Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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

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.

We are learning more and more about how play creates pathways in making us who we are. Children who play at least an hour a day are more creative and better able to negotiate multiple tasks later one in life. It’s true children need to play to learn and relax but also grow and develop — they need the unstructured kind of play that takes no planning. I’m talking go-outside-run around-play-with-traditional-toys-free-play. Not scheduled, structured, pre-defined play with organized sports or Girl Scouts. Play is important enough — especially as technology’s competition for play accelerates — that the American Academy of Pediatrics just published a clinical report this week dedicated to the importance of play. The last report about the same topic was last out in 2007 and since then, additional evidence supports play as critical in a child’s life. The report states:

“The importance of playful learning for children cannot be overemphasized…play is not frivolous; it enhances brain structure and function and promotes executive function (the process of learning, rather than the content), which allow us to pursue goals and ignore distractions.

I mean what if all played with our children for an hour a day with nothing but a few toys or the sky or the park or the backyard? Research finds it might be an affordable and awesome way to spend our lives.

Improving skills around ignoring distractions sounds so good. Play helps build children’s brains allowing for better executive function skills, it improves academic skills, and reduces the negative impacts of stress. It ultimately creates more resilient children. Roaming time, backyard time, play with a nurturing parent cannot be replaced with technology or with tasks. The report ends with conclusions that include a nudge on cultural shifts, including less parent engagement because of working full-time and fewer safe spaces to play, coupled with digital distractions — all of these have limited the opportunity for children to play. A very 21st-century truth.

Not news: the culture in the US has increasingly focused on academic readiness and skill-based accomplishment that leads many families to focus on structured activities to enrich academic results, as early as preschool. I think many of us feel pressure to enroll our children in multiple activities to prepare them for school and their academic achievement. More and more, play may need more airtime. Recess is a crucial class during the school day for learning during the rest of it.

Curiosity and exploration unfurl new skills from 4 to 6 months-of-age up until the teen years. Children will often surprise themselves with accidental accomplishments while playing. They gain confidence and joy but also skill in the discovery. No question that when playing with a parent, children experience joy which helps regulate the body’s stress response.  Unstructured play at any age fosters creativity and drives new skills and wonder. We all know this but data and these policies can help drive the way we protect it in our children’s lives.

Play is one of the most important gifts we share with our children. We want our children to have unbounded playtime without margins and restrictions. We want the opportunities for our children without screens and noise and “true toys—things like blocks and dolls” to play creatively from the very beginning. It’s obvious and true that what our children may need most is a parent’s full attention, time for play, and a place at home to stretch out and roam.

Play Is Good For Children:

Now, more than ever, play is at risk. Hate to sound like an old lady, but I think it’s perilous to avoid making sure we’re protecting time without a ceiling. We all need time to roam around the planet and inside our minds.

  • From 1981 to 1997, children’s playtime decreased by 25%, and 30% of kindergarten children no longer have recess, which has been replaced by academic lessons, according to research published in Advances in Life Course Research. Be the squeaky wheel parent. Ask your school about recess and the amount of time your child gets outside of the classroom. Children with adequate recess have better learning.
  • Play is intrinsically motivated and comes naturally to children, given the chance. “Joyful discovery” ensues.
  • A national survey of 8,950 preschool children and parents found that only 51% of children went outside to walk or play once a day with a parent. Try to make play a daily ritual. Even if it’s a short walk around the block after dinner.
  • And surveys have found as many as 94% of parents have safety concerns about outdoor play. Finding places that feel safe for our families is an essential task to make play be all it can be.
  • Play is a great place for parents and children to bond but also “scaffold the foundational motor, social-emotional, language, executive functioning, math, and self-regulation skills needed to be successful in an increasingly complex and collaborative world.” When a child asks to play – DO IT.
  • Despite research that links television watching with a sedentary lifestyle and the research that confirms it pulls children away from play and increases risks for obesity, higher blood pressure, and ultimately shorter lives. t=The typical preschooler watches 4.5 hours of television per day, according to media research. Limiting screentime is a challenge for many of us, but the AAP has an awesome resource to help your family to create a media plan that sets boundaries for how much time your children are on their devices and/or watching television.
  • I love the final conclusion in the report, “Play provides a singular opportunity to build the executive functioning that underlies adaptive behaviors at home, improve language and math skills in school, build the safe and stable and nurturing relationships that buffer against toxic stress, and build social-emotional resilience.” Everything we ALL NEED for a long and meaningful life.

