Archive for March 2014

Monthly Archive

New Autism Numbers, Ways To Advocate

1 in 68 from CDCHeadlines soared yesterday with the CDC report that the number of children with autism diagnoses had increased by 30% in the past 2 years. “Reality is there are many children who are having serious struggles because they can’t communicate well and have a hard time being with people,” Dr Chuck Cowan clearly stated to me this morning. Like a bell on a quiet night, I feel parents need to hear this most: we just want to connect children with the resources they need to thrive at home and at school and throughout their lives. Doesn’t matter what we call it, we want children of all backgrounds, of all resources, and all opportunity to be afforded the chance for a connected, lovely life. As a realist of course, I do know that numbers matter because it changes how we screen, how we advocate for children, how we move funds and resources, and how we ensure children get what we need. Numbers help activate.

The new numbers don’t mean anything is different today than it was 2 years ago really. Instead:

The “new” number published this week finds an estimated 1 out of every 68 children here in the US has an autism diagnosis at age 8. Like before, likelihood for autism is more common if you have a family history of autism and 5 times more common for boys compared to girls. Children who aren’t white don’t get identified as having autism as often and we know from numerous studies non-white children don’t get the resources they need like their caucasian counterparts. That’s not new, either. Also, there may be environmental factors at play although data on determining true environmental causes of autism, versus associations, is still unfolding. Researchers are trying to sort out the role for chemical exposures, e.g. how close you live to highways, and what your children eats in predisposing a child to challenges with communication.

Over the past few months I’d say we’ve been bombarded with unsettling news; we’ve heard that autism likely starts before birth, that children born to older fathers are more likely to get the diagnosis and we’ve even heard that taking Tylenol during pregnancy may increase the odds that our children can’t pay attention. I mean, YIPES! Before you entirely freak out, listen to this: Read full post »

Wild Success, Bill To Ban Indoor Tanning

Screen Shot 2014-03-28 at 11.29.47 AMOMG, it’s a good day for Washington. Yesterday Governor Jay Inslee signed Bill 6065 into law. Bill 6065 bans the use of tanning beds for minors in Washington State. The bill will prohibit those under age 18 the right to use an indoor tanning device. Those facilities that break the law — they’ll be fined up to $250 per violation starting in mid-June. Children and teens with a doctor’s prescription can use the tanning bed (this will happen VERY rarely). If I were able to pass for a teen (let’s be honest, that was gone years ago) I’d sign up immediately for the undercover work. :-) I’m that fired up in ensuring this law works…

For data & numbers (if you’re looking for that) on indoor tanning risks read: Clear And Present Danger: Indoor Tanning

I’m emotional about this as a survivor of malignant melanoma. That’s why I cried when I read this news. I cry because I’m excited and overwhelmed about the hope for turning the tide on rising melanoma diagnoses in children, teens, and young women and I cry because I am also reminded by the stories of loss. I never thought my career in medicine would connect me with politics. It’s moments like this that I’m so glad our public health officials and politicians work hard. Legislation helps and does improve the chances of success for us living into old age.

I see this as a big win for public health, but also feel this as a big win for me as a mom. I really do want to survive to see my kids grow old. Just this week I had to catch my breath while reading about the death of movie star James Rebhorn. Once you’ve had cancer this happens all the time. You’re reading something seemingly innocuously and then you stumble. “Holy moly,” you think, “sorry to hear that guy died.” Then you read how he died (melanoma) and the huge lump comes into your throat. “That could’ve been me.” So many unexpected reminders of the fortune to be alive after having a skin cancer diagnosis. Read full post »

Constipation, No Fun For Anyone

Constipation is really no fun for anyone. No fun for baby or child, no fun for the parent who cleans the clogged toilet, no fun for the sister or brother who waits while someone works on solving the problem in the room next door. In general, constipation is a frustrating, sometimes embarrassing, and often chronic problem for young children. Here are a few ideas to get rid of the no-fun part and ways to protect your children, support them positively, and avoid dangers that can rarely come from over-the-counter (OTC) medications.

Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop. I usually break this down for children (and parents) in visual terms. I talk about things you find outside.

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet?

In my experience, parents worry a lot about hard infant or toddler poop in the diaper but constipation sneaks up on many families to school-aged children. After children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl. Long gone are the days of staring at every diaper as parents lose track of the daily poops, how often they poop, and how a child feels when pooping. But first, some definitions: Read full post »

A Rocket And Planet Earth

rocket for pocket There are moments that take our breath away. I’ve said before that it tends to be the things we don’t think of that takes our breath away while parenting. Warning: this post will sound as if it’s written by somebody’s mom.

With the two boys I have so many of those moments, the ones so luscious that when they happen I can hardly breathe and certainly don’t see straight. When these wondrous, unexpected child utterances occur, it can feel a little like the earth stops rotating for a just a beat.

Two things recently to report. One happened this morning around 8am. I’ve written about preschool drop-offs previously. After getting over the tantrums and the wretched separation anxiety the drop-offs have really blossomed. It’s now a luxury to get to drop our 5 year-old off at school. O is really excited to be there and saying goodbye while watching him trot off and fold into his circle of friends is settling to me. Today though, he dropped a delicious bomb. We got to his cubby and he sorted through a few things. Then reached up and handed me a little piece of paper just as he was running off.

Mommy, a rocket for your pocket.

He’s a funny little guy and I’ve held onto that piece of paper (ahem, rocket) all day.

And then a moment on being a grown-up. We do this all the time, act our age… Recently we were talking with our 7 year-old about visiting grandparents and travel, the future and where he will live. One set of his grandparents lives in California and so as he was chatting about travel my husband asked,

Where do you think you’re going to live when you grow up, California or Washington?

To which our wise, old-souled 7 year-old replied,

Oh Daddy, there’s a whole planet to explore.

We really can be shortsighted while parenting these brilliant, funny, lovely people who walk around masquerading as the children in the room. We can think dreams to be contained and we can make the bad assumption that school drop-off is routine. All the while our children remind us the world is without margin and a whole lot sweeter and so much funnier than we ever imagined it could be.

Digitally Savvy Parenthood

As a pediatrician, I encourage families to search online for health advice. Yet how you search and where you click matters. Tips for you and your time with “Dr Google” or “Surgeon Bing.”

The Pew Internet Project’s research finds that over 70% of Internet users in the United States say they have looked online for health information in the last year. Furthermore, most health information seekers (ie freaked out parents searching in the middle of the night) don’t start their health search on their pediatrician’s website. More than ¾ of people in the United States start their health search by typing something into a search engine like Google or Bing. Where you click and what you do next is key.

As a mom, pediatrician, blogger and general online enthusiast, here are a few insights to assist you when looking online for health information for your child or family. We parents are active information seekers on our phones and computer ~ I maintain that this is a GREAT thing! For practicing physicians, there is a tricky balance in believing that the Internet can help save lives. Have You Been In To See Doctor Google? A few ideas to improve trust for us all.

7 Tips For Becoming A Savvy Digital Parent:

Read full post »

Smartphones At Dinner: A Wake-Up Call

lego iPhoneA new observational study illuminates some ugly truths about parental/caregiver use of cell phones and smartphones at the dinner table. More than anything else, the observations serve up a hearty reminder that cell phones are embedded into our lives (see my son’s “Lego iPhone” as case in point) and that we have to be diligent in making digital breaks a habit. As phones and devices get more useful, they become harder and harder from which to separate.

Reading the new study I felt a little queasy for two reasons.

