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6 Simple Back-to-School Tips For Parents

ImageMost kids are back in school. But that doesn’t mean we can’t make on the fly improvements to help us get back into a routine. Here are 6 quick tips to help you get back on track:

  1. Restart the bedtime routine: It’s hard to get up for school the first day unless you start back into a normal bedtime routine now.
  2. Set up a place for homework: Set expectations now and get organized. Kids thrive on routine and organization.
  3. Talk to your child’s teacher, school psychologist or nurse: If you have ANY concerns about your child academically, socially or medically, reach out in advance. Being proactive is always better than being reactive.
  4. Prepare for sick days: Kids will inevitably get sick at the beginning of the school year as they come back together in such close quarters. Kids who have asthma often benefit from restarting their controller medications in anticipation of this. Visit your doctor to discuss this or any other medical needs before school starts.
  5. Consider helping kids in school districts with less: DonorsChoose.org makes it easy to help classrooms in need. Public school teachers post classroom project requests. Find a project that has some meaning to you and your family.
  6. Don’t stress: Back to school can be stressful for everyone. Try and relax and take it one day at a time.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.

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When Should You Allow Your Child to Have A Cell Phone

This is a very common question from parents. I know my wife and I had to answer this question not too long ago.

Funny thing is, that our parents, and our parents, parents, didn’t have to answer this question. I find that fascinating. But our world is different now.In more ways than one.

Makes me wonder the type of questions they will have to ask themselves as parents 20 or 30 years from now. I can’t even imagine.

In this video, Dr. Wendy Sue Swanson from Seattle Mama Doc talks about when we should allow our children to have a cell phone.

Dr. Swanson practicing pediatrician and the mother of two young boys. She sees patients at The Everett Clinic in Mill Creek, Washington. She is also on the medical staff at Seattle Children’s and am a Clinical Instructor in the Department of Pediatrics at the University of Washington.

Dr. Swanson is passionate about improving the way media discusses pediatric health news and influences parents’ decisions when caring for their children. Dr. Swanson blogs regularly at Seattle Mama Doc

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A Little Info On Wellness Visits

Written by David Sprayberry MD

As a pediatrician, I often have expecting parents who come in to interview me or my partner to decide if they want to use us as their pediatricians.

At the visit, we talk about how our practice works and we present them with the recommended schedule of well visits (established by the American Academy of Pediatrics). This schedule can be found here.

Parents are often surprised at the number of visits that are recommended.

If they want more information, we explain a bit about what goes on at a well visit and why they are important.

We mention that we review the growth and development of their child, perform a head to toe physical exam, provide guidance on things like feeding and safety, give immunizations, and perform a variety of screens, labs and other assessments depending on the age of the child.

If you look at the Bright Futures schedule linked above, you can see how involved some of these visits are. As a result of all that is required, the visits (including paperwork, tests, and vaccines) can take anywhere from 20-60 minutes, so parents should probably plan that it will take approximately an hour to complete the visit.

Some of the visits that are less involved (like the 9 month visit) may be faster and a few may take longer (like the 4 year and 11-12 year visit).

Another thing that sometimes surprises parents is how these well visits are billed and what charges are incurred during a well visit. Medical billing is complex and is based on a process called coding.

I will address that in an upcoming post. For the time being, think of your medical bill for an office visit as being similar to the bill you receive at a restaurant.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.

Photo credit – AppleTree Learning Centers

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6 tips to help make the best of the time your teen spends with your doctor

Written by Natasha Burgert MD

Summer is the time most teenagers come to the pediatrician’s office for their annual health exams. Here are 6 tips to help make the best of the time you spend with your doctor.

1. Make an appointment. Now.

Teens are a dynamic animal. And fortunately, most are very healthy. But healthy kids need doctors, too. Subtle changes in physical exam, measurements, and lifestyle can be concerning issues to a trained pediatrician’s eye. And if teens are not routinely seen by a provider, opportunities for easy correction and treatment can be lost.

A pediatrician is expertly trained to provide a complete physical exam for your teen child. Our job is to be sure that your child’s global health is optimal, physically and mentally. We specialize in the growth and development of teens, as well as discuss the risks and challenges of their age.