More play, more roaming, more resilience this year. Yes, please.

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.

Secondary drowning, as some call it, is when water gets into lungs and causes inflammation or swelling inside the lungs, making it difficult or impossible to transfer oxygen effectively to the rest of the body. Water can enter the lungs in small amounts even 24 hours before showing signs of increasing distress as inflammation builds. The injury from a submersion injury like this wouldn’t happen out of the blue. This distress and inflammation would happen over time with coughing, feeling or acting ill, distress, coughing again, vomiting, or difficulties in doing regular activities.

Most important, thankfully, is these two unusual submersion injuries, are exceedingly rare, only representing 1-2% of drowning deaths.

Let me be clear with a scenario here….you take your child to the pool, they go under the water for a few seconds and pop up sputtering and maybe coughing a bit. They appear normal in all aspects within seconds (talking, breathing, eating, alertness, giggling, playing, etc.) and you go home. They eat a normal meal and head to bed without any cough or trouble. Your child is not going to suddenly die in their sleep from “dry drowning” without a single symptom. It just doesn’t physiologically happen this way. It’s where the term feels like it’s a scary lurking monster. And submersion injuries aren’t like that. With a submersion injury to the lung, a child would typically show signs of lung irritation, fatigue, coughing, and trouble breathing first. If at any time your child does that, of course call your pediatrician or head in immediately if you’re concerned after swimming.

What Parents Need To Know:

  • No question submersion injuries are preventable. Supervision is always our 1st line of defense! Just being present, not walking away, not allowing distractions (cell phone, alcohol, sleep, etc) will always be the best line of defense, especially with young children or new swimmers. Always closely watch children near or in water. Any tiny pool of water is a risk, especially for toddlers. Make sure lifeguards are present when children are at pools. If you don’t feel lifeguards are doing their job – speak up! Learn what to do if you spot a child you think is drowning. Learn CPR for infants and children, too.
  • Teach your child how to swim. Start as early as 1 years of age or younger if your infant is ready to be in the water with you. Data supports that children over age 1 have some protective benefits from swim lessons. Although swim lessons will not prevent all drowning, it will help children be safer around water as they age. Never use swimming lessons as a reason to leave children alone. In my mind, no one should ever swim alone.
  • Put your child in a U.S. Coast Guard-approved life jacket when playing in or near the water, on a dock or in a boat, raft or inner tube. Supervision and a life jacket are two of the most important things you can provide to protect your child from drowning.

Symptoms Of Submersion Injuries Or “Dry Drowning:”

  • Persistent coughing and/or increased “work of breathing” after swimming
  • Sleepiness out of proportion after swimming
  • Forgetfulness or change in behavior, in context of other changes after swimming
  • Throwing up (a sign of stress, and sometimes from inflammation in lungs)

For all children pulled from the water for concern of injury:

  • Call pediatrician or 911 even if you think they are ok (no hurt in checking in with them)
  • Monitor for 24 hours after submersion

Some Data To Keep Drowning In Perspective:

  • Children ages 1 to 4 have the highest drowning rates. They DEMAND constant, in arm’s reach supervision.
  • Immersion-related drownings are preventable and you being around and watching changes the game!
    • 91% of deaths were associated with lack of direct supervisor
    • 82% of deaths were 4 years or younger
    • 70% occurred at home (this means home pools, hot tubs, bath tubs, kiddie pools, etc.)

