Quick Tips To Avoid Health Issues Associated With Winter

Written by Richard Lander, MD


Winter is here and as the song says, “baby it’s cold outside”. Here are a few quick tips to avoid some health issues commonly associated with winter.

First of all, make sure your children are dressed appropriately for the cold weather. That doesn’t just mean a warm coat or layering of clothes.

Since heat is lost from the top of our heads, have your child put on a hat on their head. Also, put a scarf or face mask and be sure to protect hands and fingers from getting wet and/or cold.

Gloves help protect the skin on  hands which tends to get dry.

When skin becomes too dry, your child’s hands may become cracked making the skin more susceptible to infection.

Be aware of frostbite. This is caused when the skin has become so cold that the circulation to the fingers is compromised.

The skin becomes pale or grayish in color and may blister. Next your child may lose feeling in her fingers. If your are worried that this has happened, place your child’s hands in warm water, about 104 degrees, which is average bath water.

Then carefully pat them dry and place them on dry warm cloths. If this happens to their nose, use warm, wet compresses initially,  but be careful not to rub and then use warm dry compresses.

Often playing outside in the cold weather leaves your child’s clothes wet. Take off the wet clothes as soon as they return inside, put on warm, dry clothes and drink warm liquids, such as soup, hot chocolate.

If you and your children are spending extended periods of time outside, remember to keep yourself hydrated; drink lots of fluids.

There are many outdoor activities to enjoy during the winter months, such as skiing, ice skating and sledding.

Make sure your equipment (skis, snowboards, blades on the ice skates or the runner of the sled) are in good condition and that your children have not outgrown them.

If they are taller this year you might need longer ski poles. Perhaps their feet have grown since last year and their ski boots or ice skates are too small.

Does their helmet still fit properly?

If the children are going to use a sled, make sure the the steering works and tell them to go down feet first, not head first.

Parents, when sending your children to the bus stop remember that it is dark and cold outside. Remind your children to stay on the sidewalk and look both ways before crossing the street.

A brightly colored scarf, hat or gloves is a great way to ensure that they are visible in the dark.

Winter is a fun time of the year. Be safe and be smart.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician

Let’s Talk About Pertussis Also Known as Whooping Cough

Written by Richard Lander MD FAAP

What is pertussis?

Pertussis is an infectious disease caused by bacteria. Sometimes referred to as the hundred day cough, it can be quite debilitating. The cough is persistent and recurs day in and day out. Once you hear this cough, you will never forget it. The cough is repetitive, easily lasting 30 seconds or more and has a whoop sound at the end of it. This whoop is what gives rise to its popular name whooping cough. If you are curious, you can hear the whoop sound on the internet.

Who gets Pertussis?

Many people do-all ages and from all walks of life including: young children, teenagers, adults in middle age and senior citizens.

Is Pertussis contagious?

Yes it is. I have seen Pertussis several times in my practice this year. I have seen it spread from mother to child, among siblings and even from teacher to students.

Treatment of Pertussis

There are different phases of Pertussis. When the diagnosis is made during the first phase of the illness, it can be treated with antibiotics. This may shorten the duration of the disease. Otherwise physicians can offer supportive care and medication to help the patient sleep.


Pertussis is preventable by a vaccine. This vaccine, DPT (Diptheria, Pertussis and Tetanus) is typically given during childhood. The vaccine is given as a series of three injections in the first year of life, a booster during the second year of life and another booster before the start of elementary school. An additional booster is given at 11 year of age.

Because this last vaccine is relatively new, many children older than 11 year of age will be receiving it. Additionally the Tetanus booster which has always been recommended to be given every ten years has been change to include the Pertussis vaccine.

Therefore, adults of almost all ages are urged to obtain it even if you received a Tetanus booster a year ago. Many hospitals across the country are giving the vaccine to new mothers right after delivery and in some progressive hospitals the vaccine is being offered to new dads and to grandparents.

With this approach the State of California, which had seen deaths from Pertussis in the last few years, has dramatically decreased their rate of Pertussis. These dramatic results have persuaded many pediatricians to offer this vaccine to parents and grandparents of their patients.

Why talk about Pertussis now?