Most importantly, seeing healthy teens and their families is when pediatricians can make the biggest relationship impacts. Well child visits are instrumental in developing a working partnership with someone in the health care field that can be your family’s partner and advocate should challenges or illness arise.

And, we love to see you. Please make an appointment for your teen to be seen.

2. Define your concerns.

Since teens are generally healthy creatures, parents and kids often have absolutely NO concerns about their child’s health. GREAT! These visits can be used to review healthy habits, safe living practices, and look at vacation photos. I love those check-ups.

Your teen’s appointment is, however, the only time we will likely see each other this year, so please take a minute to think about any issues you would like to discuss. In fact, make a list. Then, remember to bring the list with you to the appointment.

3. If you have significant issues to discuss, consider sending an email or letter giving some details prior to your appointment.

Issues such as depression, weight gain or loss, menstrual concerns, ADHD, and headaches much more effectively addressed if your provider has had some extra time and some extra history prior to the appointment.

If you know that you have a significant concern to discuss, please let the person who is making your teen’s appointment know. This is to allow for extra time, if needed. In addition, ask the scheduler if you would be able to send a note to the physician prior to the appointment. This will optimize our time together.

4. Have the parent’s section of camp forms, health forms, and athletic participation forms completed.

Please.

5. Prepare to spend some time apart.

After talking with a patient with his or her family, pediatricians often speak with teens privately. It allows an opportunity for us to get to know each patient on a more personal level, without parental interruption. In addition, this allows your teen to “practice” talking with a physician – a very important life skill.

The goal of this time is to repeat and reinforce the healthy habits you are already discussing with your teen. The more we know about your family, the better this is accomplished. In addition, private conversations begin establishing a foundation of trust with each patient. As your teen’s trust with a physician grows, it is easier for them to have honest and open dialog about potential health risks.

In pediatrics, the conversations with teens are confidential and protected. Providers are obligated to share information with parents in defined situations, such as patients who are at risk of harming themselves or others.

6. Never promise your teen that there will be “no shots.”

The recommendations from the vaccine advisory boards are always changing. Vaccines are a very important way of protecting your teen from significant, deadly diseases. Teens are getting protected from chicken pox, meningitis, tetanus, pertussis, hepatitis, and human papilloma virus with some of today vaccines.

Have a great summer, and a great checkup with your pediatrician!

Dr. Burgert is a pediatrician. She works at Pediatrics Associates in Kansas City, MO .  She is a distance runner and enjoys road races around the city. She also has a passion for travel that will certainly lead to many memorable family vacations with her husband and two children. And, of course, she bleeds Husker red. Dr. Burgert regularly blogs at kckidsdoc.com

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Gifts of a Father’s Presence. Part 3 of 3

Written by David R. Sprayberry, MD

My last few posts have revolved around the negative effects that absent fathers have on their children.  So far, we have talked about how the absence of a father contributes to poverty, substance use and abuse, psychological and behavioral problems, poorer educational performance, and increased participation in criminal activities.  Today we turn to the positive things that a present father brings to the lives of his children.

Effects on Infants

Let’s starts with infants.  Even in the first few days of life, the effect of a father’s presence can be discerned.  Newborns will preferentially turn their heads to the voice of their fathers over the voices of other men.  Premature infants whose fathers visit the NICU more often tend to have better weight gain during the hospitalization and perform better on behavioral and social-developmental tests during the first 18 months of life.  Infants who demonstrate the most emotional security and attachment have fathers who are affectionate, who spend time with their children, and who have a positive attitude.  Keep in mind that these effects are happening long before the child can even walk and talk.

Effects on Mothers

What about mothers?  When fathers are involved, their children’s mothers are more likely to start and continue breastfeeding.  Mothers with positive relationships with their children’s fathers also demonstrate better parenting skill and fewer emotional difficulties.  Mothers who are feeling supported are more likely to encourage the fathers to be involved with the children.

Early Childhood

Fathers can help reduce the likelihood of stranger anxiety in their children.  Toddlers with present fathers are also less likely to worry and less likely to disrupt the play of other kids.  Preschool children of involved fathers have been found to have higher cognitive development.  They also exhibit more empathy and have a greater sense of mastery over their environment than their peers with less involved dads.

Long-term Benefits

Children who live with both parents are more likely to finish high school, be economically self-sufficient, and be physically healthy.  Fathers have a unique and strong influence on their children’s gender role development and serve as important role models for both boys and girls.