Resources:

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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No Benzocaine For Teething Babies

Hallelujah, I’ve been saying I don’t like teething gels since 2010. This is a PSA for all parents out there trying to help soothe their teething baby. Today, the FDA came out and said avoid using over-the-counter teething products containing benzocaine. That means no teething gels like Anbesol, Baby Orajel, Cepacol, Chloraseptic, Hurricaine, Orabase, Orajel, Topex or other generic brands. The agency said “products containing the pain reliever benzocaine for the temporary relief of sore gums due to teething in infants or children should no longer be marketed and is asking companies to stop selling these products for such use. If companies do not comply, the FDA will initiate a regulatory action to remove these products from the market.”

This is great news for parents (and pediatricians who have been advising against it for years). In general, I think most pediatricians think of teething as a developmental milestone, not a condition that demands medicine. That being said, we always wanna make our babies, who may look uncomfortable, more comfortable. But the last thing we want to do is reach for something that might cause harm. Read full post »

5 Quick Things: Hot Cars, 13 Reasons Why, Marijuana Smoke, Single Sports, Co-Sleeping

I recently changed up the format of reporting I do with my local NBC affiliate station KING5 News. I’m doing more of a weekly roundup of pediatric studies, current events and newsworthy topics that I think are important for parents to know about. For those of you who aren’t able to tune in, I wanted to share a brief synopsis of what I’m covering. Let me know what you think! What topics would you want me to talk about?

1. 13 Reasons Why: Netflix released the second season of “13 Reasons Why” a popular show about a high school student’s suicide. A recent Pediatrics study that found hospitalization rates are increasing for suicide attempts and ideation (doubled between 2008-2015), so this show’s release was particularly untimely. I really appreciate the HealthyChildren.org page with strategies for parents to discuss the show with their teens. These portrayals in media matter: using Google Analytics, data found that there was a significant increase in online searches for suicide, including searches for how to kill oneself, in the days after 13 Reasons Why debuted. This increase reflected as many as 1.5 million more searches than expected, with a 26% spike in searches for the phrase “how to commit suicide.” Reminder that all teens should be screened every year for depression starting at age 12. Here’s a fantastic piece with 13 Things All Pediatricians Should Know About 13 Reasons Why but I think all parents should, too.

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Is Co-Sleeping Safe? Do You Do It?

The short answer to the title is —- not really, and the risk varies. But I sure get why so many parents want to co-sleep despite most pediatricians urging against it.

I was up early yesterday morning listening to NPR when a story about parents’ love and desire to sleep with their babies grabbed my attention. The headline reads: “Is sleeping with your baby as dangerous as doctors say?” I mean, parents (like me) want(ed) to co-sleep and bond with their babies, of course, especially when their babies fuss and cry and especially when parents are exhausted. Every pediatrician hears and understands the parent who says something like, “By 3am I was just so tired I plopped her in bed with me after feeding and gave up on the bassinet.”

Parents ARE tired and want to make that crying, noise, and a baby’s sadness go away. The piece opened up the challenge in parents feeling judged or insecure about sharing truths with pediatricians who have strongly advised them to separate sleeping spaces. Many parents may feel that if they continue, in overwhelm, or instinct, or in love to bed-share and co-sleep, they have to keep it from their pediatrician.

The rub here is pediatricians want what is best for families and what’s best for the bond between babies and their parents. But they also want to protect babies as best they can with the evidence fueling guidelines and advice.  How we’re talking about this may miss some salient points in American family lives.

Putting babies on their back in safe sleep environments has proved so helpful for protecting babies. But the guidelines may have focused too little on the risk that comes with over-tired parents who just can’t follow the advice and the risks co-sleeping may pose particularly when a tired, working mom co-sleeps out of desperation. Sleep experts have helped me understand that sleep deprivation changes arousal and it may be riskier for an over-tired parent to co-sleep than a better rested one. Read full post »

Car Seats and Booster Seats And Your Precious Cargo While Carpooling

A friend pulled me aside last week urging me to write about car seat and seatbelt safety. His family had been involved in a rollover accident on the way home from school — literally, just turning in an intersection, as I understand it, they were plowed into by another car which caused their car to flip. No one was seriously injured, thank goodness, but the children were left dangling upside down, hanging by seat belts, until the medics arrived. Clearly they were shaken…and reminded how precious our time is on this planet — and how the most dangerous thing most of us do everyday is drive. All the children had seat belts on and all the children were in the back seat. Phew!

