatrics (AAP) has recommended injected flu shots over nasal flu mist (the CDC recommended both without preference) and this study sought to evaluate the data used in that recommendation and evaluate the track record for influenza vaccinations in recent years.

There’s bad news, so-so news, and I think good (great) news here.

Background: There are multiple kinds of flu (called strains). The flu vaccine typically has 3 or 4 of the strains thought to be the ones that will likely come to the US. The nasal flu mist always has all four. This year the flu vaccination was changed to include two new strains compared to the vaccine last year (one new Influenza A and one new Influenza B). And as below, the nasal flu mist vaccine was redesigned to provoke better protection in the lining of your nose and throat based on data that efficacy had been poor, specifically for children, in recent years. Read full post »

Flu Doctor: New Alexa Skill To Support Families

Last year 180 children died in the United States from influenza infections or complications from the infection. And like many seasons before, about 80% of those children who died didn’t get a flu shot. As many pediatricians and parents remember, the influenza (“flu”) season was robust last year, coming on earlier than we expected, driving many children into serious-enough infections to require hospitalization, and causing tragedy in way too many families.

Influenza is predictably unpredictable so layering protections in our families can help (get flu shots, wash hands, stay home when ill, stay away from those who are sick). But the reality is, some people can spread influenza infection even before they feel symptoms, so there’s no fool-proof way in outsmarting the virus. Basically, influenza is gnarly and can be super gnarly some seasons. No way to know which kind of year it will be.

The wonderful thing about 2018 is that we have a vaccine for that. The flu shot and influenza nasal spray!

Alexa Flu Skill: Flu Doctor

We’re launching a new communication technology this week to help get the word out on ways to prevent influenza infections and reduce the likelihood of ever getting, or dying from, flu. We use the word “flu” because everyone else does but we clearly know we’re talking about one specific virus called Influenza.

The new Alexa skill is already waiting for you in your Alexa speaker — but you have to enable it. The goal here in doing so is for parents to gain more trust in the flu vaccine and the science behind recommendations, access accurate influenza information as flu season unfolds, and expand ways to help families understand the benefit of vaccination in preventing influenza. Our digital health innovation team at Seattle Children’s partnered with the digital health and innovation team at Boston Children’s Hospital in collaboration to build the “Flu Doctor.” It’s got flu shot information and answers to questions you may have — right in your kitchen — if you have an Alexa smart speaker. It’s live today and full of information, but I’ll also keep you updated as the flu season progresses with regular updates on how influenza is affecting families, the protection provided by influenza vaccinations, and additional ways you can protect your family. Read full post »

5 Ways To Protect Babies And Children In The Car: No Age Limit For Rear-Facing Car Seats


Unbelievable coincidence today: I stayed back this morning to finish this post while my family dropped off my son for a birthday party. There are complex carpools happening to get to the party (thank you, Village!) and while sorting it out someone offered my nine year-old a seat in a car — saying it would work out fine but the seat would be without a seat belt.

What? This kid of mine always uses a booster and a seat belt (he’s only 4 foot 7 inches tall). I mean, it’s 2018 and we know seat belts have saved more than 329,715 lives between 1960 and 2012 alone — more than all other vehicle technology combined, including air bags, energy-absorbing steering assemblies, and electronic stability control. I think we take their protective gift for granted. It’s hard for me to stay quiet with the “it will be fine” mentality to one of our riskiest endeavors — riding in the car. That video up there is one of my favorite PSAs of all time…

It’s not just family protection that makes protecting children a challenge. National Highway Traffic Safety Administration (NHTSA) data show that as children get older they are less likely to want to buckle up. For example, in 2016, 262 children 8 to 12 years old were killed in crashes. Nearly half of those who died were not wearing seat belts. But wearing seat belts greatly increases the chance of surviving a crash. AND using car seats, booster seats, and staying in the back of the car until age 13 years make it even safer.

Child safety seats reduce the risk of injury by 71% to 82% and reduce the risk of death by 28% when compared to children of similar age use in seat belts. Booster seats reduce the risk of non-fatal injury in 4 to 8 year-olds by 45% compared with seat belts alone.

This stuff matters. It always sounds so preachy to talk about, and I don’t want it to, but car safety is a place we SHOULD NEVER cut prevention corners. I just don’t know how to look at the world with a, “it’ll be fine” lens. Maybe because I’ve seen so many times, mostly during my medical training, that without proper seat belts and boosters it sometimes isn’t fine. Okay. New recommendations for car seats and seatbelts out this week. Let me get us all up to speed:

Since 2011 I’ve been saying: “2 is the new 1” when it comes to car seats but now it’s more like “4 or 5 years-old may be the new 1.” Babies, toddlers, & preschoolers are safer when in seats that face the rear of the car.