Discipline

Fathers who set appropriate limits for their children and who provide sufficient autonomy have children with higher academic achievement.  Fathers who discipline harshly and/or inconsistently have a negative impact on emotional and academic development.

Educational Benefits

When dads are involved, kids tend to have improved educational outcomes.  Children of fathers who are involved in their children’s education are more likely to achieve better grades, more likely to enjoy school, more likely to participate in extracurricular activities, and are less likely to have repeated a grade.

Additional Benefits

There are numerous other benefits that result from fathers who are involved.  Fathers who spend time alone with their kids and perform routine childcare at least twice a week raise the most compassionate adults.  Physical play with fathers promotes intellectual development and social competence.
Fathers are capable of doing incredible good to their kids by staying involved in their lives.  Dads, you only have a few years with your kids at home.  Make the most of them and be their dad!  Perfection is not necessary.  Presence and participation are.
Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.


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Who’s Your Daddy?: Part 1 of 3

Written by David R. Sprayberry, MD

You have undoubtedly heard this question used as a taunt of another, but let’s take the question seriously.

What do you know about your dad? Do you know him or do you know of him? I grew up in a two-parent home with my birth parents.

Things were not always perfect. I can tell you the positive things about my dad and some negatives.

The reason, though, that I can tell you the negatives is that I know my father and I know him well because he was there.

He was there at the dinner table. He was there at my baseball practices. He was there at my basketball games. He was at all the school functions and awards nights.

He was there.

During my pediatric residency, one of my classmates was posed this question by one of the kids he was seeing in the clinic: Are you my daddy? Sadly, this was not a joke.

The child had no idea who his father was. More and more American kids are growing up not knowing their fathers at all or having minimal relationships with them. Their dads are just not there, either partially or fully.

The absence of a father from a child’s life can do immense harm and the presence of a father can do immense good.

Scope of the problem

In discussing this issue, it is important to define what an absent father is. In general, when we use the term absent father, we are speaking of fathers who are physically absent from the child’s primary home. This includes fathers who have only joint custody of their children.

The degree of this issue is immense. Over one-third of all U.S. children live absent from their biological fathers. Nearly half of all children from disrupted families have not seen their fathers in the past year.

Nearly 20% of kids in female headed households have not seen their fathers in 5 years.

From 1960 to 2000, the proportion of children living with just one parent increased from 9% to 28% over that 40 year span. When the statistics are broken down by race, results become even more alarming.

As of the year 2000, 20.9% of all white children lived in single-parent homes. At the same time, 31.8% of all Hispanic children and 57.7% of all black children were living in single-parent homes.

The reasons for the racial differences are debatable, but what is clear is that this is a problem that is not limited to a single race.

Reasons for father absence

Why do we have so many absent fathers? There are many factors that contribute to this problem, but a large proportion of absent fathers are absent for one of the following reasons.

One of the largest reasons that fathers are absent from the homes of their children is divorce. The number of currently divorced adults has nearly sextupled from 4.3 million in 1970 to 23.7 million in 2010.

The number of divorces per year has increased from 390,000 in 1960 to 1.2 million in 2009.

There are recent reports of decreasing divorce rates, but these decreases are generally looking at divorces as a proportion of the general population, not as a proportion of marriages. Additionally, the marriage rate has declined considerably, likely leading to an increase in the second factor contributing to absent fathers.

A second significant reason that fathers are absent is births out-of-wedlock. Forty-one percent of all newborns in the U.S. were born out-of-wedlock in 2009, up from 33% in 2000.

About 75% of all teen births are out-of wedlock. In many of these cases, the father never lives in the child’s home, even at the beginning.

A smaller, but still significant, reason for father absence is incarceration. As of 1991, there were an estimated 423,000 fathers in prison with children under the age of 18. That number has increased to 744,200 as of 2007.

To be fair, many men may not be able to control the amount of time they are with their children. They may want to be involved, but are prevented by factors beyond their control.

As a pediatrician, I understand how difficult it is to balance a demanding work schedule and family life, and I don’t always do a great job at maintaining that balance.

I point these issues out not for the sake of being critical, but in order to spur men on to take a larger role in the lives of their children and to become more physically and emotionally present for them. We have a relatively short time to raise our children. Let’s make the most of it.

