Set Limits to Protect Hearing

Published on January 26, 2012 in Uncategorized. 0 Comments

If your family is like many I know, you probably started the new year with a few extra gadgets in the house. Electronic devices that come with earbuds or headphones may be among those new toys.

Technology and music can be awesome things, but a study out of Colorado University (CU) and Children’s Hospital in Boston (CHB) suggests that the use of devices at full volume for as little as five minutes a day can lead to permanent hearing loss. The longer a person listens and the louder the music, the greater the risk. A 2010 study from the Journal of the American Medical Association reported that the prevalence of hearing loss among youth aged 12-19 years increased significantly from 14.9 percent in the period of 1988-1994 to 19.5 percent in the period of 2005-2006.

Unlike a broken bone, once you permanently damage your hearing, it doesn’t heal. You can tell this to your kids (particularly teens) until you’re blue in the face, but this can be one area, in particular, where they really don’t get it. I’ve even had parents say that their kids will actually turn up the volume if they’re pressured by family or friends to decrease the sound.

I don’t think that parents should deny their kids audio devices entirely, but one thing I do suggest is to set the volume limit for the device right out of the box, if you can. Devices such as iPods have volume limits that you can set with a passcode that only you know.

How should you set it? The CU and CHB study suggests that listening to a player through stock earphones at 80 percent volume for 90 minutes a day may be okay to preserve hearing (at softer volumes, they suggest you can listen even longer: 70 percent volume for about 4½ hours a day). For younger children, you could be even more conservative with a 60/60 rule, which is to limit volume to 60 percent maximum for no more than 60 minutes a day.

When it comes to the type of earphones: buds versus the old style, the literature is mixed from what I can find. We chose over-the-ear headphones for my daughter, recently.

Setting limits (literally!) can give you piece of mind that your kids are enjoying their music at a safe volume that won’t jeopardize their hearing (which can lead to issues down the road with learning, and social adjustment, among other issues).

 

You Can Help Halt the Spread of Whooping Cough

Published on January 18, 2012 in illness, Prevention, Uncategorized and Vaccine. 0 Comments

Whooping cough, otherwise known as pertussis, is a respiratory infection caused by the bacteria Bordetella pertussis. The disease continues to make headlines this year, with Snohomish County declaring an epidemic and cases popping up in counties throughout Washington. I have swabbed a few children in clinic, but fortunately, there hasn’t been a positive test thus far.

Prior to the availability of vaccination, whooping cough would kill 5,000 to 10,000 people in the United States each year. The symptoms initially appear like a common cold. After about 1 to 2 weeks, a dry cough develops that evolves into coughing spells. Children can cough for periods longer than a minute, causing them to struggle for oxygen—a frightening development that can lead them to turn red or purple. At the end of this coughing spell, the child may make the characteristic whooping sound as they begin to breath again. Pertussis is highly contagious and can be spread from person to person. For us grown ups, it is an annoying cough that lasts over a month. For young children, it can be deadly.

At Group Health, we now give a booster dose of the pertussis vaccine to all children at their 11-year check up. The Tdap vaccine is also important for grown ups to get as well, as the immunity of the vaccine we received has children wears off in adulthood.

Please take the time to make sure you are protected, and that you protect others by being vaccinated. More information is available on ghc.org.

Obesity: A Sensitive Topic, a Challenging Problem

Published on January 12, 2012 in Uncategorized. 0 Comments

I loved reading the article in the winter issue of Northwest Health on kids and obesity. Many of my colleagues are passionate about this growing epidemic and contributed to the content of this article. Some things really resonated with me.

Obesity is something that I see more and more in clinic these days. American kids truly are heavier and less active than at any other time in human history. I am also beginning to see associated diseases, such as high blood pressure and glucose intolerance, more often now than I did when I started over a decade ago.

A child’s weight can be a challenging and sensitive subject to broach with families, at times. Even though it is never my intent, my words can be taken as an attack on parents’ parenting skills. Personally, there are times when I handle the conversation well and other times when I clearly wish I had the opportunity for a do over.

Ironically, on a daily basis, I will have a family come in with a child who is growing in a perfectly normal way and tracking along a consistent and stable percentile. But they still have the concern that their child is underweight. Quite often it can be the grandparents with the real concern, but unfortunately they are not the ones sitting in the room with me. I really do echo the sentiments of Dr. Nalini Gupta, in Spokane, “The problem is so pervasive that a lot of people no longer seem to know what a normal-weight child should look like.”

I fully agree with Dr. Paula Lozano when she says that the good news is, it’s not a mystery how we got this way. She goes on to say that we need to eat less and move more. Unfortunately, this is something that can be very difficult to actually deliver on. “We all try to be good parents, but in this environment, we need to be super parents.”

