Seattle Mama Doc

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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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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