ONE: there are moments I fail my children in this regard. I think you’re fooling yourself if you don’t think you are (if you own a cell phone, smartphone, tablet, or computer). I would suspect most parents who read the study see a bit of themselves in there. I certainly remember (vividly) the day that my then 3 year-old son wanted my attention while I was working on my phone. He must have asked and gotten no response. He then literally put his head between my cell phone and my face to get my attention. Talk about a wake-up call…

TWO: I really hate to read about children becoming either helpless and/or giving up on trying for their parents’ attention (this was observed in the study). I also hated reading about children who kept vying for their parents attention and then get shot down and yelled at for interrupting. Just so unfair to children during dinner. Parenting really is different now. We weren’t raised by parents with these distractions. The implications on our children’s (and our own) health are just starting to to come into focus.

We’re all vying for a sane balance with our digital devices. The study detailed below offers up some uncomfortable observations and fuel to make changes now:

Read full post »

Finding Calm And Confidence

Mama Doc Medicine Cover Hi-ResOfficial launch of my book is…… today! Mama Doc Medicine: Finding Calm and Confidence in Child Health, Parenting, and Work-Life Balance. I’m seeing patients in clinic today but certainly am planning on walking over to the bookstore during my lunch break at clinic to see if it’s there. That will be a first…

More than anything, I wrote Mama Doc Medicine to connect parents and families with science and story (see video below). Although in some regards this book was designed to be the perfect baby shower gift, it has information on parenting children at any age, work-life-balance, and tips for raising your children with great social emotional skills.  There is information about sunscreen on babies, fostering generosity, fighting cavities, Tina Fey, risks for SIDS, Measles in America, taking digital breaks from your cell phone, and chicken pox.

In addition to about 100 magazine length sections (perfect for reading while nursing or sitting in the bleachers waiting for practice to finish), there are tweets, infographics, bar graphs (bouncy house injuries!) and boxes with custom links to research, awesome parenting videos, and online resources I go to.

If you’re wondering just when and why the soft spot closes or exactly how much crying is normal for a one month-old, or are looking for simple ways to increase your family’s health (hint: go outside) this is for you. The book is available in bookstores everywhere today and of course, online. Kindle version is also available!

Book Reading And Appearances


The book has offered up a flurry of opportunity to talk about health and prevention, vaccine science, and my journey as a digital and public physician. In addition to a number of Seattle and Chicago appearances,  I’ll be on The Today Show on March 13th and interviewing with Katie Couric (and taking audience questions) on Katie in April. Would love to know you’re watching while I’m there…

I’ll be presenting and doing a book signing this weekend in Chicago at the American Academy of Pediatric Expo — the first ever Healthy Children educational event designed for parents and children. Only $8 to attend (kids are free). I’m doing a talk with 10 things families should know and a book signing at 12pm (first 300 books are free and we can connect in real life!).

Next couple book readings are near Seattle: University Book Store (March 20) and Third Place Books (April 9th) and Village Books (April 26th) Read full post »

New Recommendations Parents Should Know

New 2014 recommendations are out for improving our prevention efforts for children. Parents can help ensure children get what they deserve at check ups. The updates to recommendations for wellness check-up are written to guide physicians but parents are a key voice in ensuring it all happens!

Updated 2014 Recommendations For Check-Ups

Some relevant changes to prevention/screening for children:

  • Infants: All infants need a pulse oximetry screen at or after 1 day of life to screen for heart defects. The test is non-invasive (just requires a technician, nurse, or doctor put an oxygen probe on their arms and legs). More information on the test here. Ideal time for testing is between 24 and 48 hours of life. If your baby is born at home or outside the hospital, go in to see pediatrician for the screen on day 1 or 2! Toddlers should be screened for iron deficiency risk at 15 and 30 months of age.
  • Children: All children should be screened for depression every single year starting at age 11 years. Don’t ever shy away from discussions about mood with your pediatrician. In addition, all children are recommended to have cholesterol screening at age 9-11. I reviewed ways to prevent heart disease and cholesterol screening policy statement here.
  • Teens: All teens need an annual check-up (a complete check-up will provide some time alone with doctor and nurse; mom or dad will be asked to leave for at least part of the visit). All teens need HIV screening test at age 16-18 (or sooner) and girls get their first pap smear at age 21.

5 Things Parents Need To Know About Check-Ups

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