Pertussis is on the rise in the United States. From January through March in 2012 there were seven times the number of cases seen in Washington, D.C. than in the same time frame the year before in 2011. So why you might wonder: why this rise in Pertussis now? Several years ago we experienced a number of parents refusing to have their children vaccinated against childhood diseases including Pertussis.

These refusals were based on fears of the vaccines and components of the vaccines such as aluminum or mercury. Thankfully, these fears have been proven to have been unfounded. Unfortunately, once people stopped vaccinating their children, herd immunity was lost.

Herd immunity is gained when a majority of people in a geographic area receive a vaccine. These vaccines then protect even the few who were not vaccinated.

As the number of vaccine refusers climbed, we lost herd immunity. Hopefully today with increased knowledge through education, the number of vaccine refusers is beginning to decline and more people are again protected against infectious diseases such as Pertussis. Scientists are working tirelessly looking for clues to currently unanswerable medical questions.

Every day they race the clock in an effort to look for a treatment for currently untreatable medical conditions and diseases. Pertussis is not one of them. Pertussis is preventable with a vaccine It is criminal that there are people living in the United States in 2012 suffering from a disease they did not have to have. Please don’t be one of them. Ensure that you and your loved ones do not get Pertussis. Get vaccinated! Get vaccinated now!

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

Why You May Still Owe The Doctor Even After Paying Your Copayment

Written by Richard Lander, MD

Have you ever received a bill from your doctor’s office and said to yourself, “Wait a minute, why do I have a bill? I always pay my co-pay in the office”.

Insurance coverage in the 21st century can be confusing . It is not always easy to discern what you owe your doctor or why it is owed. It is often confusing for you the consumer and even at times for the doctor’s office. Some families pay their monthly premiums directly to the insurance company while others pay through their employer.

The amount owed is dependent on your employment contract.

Many years ago employers paid the entire amount of a health insurance policy however, in today’s economy, more and more employers are shifting a portion of the health care costs to their employees.

While some look at the escalating cost of medical care and point the finger of blame at doctors, and hospitals and the cost of medication, one need only look at the ever increasing profits of the insurance company to find the true culprits.

According to the New York Times in February 2012, one large national insurance company posted a 73% increase in profits.

Many American families are feeling the pinch of the ever increasing cost of healthcare. Therefore when you have paid the co-pay at the time of the office visit and you receive a bill stating you still owe money, there is disbelief. Depending on your individual insurance policy you might have a deductible before the insurance company will pay any benefits. This is typically seen in the beginning of the calendar year. Another possibility is that your insurance policy might cover a percentage of the charges leaving the balance for you to pay.

It is also possible that your policy does not cover a specific office visit or procedure and you are responsible for the payment. An example of this might be a breathing test performed in the doctor’s office. Your policy might cover this if and when given at the hospital but not at the doctor’s office. It might be a rapid strep test which is not covered. Occasionally a policy might exclude well visits or only cover one every other year.

It is your employer who has chosen what benefits to cover, not your doctor.

It is important to know the details of your individual insurance policy so that you know its limitations. Your doctor does not have this information. Once you receive a non-covered service you then take on the financial obligation for that service. So make it your business to know the details ahead of time. It will avoid a lot of pain and misunderstanding if you do.

Then when you receive a bill from your doctor, you will know not to discard it and assume it is a mistake because you know you paid your co-pay. Call the doctor’s office and discuss it.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.


Top 10 Pediatric Post of 2011

We had some really great post this year. But only 10 made it to the top. Below are our TOP 10 post of 2011.  Hope you enjoyed them as much as we enjoyed writing them.

  1. Why Can’t Pediatricians Prescribe Medicine Over the Phone?
  2. If a patient can charge for her time, why can’t the doctor charge for his?
  3. She has a fever, her temperature is 99.2. Is It Normal?
  4. Michele Bachmann Is Not a Doctor (she reveals), But Pediatricians Are
  5. What I Wish Parents Knew About Medical Billing
  6. Things Your Mother Told You That Were Wrong
  7. In Defense of Cough
  8. Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic
  9. Are High Fevers in Children Dangerous?
  10. What is the most important thing I can do to make sure my child is as healthy as possible?

Well, there you have them. Do you have a favorite one? We’d love to hear your thoughts.