Thing is, just after this dad urged me to write this, I mean literally, just minutes later, we pulled away from a group of parents at pick-up and I watched an 11 year-old get into the front seat of her family’s car and drive away. My stomach dropped. Children under age 13 shouldn’t be in the front seat and goodness gracious, the irony of the timing just got me in the gut. Hard to message and write about something that I feel parents don’t want to know more about. Something about a laxity here for many people remains…seems this is advice many already feel they know (and don’t want to take).

3 reasons children shouldn’t sit it front seat until age 13 years: 1) It’s always safer to ride in the backseat (it’s also illegal to ride in front under age 13 years in WA state), 2) children under age 13 years are at increased risk for injury from airbags (designed for a 140 lb male), and 3) children’s bone development at the hips and breastbone is immature leading to increased risk of more serious injury in front seat

When it comes to infants and little children, maybe it’s different — I feel like parents are more interested in the data and reminders. Research out last week confirms what pediatricians have been recommending for years: rear-facing car seats to keep children safer in rear impact collisions. “We found that the rear-facing car seats protected the crash test dummy well when exposed to a typical rear impact,” said lead study author Julie Mansfield. If you’re hit from behind or the side or the front, we want children under 2 years of age rear-facing! Read full post »

5 Things You Should Know About Concussions

This is a post authored by J. Forrest Bennett, ARNP who works in the rehabilitation department and on the concussion team led by Dr Samuel Browd (@DrBrowd), medical director of Seattle Children’s Sports Concussion Program. Forrest has had the unique experience to care for children after concussions in the immediate time after injury and in weeks to months thereafter when symptoms are prolonged. His wisdom can help us all understand the opportunity we have to improve children’s recovery after a head injury. In this post he explains what happens to the brain cells during a concussion, what constitutes risk for concussions, and the 5 things all of us need to know about concussions. I certainly know more after reading this and suspect you will too. Please leave comments or questions if you have them. Click here to read the first post in this series. 


Soccer is the highest risk sport for school-age girls.

Soccer is the highest risk sport for school-age girls.

What Happens During A Concussion?

A concussion is a complex process affecting the brain, brought on by biomechanical forces (like a blow to the head, car crash, etc.) The force is transmitted to the head and can result in usually short-lived symptoms such as headaches, brief loss of consciousness, nausea, and/or dizziness. These symptoms are believed to be due to a temporary shift in the neurotransmitters (chemicals that allow cells to communicate) in the brain. This helps explain the symptoms associated with a time-limited injury such as a concussion.

This also explains why diagnosing and managing concussions can be frustrating for families and medical providers. Unlike a broken bone, we do not have imagining or blood tests that enable definitive diagnosis of concussion. Medical providers will sometimes order head CTs or brain MRIs to make sure that there is not a more severe injury, but the scans cannot diagnosis concussion.

Diagnosing concussion currently relies on a detailed history and physical exam. If an injury occurs when a child is playing in an organized sport, a sideline assessment should be performed to look for common post-concussive symptoms. In 2017, the guideline for sideline assessment for concussion was updated. Depending on the severity of the initial presentation, one may need to be evaluated in an emergency department to help rule out a more severe injury.
The goal is to prevent injuries, screen for potential head injuries when appropriate, and to diagnose injuries so that we can treat the symptoms and limit the impact.