In fact, recently at our South Region pediatric meeting, we had one of the physicians give a talk about how to have a meaningful conversation with families during a clinic visit. For pediatrics, prevention is the key, and in the case of obesity, prevention is far easier than treatment. There are things that we primary care providers can start doing at a very early age to give parents more tools and guidance on how to feed their child. Our focus today was to get us on the same page as a group so we are all giving a more consistent message on the prevention front at a very young age.

The cliff notes version of what we discussed at the meeting is that as parents, when it comes to food, we are in charge of what our child gets to eat, where they eat, and when they eat.  The child gets to be in charge of deciding if they are hungry or not for a given meal or snack. This helps a child learn to follow their own hunger cues. If they aren’t hungry then they should never be forced to eat. My own daughter chooses not to have dinner at least once a week and we are perfectly fine with this.

In clinic, I will occasionally ask a parent about their own eating habits. Who knows better than they do whether they are hungry or not? Why would it be any different with their child? The light bulb often goes on at this point. Our job as parents is to provide healthy and nutritious food. To prevent grazing, we should dictate when it is mealtime and when it is snack time. We also need to set the expectation, and model the behavior, that all meals and snacks are eaten at the table and with the television turned off. There’s also so much to be said for gathering the family whenever possible for family dinners, which not only helps kids eat better, but helps strengthen their emotional health, as well.

 

A Reflection on 2011

Published on January 7, 2012 in Uncategorized. 0 Comments

2011 was an interesting year for our family. It seems that every year there are a variety of mishaps. The everyday cold and stomach bug problems don’t faze us these days. It is the bigger things that generate attention. My son needed to have a head laceration closed for the third time in his life. So far we’re batting once per year of age and there’s six months left to keep the streak alive. This is one streak I want to end.  Typically, I’m never my children’s doctor, but for the last time, it sure came in handy when I glued him back together just like Humpty Dumpty. I gave him the choice of glue or sutures. His sister was really pushing for sutures but she did not win that argument with my son.

For my daughter, she fractured her toe to end the year. When I got the text from my wife saying she needed a medical consult from me, I looked at the attached photo and quickly realized it was broken and that she needed to go in and see somebody at the clinic. The lesson my daughter learned was to not play on the stairs. How many times have we all told our children that before?

Come the end of the day, we are just very fortunate and thankful that we have healthy children.

May 2012 bring wellness to all of you.

Head Off Underage Drinking Before it Starts

Published on December 30, 2011 in Uncategorized. 0 Comments

I have been seeing a lot of different angles on teen drinking and prevention in the news in recent months. Parents and community leaders are bracing for the potential that more kids will have greater access to alcohol when liquor sales move from the state to the mainstream. And then more recently, Mercer Island, like some other communities in the country, have made a move to fine parents and homeowners for underage drinking that happens on their property. The reality is that underage drinking is happening at younger and younger ages, and parents and communities continue to struggle with how to handle it.

But what if you could help your kids learn to make better choices before they ever even consider bringing a drink to their lips? My colleague Jeff Lindenbaum, MD, at the Group Health Adolescent Center in Bellevue believes that there are many things you can do when your child is young that can make a big difference in how your kids will make decisions about alcohol if and when it comes up in their lives.

“Parents are the single most important factor in helping kids develop a solid inner compass for decision making,” Dr. Lindenbaum says. “You want to incorporate some of these values around not drinking early so they become a part of your child.”

What are some strategies?

Talk to kids early and often. According to Dr. Lindenbaum approximately half of all kids have tried alcohol by 8th grade, so you want to get to them before their peers do. Ask your pre-teen or teen what they think about drinking on T.V. or in a movie and the decisions that the characters made. You might role play with your teen to help them form a strategy for handling peer pressure if someone were to ask them to have a drink. This website can help you have age-appropriate conversations with your kids.

Practice what you preach. Kids don’t appreciate the “do as I say not as I do” method of child raising. Consider what it says to your kids if you’re having a drink, even just one, and then driving, or if you’re obviously using alcohol to deal with stress in your life. How are your kids learning about alcohol from your habits as a parent?

Build a relationship of trust. “It’s important to lay a good foundation in how you approach all kinds of problem behaviors,” says Dr. Lindenbaum. If there is a long-term record of kids being able to share challenges that come up in their lives, without parents overreacting or blowing up, kids are more likely to continue to talk to their parents and keep the channel of communication open.