Preparing Your Child For The Fall

Written by Richard Lander, MD

Fall is fast approaching; the leaves are beginning to change colors, vacations are behind us, and our bathing suits are put away with the suntan lotion. We no longer have to worry about swimmer’s ear and sunburn and the children are back in school. So now we have nothing to worry about, right?

Ah but fall brings its own worries. In early fall we can have and Indian Summer so children playing sports have to think about not getting a sunburn. They also have to remember to drink plenty of fluids so as not to dehydrate. It is important to make sure that all sports equipment is in good shape and review the rules of the sport being played. Warming up and stretching before a practice or a game is a good idea.

Fall is a time of year when there is work to be done around the house. After raking those leaves, don’t leave the rake lying on the ground. Where somebody can trip, fall or be impaled. If you are doing work on your roof or putting up storm windows, replace ladders in the garage; never leave them standing against the house.

Many children are riding their bicycles to school so this is a good time to review road safety. Remind children to look both ways before crossing the street and always wear a helmet. Parents, be sure that bicycles are in good working order. For those who walk to school, never accept a ride from an unauthorized person. To avoid uncertainty regarding who is a stranger, arrange a pass word to be used if Mom or Dad are not picking up your child. Never go with anyone who does not give the correct password. For those students who will be driving to school for the first time, remind them of the rules of the road, and the importance of defensive driving. Of course, seat belts should be worn by all passengers in the car.

Back to school can be a trying time for some. The little ones might experience some separation anxiety at first. Give an extra hug and reassure you will see him/her after school. Many middle schoolers will be coming home with more homework than they did in grammar school. Help them organize their time and work with them on study skills. High schoolers have their own issues. Some mid-adolescents are starting to feel their oats. Their friends become their primary company; they are all knowing and you parents know nothing. Give your adolescent some space but be present and involved in their lives. Give yourself permission to question where they are going, with whom they are going and tell them when to be home. They won’t admit it even to themselves but they both need and want limits. Be supportive, offer advice but don’t force it and always remember your child has friends; you be his/her parent.

For senior high school students, this is a very anxiety producing time of life. The future is so uncertain. Your student is wrestling with where he/she will be going to college, will he/she make varsity this year, will he/she have a date for prom? Don’t ask too many questions but be available. The family dinner table can present a perfect opportunity for sharing.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.

Photo Credit: Svetlana Hanina


When Should My child Start Seeing My Adult Physician?

Written by Richard Lander MD FAAP

As a pediatrician I am sometimes asked, “When should my child start seeing my adult physician?”

My answer is not until their early 20’s.

Pediatricians are trained to treat babies, toddlers, children, adolescents and young adults. Pediatric training encompasses four years of medical school and a minimum of three years of residency in pediatrics.

Throughout our career, we are constantly attending conferences and reading journals or medical literature to ensure that we are always current and apprised of cutting-edge pediatric medicine.

Your pediatrician helps you deal with your baby’s acid reflux, guides you on how and when to introduce solid foods and thrills with you when your baby speaks his/her first words.

At your well visits, your pediatrician asks questions to determine if your infant/child is developing properly and if not, you will be directed to the proper place for evaluation. You are counseled on proper nutrition and exercise for your child and encouraged to expose your child to a range of cultural and educational experiences.

When your child is wheezing or crouping in the middle of the night, it’s your pediatrician you call on for help. When your child has a 104 degree fever on a Sunday morning your pediatrician tells you to come over to the office to be examined. It is your pediatrician who is there with you as your child becomes an adolescent and together we deal with adolescent issues such as acne or uncomfortable menstrual cycles.

With some of you, we traverse the difficult terrain of painful adolescent anxieties or drug and alcohol problems. It is your pediatrician you consult for concussions and sprains from sports. When your child begins thinking of college and a future career, your pediatrician is as excited as you are, because your pediatrician has been there with you as your child has grown into a young adult.

It is your pediatrician who takes your child’s phone calls from college to help with a health issue or an emotional problem. When it becomes time to move on to an internist, it is a happy but also sad parting of the ways.

And then of course the fun begins again as your pediatrician begins to care for your child’s child: a very special pleasure for your pediatrician — the second generation.

As you can see, there is no other healthcare professional who knows your child the way your pediatrician knows your child.

