Seattle Mama Doc

A blog by Dr. Wendy Sue Swanson.

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


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.

I’ll try to explain it. And I may not be able to. But I know you know these moments and I want to connect with you knowing them. The ones where you’re reminded that the love you have for your child and the devotion you feel to your child amasses something almost uncontainable.

It was a regular morning this morning. We were buzzing around, readying for school, walking the dog, making the coffee later than we wanted, ensuring the plan for the school day and pick-up and work schedules were intact. Like the middle of January every year, the sky was darker than anyone wants it to be. The air in the house just a tiny bit cool as the heater worked it’s way up to the set temperature. And the moment, the twinkle, the one that happened for me came quickly. But I’ll remember it a long time and I know I’ll get to see it again.

My sweet 10 year old was eating oatmeal. Moving the sticky around in the bowl and occasionally taking a bite. I had that truly blessed feeling I can get when I watch my children eat – the divine pleasure in being a part of nourishing and growing them. So I suppose on some level I was primed for this to happen. I was already feeling so connected and content being at the table with him. But then he did this thing. The thing that he’s always done and I’ve never seen or known in another. He did it the very first time I put a spoonful into his mouth. It’s always felt an emblem to me of his spirit, his willingness to enjoy almost anything that happens to him in a way bigger than everyone around him. And this little bite of oatmeal was no different. He took his spoon, filled it up and then brought it to his mouth. But just before he put it in, both of his eyes opened up a little wider. His eyelashes raised up and his eyes –like his mind and his soul — seemed to take the moment in. Like his eyes were saying just what he feels about so many things, “yum.” His anticipation for the oatmeal as his anticipation for the rest of his life.

And it was just that.

That little thing that only he does. That his eyes bite his experiences just before he does. The involuntary fingerprint way he enjoys and eats up his life.  And in that moment when I recognized my sweet Oden just as he is, I felt so whole. In love and present and washed with the enormous bounty at once in being a parent and being alive.

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.

The bad news: The data included in the analysis (covering over 17,000 children) found likely what you’ve heard…that in the past years (specifically 2013 until 2016) the nasal flu mist wasn’t very effective protecting children against infections for Influenza A. The data also found that the nasal flu mist was mildly superior in protecting children from Influenza B.

The so-so news: We don’t know yet about this year’s influenza vaccination efficacy so there’s nothing conclusive today in the news despite what you’re reading…but we have a hunch. Especially because England has been widely giving children nasal spray flu vaccine since 2012.

The good news: The flu vaccine protects against influenza infections which can be gnarly and even deadly. Also, researchers note in the discussion of the study (and in an accompanying commentary) that the nasal flu spray vaccine has been redesigned (laboratory data demonstrated “improved replicative fitness in the lab and increased shedding and antibody responses).” In addition, preliminary estimates from the flu season in the United Kingdom suggest good effectiveness. The new 2018-2019 nasal flu vaccine may show great promise for improved efficacy protecting against Influenza A. In addition, in the United Kingdom during the 2017-2018 flu season, they found the redesigned nasal vaccine proved much better against strains of Influenza A (90% vaccine effectiveness against H1N1 strain last season)!

Below is an annotation I made summarizing figure 2 in the study and summarizing my opinion (feel good about either flu vaccination this year!)

BOTTOM LINE: Influenza infections are currently spreading all over the US. The influenza vaccine is an effective way (ahem: the best way, in fact) to protect your child from getting influenza. New data out of Europe where children were immunized with 2017-2018 redesigned nasal flu spray look very promising for great effectiveness for both Influenza A subtypes and Influenza B. England Public Health reports that last year, where they used updated nasal spray vaccine, the nasal spray was 90% effective against Influenza A (H1N1). This is very encouraging that the new nasal spray will work very well with children. But the data summarized in this week’s report (poor efficacy for Flu A with nasal) reflects why The AAP recommends shots over nasal this year. GET FLU SHOTS for everyone in your family. If you get a nasal flu spray (for those over age 2 who are healthy and without underlying medical problems) the hope is it will likely work very well protecting you and your child, as well, because of the redesign.


Annotation of data published online January 7, 2019

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.

Really this is just the beginning in learning how to use tools like Amazon’s Alexa smart speaker to connect you with vetted information. We want to learn how to support families in understanding immunizations at large by starting with one vaccine in particular. We’re dreaming up skills that will help remind you to get your child vaccinated (imagine how nice it will be when your child turns 4 and your smart speaker explains what shots she needs and WHY and then helps you schedule an appointment)!

Our Flu Doctor responses (and my recordings) were vetted with communication experts at The Centers for Disease Control (CDC), The American Academy of Pediatrics (AAP), pediatric infectious disease experts, and the WA State Department of Health. Our skill offers responses and education on a variety of influenza topics. When you open the skill with Alexa (say, “Alexa, open Flu Doctor”) she will allow for a two-way conversation about influenza, influenza vaccination, and support you in finding the closest location for a flu shot. More in this skill:

  • Who should get a flu shot (everyone over 6 months of age).
  • When you should get a flu shot (read: now).
  • Common side effects of flu shots (soreness at the injection site, sometimes fever in young children, & malaise).
  • Treatments & remedies for influenza infections (OTC medicines, prescription anti-flu medicines if started within 48 hours of symptom onset).
  • Where you can get a flu shot. The skill has awesome integration powered by Vaccine Finder. You can ask Flu Doctor to find the 3 closest locations to your home or office.
  • How to help with needle fear and children who are scared of shots.
  • Support for families with allergies (no need to avoid flu shots with an egg allergy).
  • Data for pregnant moms and ways to protect newborn babies (get flu shot, pass on antibodies to baby in 3rd trimester).
  • Efficacy statistics — how well the vaccine has worked in the past and how well it’s working this year (updates as data unfolds).
  • Common symptoms and ways to know or suspect influenza and tips on when to call the doctor.
  • Types of vaccine available this year (flu shot versus nasal spray, and the 2 new strains included in this year’s flu shot).

The Flu Doctor skill includes about a dozen video responses for those who own an Alexa Show (a smart speaker with a smart screen).

As a pediatrician in digital health, I want to learn about how families may want to use Alexa to help in their homes and family decisions around prevention and health care. Will you please enable the skill on your Alexa device and try it out? I would love to hear your feedback. What do you like? What could we improve? What questions didn’t we answer? We have two awesome teams ready to improve this skills as time unfolds…and keep building more.

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…’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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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 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?

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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 »