Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

2019 Measles Outbreak: Information for Parents

Measles, measles, and more measles. I know, it seems like all I’m writing about.  I’ve been doing media interviews for weeks now on measles infections and there doesn’t seem to be a slowdown yet. As it stands, there are currently 839 measles cases in the U.S. and children under age 5 years old account for about half of the cases. The vast majority of cases are in those who are unvaccinated. I’ve been asked: “Is the situation improving?” The answer is…no…sadly. The 75 new cases this week are a higher bump than in the previous two weeks, when about 60 additional cases were reported each week. Measles is wildly contagious. It spreads when a person infected with the measles virus breathes, coughs, or sneezes. You can catch measles just by being in a room where a person with measles has been, up to 2 hours after that person is gone.

The great news, as always, is that we have a vaccine for this! We can prevent this from ever happening in the first place! Parents and children who are immunized are well protected and don’t need to worry right now.

This is the greatest number of cases reported in the U.S. since measles was eliminated from this country in 2000.  The high number of cases in 2019 is primarily the result of a few large outbreaks – one in Washington State and two large outbreaks in New York that started in late 2018. New York has the biggest outbreak, accounting for almost 700, or more than 80%, of the cases nationwide. There are 4 new confirmed measles cases in western Washington involving people who spent time at the Seattle-Tacoma International Airport. If you’re concerned you could have been exposed, talk with your doctor.

If you wonder if you’re up-to-date on MMR vaccines talk with your doc about a blood test to prove your immunity or repeating/starting the MMR shot. Here’s info on MMR shot.

Perhaps one shining light that has come from this awful outbreak is that new laws are being passed to increase safety in our schools and communities. Last Friday, in my home state, Washington’s governor signed a law that says parents with children heading to daycare or school will no longer be able to claim personal or philosophical objections to the measles, mumps and rubella vaccine — schools will increasingly be the LAST place your child would ever get exposed to measles. Big win!

Children Too Young To Be Immunized:

The question I may have received the most is surrounding protection for babies too young to be immunized. Can I travel with my baby? Should I avoid the grocery store? Can they go on playdates? My answer is a little complicated — but yes, even during this outbreak we can live mostly as we normally do. You do not need to hunker down at home.

I hate that I can’t completely say infants are perfectly safe during an outbreak. Infants are a vulnerable population during a measles outbreak …however, newborns are well protected by the antibodies their mom passed onto them. With each month after birth, infants gradually lose some of those maternal antibodies and they become more at-risk if, in the rare case, they are exposed. Breastmilk has immune protection but it isn’t thought to be enough to protect an infant alone.

Measles is wildly contagious and during an outbreak, it can spread, especially to older infants and children 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 also spread it to your baby). If you don’t live in an area where there is an active outbreak, I would say, yes, take your baby grocery shopping and go on your vacation. If you are traveling internationally, and your baby is 6 months of age, we recommend they go get the MMR vaccine a little early (typically given at 12 months of age). Here’s some more information I wrote when the outbreaks started about infants and young children.

What About Infants 6-12 Months Who Live Where Outbreaks Are Occurring?

You can always talk with your own pediatrician about this. The short answer is there is no need to accelerate the vaccine schedule for your baby (no need to get an “early shot” of MMR) right now in the US and in fact, there may be more reason not to. Here’s how the state of Washington Dept of Health explains it that I’ve just learned:

“Although there is urgency to protect the public, there is currently no Washington State Public Health recommendation to immunize infants below the age of 12 months earlier than the recommended schedule.  Although the Advisory Committee for Immunization Practice (ACIP) recommendations include vaccinations for children in this age group related to international travel and for prophylaxis within three days of exposure to measles, there are risks associated with receiving MMR vaccine under the age of 12 months.  A review of Washington Immunization Information System (WA IIS) indicates a higher number than usual children below the age of 12 months received the MMR vaccine in January and February 2019. The vast majority of these doses were not given as prophylaxis in the three days following an exposure to a measles case, and only a few are likely to be related to international travel. This is of concern because administration of MMR below the age of 12 months has been associated with blunting of the immune response to subsequent doses administered according to the routine ACIP recommendations.”

This means that there is no need to get the vaccine early (in a healthy 8 month-old baby living in Seattle, for example) as the early immunization may make the later immunization less effective and durable. Because the risk is still SO LOW in getting measles, it’s not recommended. If an infant is exposed to measles, then we would immunize early because the risk is so increased in getting measles that it’s worth the small risk in it “blunting” the later immunizations to avoid an infection now.

Bottom line: talk with your pediatrician if any concerns but no need to change the vaccine schedule, even as we see more local cases and additional cases sporadically around the country. I’ll keep you posted if this changes.

Nice 1-page handout on measles and the vaccine for you for sharing!

MMR Vaccine Recommendations:

Routine vaccination

  • 2-dose series at 12–15 months and again at 4–6 years
  • Dose 2 may be administered as early as 4 weeks after dose 1.

Catch-up vaccination

  • Unvaccinated children and adolescents: 2 doses at least 4 weeks apart

Special situations & International travel

  • Infants age 6–11 months: 1 dose before departure; revaccinate with dose 2 at 12–15 months (12 months for children in high-risk areas) and dose 3 as early as 4 weeks later.
  • Unvaccinated children age 12 months and older: 2-dose series at least 4 weeks apart before departure
  • What should be done if someone is exposed to measles? Notification of the exposure should be communicated to a doctor. If the person has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within six days of exposure.