The walk-in clinic has no frame of reference; they have not treated your child throughout the years. Many internists and family practitioners do not treat large numbers of children and are therefore not equipped to handle the range of issues involved in treating children and adolescents.

Many non-pediatrician physicians do not have the vaccines needed to keep your child properly immunized. Most do not see patients after hours; they send patients to the emergency department.

With your pediatrician you have grown accustomed to being seen right away and in the office where you are comfortable. Your pediatrician has been trained to deal with your child’s health issues from birth until they are young adults. We know your family and we know your child’s history. We know you and we are always there for you.

Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.


Six Reasons You May Want to Bring Your Child to the Pediatrician’s Office Instead of a Retail Based Clinic.

Written by Richard Lander MD

Why should I bring my child to the pediatrician when he/she is sick? It is so much easier to run over to the local retail-based clinic (RBC) at the pharmacy where there is lots of parking, I don’t need an appointment and while I’m there I can pick up tissues, milk and medicine. Right?

Here are six reasons why going to a RBC may not be in the best interest of your child’s health.

1 – Most RBCs are not Staffed with Board-Certified Pediatricians

Your child will probably be diagnosed and treated by a nurse practitioner or physician’s assistant. Imagine that you are concerned about your child and therefore a little distracted and forget to mention that your child has allergy to an antibiotic. This could have a bad outcome. If you are at your pediatrician’s office, that allergy information is kept in your child’s chart.

2 – You Can’t Call The RBC in the Middle of the Night

Now imagine that your child’s condition worsens at midnight. The RBC you visited earlier is now closed and so you can’t ask for further advice. On the other hand, had you called your doctor earlier and then required additional help later in the evening, you would be able to receive consistent medical advice because your doctor or a covering doctor is on call 24/7. The American Academy of Pediatrics has always stressed the importance of continuity of care. It’s what I want for my children; it’s what I want for your children.

3 – RBCs Have Age Restrictions

Many RBCs have an age below which they will not treat a patient. What will you do if two of your children are sick — take one to your doctor and the other to the RBC?

4 – RBCs Can’t Handle Complex Medical Issues?

Worse still, the RBC cannot deal with complex medical issues. If you visit the RBC with a problem that is beyond the scope of their training and knowledge, they will tell you to see your doctor or send you to the emergency room.

5 – RBC Provides No Continuity of Care

Let’s think about vaccines. Your child needs a flu vaccine as well as one or two other immunizations. Many of the RBCs are only prepared to give the flu vaccine. If you are receiving the flu vaccine at the RBC and all other immunizations at your pediatrician’s office, no one will complete your [child’s] vaccination record. Again this speaks to a lack of continuity of care. This fragmented record keeping could cause trouble in the future.

6 – An RBC’s Not Your Medical Home

Your pediatrician’s office should be your child’s medical home. Your pediatrician has cared for your child’s physical and mental well being since birth. At your pediatrician’s office you received vision and hearing screening, and we assessed your child’s fine and gross motor skills. Your pediatrician has checked for autism and ADHD, asked you questions relating to your child’s growth and development and if there was a concern, and addressed it. When a behavioral problem at school or home arose, it is your pediatrician who thought about the possible medical conditions that could cause these behavioral changes. Will your RBC help you with your child who is crying out for attention secondary to a new baby at home or to parental discord? Will your RBC talk to your teenager about depression, alcohol, drugs or tobacco use? If your child has a GI problem, a broken arm, a heart condition or a blood disorder, will your RBC recognize the problem and send you to an appropriate specialist? Would you want the recommendation of a competent specialist to come from your RBC or from your doctor who knows you and your family’s medical history?

Your pediatrician provides your children with vaccines after they have looked at the medical research. He/she does not give vaccines because a corporate entity (RBC) made the decision to do so. Your pediatrician went to medical school for four years and then did a pediatric residency for an additional three years and continues to both attend medical conferences and read the medical literature to make ensure that he/she remains current and ahead of the curve. One of the national RBC chains has the tag line “You’re sick, we’re quick.” Is that the kind of medicine your loved ones deserve?


Dr. Lander has been practicing pediatrics for 32 years in New Jersey and is the immediate past chairman of the American Academy of Pediatrics Section on Administration and Practice Management.  He says if he had to do it all over again he wouldn’t hesitate to be a pediatrician.