Foster connectedness. Explains Dr. Lindenbaum, “Being understood, loved, and valued are key in protecting kids from risky behaviors.” Look for opportunities to create positive connections with your kids. Find fun things you can do together that you both enjoy. Remember to praise your child when they make good decisions or put in solid effort.

The decisions your child makes about alcohol can affect not only them but also others in their circle. Please talk to your kids and have a save and joyful New Year’s.

More resources:
North Seattle high schools have found success combating teen drinking through Prevention Works programs.

Talk Early, Talk Often, Get Others Involved is a Resource of the Substance Abuse and Mental Health Services Administration.

The One Big Thing

Published on December 21, 2011 in Parenting and Uncategorized. 0 Comments

Recently, a parent asked me if they could do one thing to raise a happy, healthy child, what would it be? It didn’t take me long to come up with an answer. I think the best thing we can do for our kids as parents is to be present and connected with them as much as we can.

All of us, myself included, are way too busy. We have our smart phones by our sides nearly 24/7, tempting us to check e-mail or text away. I’m no better than anyone else in this area. Sometimes when I’m at the park I catch myself doing that very thing while my kids play.

Distractions in life are everywhere, and it can be a struggle to stay in the moment and appreciate the time you have right now. I try to remind myself daily that I have this once-in-a-lifetime opportunity to be a parent, and that my kids, now eight and four, are going to grow up so quickly.

Connections you build with your child will pay off in leaps and bounds when they are older. Read a book and ask them what they think about it. Eat dinner together as a family as much as possible and please, turn the TV off. I promise there will be things to talk about.  Really cherish those moments because they go by so quickly.

Along with the smaller moments we share, something else I try to do at least once a week with each of my kids is take 30 minutes where my child can be in charge of the time slot. I give them my full and undivided attention. I’ll say, ‘okay, what do you want to do now?’ And, as long as it’s a safe activity, it’s their show to direct. If my son wants to play Star Wars, I’ll sit down with him and use my imagination and explore the galaxy like a four year old. If my daughter wants to play outside, then we do it. The first time I tried this with my daughter, she was at a loss of what she wanted us to do. So much of the day kids are told what to do by adults. Letting your kids be in charge in this way once in awhile gives your kids a sense of control and that their opinion and their needs matter. It builds self confidence, it strengthens your bond with your child, and helps maintain the health of your family as a whole. My wife and I  have personally found that this strategy has eliminated many power struggles, especially with my daughter as she is strong willed.

Hope you all have lots of special moments with your families for the holidays. Enjoy the season!

Hoping State Law Can Help Reverse Trend

Published on December 7, 2011 in Vaccine. 2 Comments

This article from from the New York Times, “More Parents Skip Childhood Vaccines,” calls out Washington state, but not in a way we want to be recognized. We have parts of the state where vaccination exemption rates have been more than 20 percent. Not a good thing. As a state, we have seen this increase happening over the last 10 years. The graph at the bottom of this page illustrates the changes occurring locally.

Time will tell if Washington’s new vaccine exemption law helps alter this trend by making opting out just a little more difficult. As the Washington State Department of Health website explains, exemption rates have been high in our state part because it had been so convenient to opt out in the past. Now if parents opt out, they do so after being presented with information about the benefits and risks of immunization. These parents or caregivers must provide an exemption form signed by their health care providers. Children who have exemptions must stay home from school if outbreaks of disease occur until they bring in vaccination records or until they receive the appropriate vaccination.

Some of you may ask what’s wrong with more families choosing not to vaccinate. Put simply, we reach a point where there are so many non-vaccinated people in the community that disease continues to spread, instead of fizzle out. Herd immunity is threatened as vaccine rates decline, which I talked about in this post from last spring. This is a subject I wish I didn’t have to talk about so often.

Happy Thanksgiving, Mashed Potatoes and All

Published on November 22, 2011 in Healthy Eating and Holidays. 1 Comment

Last Sunday, I had what I thought was a great idea, a pre-Thanksgiving dinner at home with my family. We always go to my brother’s house for a family get-together on the actual day. The event there is so over the top, it puts Martha Stewart to shame, so we wanted to celebrate with our smaller family unit in advance. I roasted a turkey that came out perfectly, the beans were nice and crisp, and the mashed potatoes to die for. Some background for those that do not know me well, I am the chef of our family and I love to cook. I view recipes as guides that are meant to be broken.

The table was set by my 8-year-old daughter, the candles were lit, and the food was set out on the table. We started to say a brief prayer when everything fell apart. My daughter went running off upstairs, crying all the way, and my son followed suit, just to get some sympathy. My wife and I were left sitting across from each other, perplexed. “Happy Thanksgiving,” I said to her, with a sigh. Ultimately, we were re joined by our little munchkins, and the evening finished out fairly well.