Measles, MMR Vaccine, Immunity, & Breastmilk

So much in the news lately about measles. A bit disappointing considering we sincerely thought it was “eliminated” in 2000. As you’ve heard, in the New York City area, there have been 285 confirmed cases since their outbreak began in the fall. Mayor Bill de Blasio declared a public health emergency that would require unvaccinated individuals living in Williamsburg, Brooklyn, to receive the measles vaccine. The mayor said the city would issue violations and possibly fines of $1,000 for those who did not comply who lived in areas with dense outbreaks.

Under-vaccinated populations are at risk for outbreaks. Case in point in New York and Washington State. Public health officials are stepping in to stop the spread, the hospitalizations, and the absolutely unnecessary toll it’s taking on human health. Measles IS and remains a wildly contagious virus; measles IS and remains vaccine-preventable.

Across the country, there have been 465 measles cases since the start of 2019, with 78 new cases in the last week alone, the Centers for Disease Control and Prevention said on Monday (4.8.19). In Washington State, our outbreak led to 73 confirmed cases.

I don’t think I can be any more clear: the best way to protect yourself against measles is to get immunized (>98% effective vaccine for lifelong protection) or to not be exposed in the first place (live in an immunized, safe community). The healthiest place to live is where everyone is healthy and immunized. If you and your children are immunized with 2 doses of the MMR vaccines, you can feel very comfortable, even in the midst of an outbreak. The vaccine is that good — safe and just amazingly effective at creating immune protection that is iron-clad.

MMR Vaccine

The 1st dose (and 2nd dose for those infants and children who didn’t respond to the first) of the MMR (measles, mumps, rubella) vaccine work to trigger lifelong immunity. Typically after the 1st dose (given here at 12 months of age), 95% of people immunized are protected for life. The 2nd dose (typically given at age 4 years) 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 yet, 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.

Infants, Antibodies, and Breastfeeding:

Under 6 months: Infants are a vulnerable population during a measles outbreak. We don’t recommend the MMR vaccine to infants under 6 months of age. The reason being, if the mom has had the MMR vaccine or had a measles infection, her maternal antibody protection is passed onto her baby while in utero. Those antibodies stay with the baby after birth and circulate in baby’s bloodstream — therefore those very maternal antibodies would prohibit the vaccine from working in the first place. If you administer a vaccine while maternal antibodies are still around, the vaccine won’t stimulate the baby’s own immune system to respond, the vaccine itself will just get soaked up by the maternal antibodies doing their job.

Over 6 months: After your baby is 6 months of age, if you live in an area of outbreak or if you’re ever traveling out of the country, you can consider early vaccination with MMR to protect your baby. 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 at any time (even when no outbreaks here in US). Your baby will still need to repeat that MMR dose at 1 year of age, and get the last shot at age 4 years, but they will be better protected during travel to higher-risk areas while still an infant.

What about breastfeeding & measles protection? When it comes to breastfeeding and passive immunity coming from mom, the data is a little murky. The strongest point I can make is that stronger protection comes from vertical transmission (in-utero immunity passed on by mom through the placenta directly to baby) than from antibodies in breastmilk. We know there is likely some immune protection against measles in breastmilk, but its utility is not known or trusted. If you are breastfeeding, your baby is not receiving full protection against any infection from your breastmilk. Measles is no different – and I’d say even harder to protect against compared to other infections because it is so contagious and so serious. The best way to protect your baby from measles is to steer clear of the infection if known outbreaks, immunize your baby if over 6 months of age in an area of outbreak or if you’re leaving the country, and then make sure you immunize your baby at age 12 months. Breastmilk is triple great for you and for baby but is not singularly protective (or strongly protective at all) for fighting off or preventing, measles infections.


How And Why To Treat Teen Acne

Acne can be an extremely difficult medical challenge for children, teens, and adults. And let me be straight here: there is almost always something we can do to make it better. You don’t have to accept untreated acne as the end game. If you think acne is an issue of vanity, I urge you to read on. Acne can have enduring emotional and psychological consequences. Doing something now to support someone you know and love with acne can be powerful advocacy.

I’ve seen teens who worry about their acne be errantly categorized as having a concern for an appearance issue or be questioned about their “vanity” … when in reality, acne commonly causes real self-esteem issues and significant stress. Acne is a medical condition and many teens can use affordable, regular treatments that improve appearance, health, and well-being. Rarely, acne can cause disfiguring acne lesions, pox, or leave life-long scars. So approaching a plan for acne always makes sense. As long as anyone around a teen (or even an adult) treats acne as a vanity issue we’ll be under-supporting people and patients who don’t like the acne on their face or chest or back (or all of the above). No question early treatment of acne can prevent emotional distress. No question this is a medical condition.

Our face, and the skin on it, can at times feel like our largest presentation to the world despite how much stronger who we are — at the level of our soul — really matters. Practically speaking though, the biggest organ in our body is our skin and it does play the lead role at times in our life, especially when it’s not what we want it to be. When we have acne it can at times cause us to feel uncomfortable physically (big pimples really do hurt!) but also, emotionally.

The good news is that although the far majority of teens (75-80%) have acne lesions at some point, there are lots of ways to treat and even cure acne.

Here is a lively podcast I did with pediatric dermatologist, Dr. Markus Boos. He’s an awesome and super smart dermatologist. We bust myths, review Pediatrics guidelines, and highlight ways to treat teen acne.

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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):

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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 »


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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