Back in 2011 we got serious, encouraging parents not to turn their newly-minted one year-old forward-facing in the car — the reasons were clear – data confirmed it was much safer for toddlers to remain rear-facing in the car (and in the event of a huge slowdown or car accident as the car comes to a stop, a toddler’s relatively large head and neck are protected better with the entire back, and sides of the seat, restraining them).

That recommendation has recently changed based on re-examination of the data and the ongoing understanding that rear-facing is safer……even longer. We’re borrowing from the Scandinavians here where most children sit rear-facing all through toddlerhood and preschool. Fortunately most “convertible” or car seats designed for toddlers are built to accommodate children rear-facing well past age 2 years. Seats have weight and height guidelines and restrictions on the seat itself, so you can always check the seat and ensure it accommodates your 3 or 4 year-old facing the back.

There is no rush to move children forward-facing — in fact every transition we make as our children grow decreases the protection they get (from infant bucket seat —> convertible 5-point car seat facing back of car —> convertible 5-point car seat facing front of car —-> booster seat in backseat —-> seatbelt in back seat —-> seat belt only in front seat at age 13 years) The new American Academy of Pediatrics guideline eliminates the age-specific milestone to turn a child’s car seat around. Instead, children should ride in rear-facing car seats until they reach the height or weight limit provided by the car seat manufacturer. That might be just before starting pre-K or Kindergarten.

5 New, Clear Recommendations For Protecting Babies and Children In The Car:

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Quick Reminder: Children Need To Play

Rounding off the summer with a somewhat obvious reminder to let our children play. This, as we bolster ourselves for the onslaught of the school year. Play remains an essential element of childhood and is good for children (of any age). Eating-vegetables-good-for-them but a lot more fun.

Summer has been a gorgeous reminder for me in how much joy I feel when my children roam and play and react and delight. I mean clutch-my-chest moments in just watching them tool around on a scooter, in the lake, or with our puppy in the backyard. Playing cards and laughing about how bad it all goes…..it’s these moments that feel most precious. A no-duh, I suppose, but each summer I’m reminded in a new way. I remember a moment in a Wisconsin lake this summer nose-to-nose with my youngest, the light silhouetting him, as a moment I want to (and plan to) hold onto forever. That tiny time in my life (lasted just seconds) so beautiful and HUGE and dear to me the memory of it almost seems to play in slow motion.

Nothing like that happened with an iPad this summer.

There’s reason not to maintain some of this summer-time play attitude all year. Play and this silliness remain relevant to raising children, and in my opinion, we gotta fight to protect it. Read full post »

What Is Dry Drowning

There was a media blitz on “dry drowning” last summer, just about this time, on a topic that is stirring up angst and worry among parents again this year. There’s good reason it makes parents nervous – drowning at baseline is a preventable tragedy that is terrifying to think on–  and it’s the leading cause of accidental death to children between age 1 to 4 years, and the second leading cause of accidental death in those between 5 and 14 years. Everyone is scared of it for good reason. But “dry drowning” (a submersion injury that happens in a different way from what most of us think about when we think about children drowning) sends people through the roof, in part because of misunderstandings. And the language, and the misleading nature to it all.

What Is “Dry Drowning?”

The term in itself is a bit confusing (and a little controversial among doctors — most emergency room doctors and pediatricians don’t want to use the term AT ALL). Pediatricians prefer and recommend referring to both dry and secondary drowning as “submersion injuries”. Drowning is drowning — but drowning, in and of itself, doesn’t mean death, it means exposure to water, by submersion, and injury from it. Technically speaking, as I understand best how parents and media talk about it, dry drowning is when a small amount of water causes spasms in the airway and the soft tissues in the airway (epiglottis, larynx) thus causing the airway to close up and make breathing very difficult. This is rare – but would happen within a few minutes of water entering the mouth and throat and being pushed back towards the airway, instigating spasm. This happens immediately after exiting the water. The spasm can be very dangerous and typically would cause sputtering or coughing or choking. This is an immediate reaction to water entering the airway. Read full post »

10 Things To Do While You Wear Orange To Support Reducing Gun Violence

Bravery — this is gonna take ongoing bravery!

Today is National Gun Violence Prevention Day and many around our country are rallying by wearing orange. Wear orange, please, but let’s remember that this is a long-term effort — to protect our children this is an everyday thing to help shape and change our culture. We must be persistent and carry today’s inspiration for orange through every day and tackle every opportunity we are presented with to reduce gun violence and tragedy. We must be brave to speak out and up about what we believe. We know #BlackLivesMatter and we know risk from gun violence isn’t the same for all of us. Children of color are at higher risk. We can work to reduce gun violence in so many ways by becoming more intolerant of injustices we see. They are everywhere and I think we are collectively learning more and more every day. This week’s news on twitter is no exception. We know school shootings go against everything we all want for our children. In addition to orange, let’s be bold. Let’s keep inventing new ways to reduce violence, suicide, tragedy, harm, and suffering from gun violence. This remains personal to me and I won’t relent.

10 Resources And Ideas To Help & Organize & Support #EndGunViolence

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