I thought I would share a recipe from that day: the famous mashed potatoes. Again, I do not write anything down and do it from memory, tasting as I go.

Boiled peeled potatoes
Butter (we used yogurt spread)
Sour Cream (lite)
Chopped up cooked bacon (about ½ a pound)
Chopped chives to taste
Grated Parmesan cheese
Salt and pepper

Mix everything together with either a stand-up or hand-held mixer. Place in a glass Pyrex baking dish, sprinkle the top with more grated Parmesan cheese and put into the oven at 325°F until warm and ready to eat.

Happy Thanksgiving.

What Do You Do to Get Your Zs?

Published on November 16, 2011 in Babies and Uncategorized. 0 Comments Tags: , .

The first question I typically ask parents of newborns at that first visit is “how exhausted are you right now?” I recall being a walking zombie after my daughter was born. Getting kids to sleep through the night is one of the top subjects I discuss with parents in clinic and the benefits of sleep for kids is something I’ve blogged about before. But equally important is the need we have as parents for sound sleeping.  I’m a better dad and husband when I’m well rested. I have more energy for my family and all the many things life throws my way as the Chief of Pediatrics for this massive and wonderful organization, Group Health. Sleep deprivation does nothing to help my patience level and ability to accept advice and respond to my wife and children with kindness and compassion.

Getting a good night’s sleep eludes many parents, and not just those with infants. Working moms, with a million things on their to-do lists for both their home lives and jobs, can be especially affected by insomnia. Dads are also known to wake up with our eyes wide open in the middle of the night and our minds running through the possible events for the next day. I certainly do.

It doesn’t always work, but if I think I’m going to have trouble sleeping, I start by making sure that I leave some time to read prior to bedtime to allow my brain to “turn off.” And for those very challenging nights, I will use some meditation techniques and visualize that I’m in a tranquil place such as running down an endless beach in Maui. So far, I have never hit the end of this imaginary beach.

The parents I see every day at clinic have shared many of their sleep strategies over the years. One mom told me that every night before going to bed she writes down her schedule for the next day including a list of all the things she can think of that she’ll need to do. This way, she knows the thoughts and concerns are out of her head and on the paper and her mind can be peaceful and at rest so she can sleep better. Yoga before bed, meditation during the day, and regular exercise, are all things that can help people get a solid night’s sleep. Melatonin comes up quite a bit, with many finding it helpful. Pharmaceutical sleep aids that are advertised everywhere on television are rarely the long term solution.

What do you do for a good night’s sleep? I welcome your ideas and suggestions!

Chickenpox Lollypops Anyone?

Published on November 9, 2011 in Babies, H1N1 (Swine Flu), Safety, Uncategorized and Vaccine. 0 Comments Tags: , , .

I was listening to the radio on my drive to work the other day and I heard a story that made my jaw drop. The topic of discussion was chickenpox. It seemed simple enough at first until the commentator starting talking about the “chickenpox lollypops” that people are advertising on social media sites. Yes, you heard me right. People will buy candy that has been contaminated by another child for their own children to suck on. Their hope is that by exposing their child to chickenpox (varicella virus) in this way, the child will catch the actual disease and then gain immunity thereafter. The notion seems to be that having “wild” type varicella virus is just much better than being vaccinated.

There are so many things that are wrong with this practice. First of all, who knows what other diseases that other child could be harboring? Why would a parent be willing to expose their child to the germs of a stranger, rather than give them a vaccine that is sanitary and has been proven countless times to be effective against chicken pox in numerous studies? Not to mention the fact that the act of mailing an infectious disease via mail is illegal. This is the chickenpox party taken to a whole new level. The pox party fan pages are trying to distance themselves from the new approach—like having an organized gathering to intentionally catch an illness is any better.

I recall when I was a child being sent over to the neighbor’s house to play with them when they had chickenpox—a mini-pox party. Well it worked, but what my mom didn’t know is that she took a calculated risk. Chickenpox is not always the benign disease that people make it out to be. The mortality rate is around 2 per 100,000 in otherwise healthy children. You have better odds of having a fatal case of chickenpox than winning the lottery. I have seen two normal healthy children die from chickenpox during my pediatric residency days—something I don’t ever want to see again. Fortunately, deaths in the United States from chickenpox have dropped by 97 percent in children and adolescents from widespread use of the vaccine.

This latest damaging fad brought about by vaccine “refusers” is just one more reason why I’m glad Group Health is supporting the Vax Northwest partnership. The partnership will help parents make informed and educated choices about their children’s health.