How To Prevent Head Injuries

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Sore Throat Versus Strep Throat

When you or your child has a sore throat, it can be hard to tell if it might be something that needs medical intervention, like Strep throat. Strep throat is an infection caused by group A Streptococcus (GAS). When you confirm (by throat swab in the lab) that GAS is present, your child needs 10 days of antibiotics. If the test is negative, it’s unlikely you need any Rx medical treatment! More below:

  • Sore Throat
    • Tonsillitis refers to tonsils that are inflamed. Inflamed tonsils (and even when they have white stuff on them) doesn’t necessarily mean your child needs antibiotics. If enlarged tonsils make it hard to swallow or changes the sounds when your child breaths, they need to see a pediatrician.
    • Pharyngitis refers to an inflamed throat. Most episodes of pharyngitis are caused by infections from viruses. Some are caused by other bacteria that live in the throat that aren’t as problematic as GAS and don’t require antibiotic treatment.
    • Viruses, bacteria, allergens, environmental irritants (such as cigarette smoke), and chronic postnasal drip can all cause a sore throat. Most tonsillitis & pharyngitis will typically resolve on their own without prescription treatment.
    • Try acetaminophen or ibuprofen for pain, throat lozenges, warm beverages, gargling salt water and get lots of rest. In time, sore throats typically improve in a few days.
  • Strep throat is an infection caused by a specific type of bacteria, Streptococcus. Infections from the bacteria can be minor or severe. When your child has Strep throat, their tonsils are usually very inflamed, they likely have a fever and swollen lymph nodes in the front of the neck, a BAD sore throat, and sometimes a headache. Many children complain of lots of pain with swallowing. Strep throat symptoms typically come in isolation from other “cold symptoms.” With typical strep, most children do not have cough, runny nose or hoarseness (changes in your voice that makes it sound breathy, raspy, or strained). No one can diagnose strep throat just by looking at your throat. Instead, healthcare professionals use two tests to see if group A Strep bacteria are causing a sore throat. A “rapid strep test” involves swabbing your throat and gives results quickly, usually in about 15-20 minutes. The test is accurate about 95% of the time meaning only 1 in 20 people (5%) who have a negative test actually may have the infection. If the rapid test is positive, your doctor or provider will prescribe antibiotics. If the test is negative, your healthcare professional may likely send the swab for a full throat culture (to catch the 5% that falsely didn’t show an infection). A throat culture involves sending a throat swab to a lab for 1-2 days to see if bacteria grow from the sample. If it turns positive, then your child should be treated with an antibiotic for 10 days.

Great information from the American Academy of Pediatrics on the differences between a sore throat and strep.

E-cigarette Studies In Teens Bust Safety Myths

Two new studies out today on e-cigarettes showed e-cigs remain a significant concern for teen users. E-cigs were found to pass along carcinogens (cancer-causing chemicals) to those who used them and are associated with future tobacco cigarette smoking in teens. Data out today in Pediatrics finds that teens who used e-cigarettes had up to three times greater amounts of five volatile organic compounds (carcinogens) in their urine compared to teens who did not use e-cigarettes at all. Teens using fruit flavored e-cigarette products, often the preferred choices for teens, produced significantly higher levels of acrylonitrile (a volatile organic compound, known to be toxic). Teens who used both e-cigs and tobacco cigs had even higher levels of the carcinogens overall.

Let’s be clear, e-cigarettes are not “safe” nor do they provide health benefits for teens. It’s our obligation to help teens and parents everywhere understand that…the data keeps accumulating as more and more teens use e-cigs across the country. E-cigs tend to increase smoking of traditional tobacco cigarettes, too. My worry is many teens believe e-cigs are safe to use. More and more, I’m certain they are not.

Relevant E-Cigarette Statistics:

  • About 95% of adult tobacco users started using before they turned 21 years of age. In the study out today, E-cigs were positively and independently associated with progression to being a regular, established smoker. Researchers conclude, “data suggest that e-cigarettes do not divert from, and may encourage, cigarette smoking” in teen population. Especially in those who have a tried a few cigs but not yet established a smoking habit. Rather than being a “safer” choice e-cigs enhance the choice to smoke traditional cigs in teens.
  • Use of e-cigarettes rose 900% between 2011 and 2015. And between 2014 and 2016, US middle and HS students used e-cigs more than any other tobacco product.
  • 85% of e-cigarette users ages 12-17 use flavors. In the study out today, carcinogens and toxic substances were increased in teens’ urine in those who used e-cigs compared with those who didn’t. Added risks may be in fruit-flavored e-cigs preferred by teens; even higher levels of a specific toxin (acrylonitrile) was detected.

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