My next post (the second in a three-part series) will discuss the consequences of father absence and the benefits of father presence.

Dr. Sprayberry is a practicing pediatrician and believes there is more to medicine than shuffling patients in and out the door. To read more about Dr. Sprayberry’s medical trips to Kenya, visit his blog, Pediatrics Gone to the Dawgs.

 

Photo credit:  Chin.Musik

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Your Child’s Fever, Good or Bad?

Written by Kristen Stuppy MD

Fever is scary to parents.

Parents hear about fever seizures and are afraid the temperature will get so high that it will cause permanent brain damage. In reality the way a child is acting is more important than the temperature. If they are dehydrated, having difficulty breathing, or are in extreme pain, you don’t need a thermometer to know they are sick.

Fever is uncomfortable.

Fever can make the body ache. It is often associated with other pains, such as headache or earache. Kids look miserable when they have a fever. They might appear more tired than normal. They breathe faster. Their heart pounds. They whine. Their face is flushed. They are sweaty. They might have chills.

Fever is often feared as something bad.

Parents often fear the worst with a fever: Is it pneumonia? Leukemia? Ear infection?

Fever is good in most cases.

In most instances, fever in children is good. It is a sign of a working immune system.

Fever is often associated with decreased appetite.

This decreased food intake worries parents, but if the child is drinking enough to stay hydrated, they can survive a few days without food. Kids typically increase their intake when feeling well again. Don’t force them to eat when sick, but do encourage fluids to maintain hydration.

Fever is serious in infants under 3 months, immune compromised people, and in under immunized kids.

These kids do not have very effective immune systems and are more at risk from diseases their bodies can’t fight. Any abnormal temperature (both too high and too low) should be completely evaluated in these at risk children.

Fever is inconvenient.

I hate to say it, but for many parents it is just not convenient for their kids to be sick. A big meeting at work. A child’s class party. A recital. A big game or tournament. Whatever it is, our lives are busy and we don’t want to stop for illness. Unfortunately, there is no treatment for fever that makes it become non-infectious immediately, so it is best to stay home. Don’t expose others by giving your child ibuprofen and hoping the school nurse won’t call.

Fever is a normal response to illness in most cases.

Most fevers in kids are due to viruses and run their course in 3-5 days. Parents usually want to know what temperature is too high, but that number is really unknown (probably above 106F).

The height of a fever does not tell us how serious the infection is. The higher the temperature, the more miserable a person feels. That is why it is recommended to use a fever reducer after 102F. The temperature does not need to come back to normal, it just needs to come down enough for comfort.

Fever is most common at night.

Unfortunately most illnesses are more severe at night. This has to do with the complex system of hormones in our body. It means that kids who seem “okay” during the day have more discomfort over night. This decreases everyone’s sleep and is frustrating to parents, but is common.

Fever is a time that illnesses are considered most contagious.

During a fever viral shedding is highest. It is important to keep anyone with fever away from others as much as practical (in a home, confining kids to a bedroom can help). Wash hands and surfaces that person touches often during any illness.

Continue these precautions until the child is fever free for 24 hours without fever reducers. (Remember that temperatures fluctuate, so a few hours without fever doesn’t prove that the infection is resolved.)

Fever is an elevation of normal temperature.

Normal temperature varies throughout the day, and depends on the location the temperature was taken and the type of thermometer used.

Digital thermometers have replaced glass mercury thermometers due to safety concerns with mercury. Ear thermometers are not accurate in young infants or those with wax in the ear canal. Plastic strip thermometers and pacifier thermometers give a general idea of a temperature, but are not accurate.

To identify a true fever, it is important to note the degree temperature as well as location taken. (A kiss on the forehead can let most parents know if the child is warm or hot, but doesn’t identify a true fever and therefore the need to isolate to prevent spreading illness.)

I never recommend adding or subtracting degrees to decide if it is a fever. In reality, you can look at a child to know if they are sick. The degree of temperature helps guide if they can go to school or daycare, not how you should treat the child. Fevers in children are temperatures above

  • 100.4 F (38 C) rectally
  • 99.5 F (37.5 C) in the mouth
  • 99 F (37.2 C) under the arm

Fever is rarely dangerous, though parents often fear the worst.

This is the time of year kids will be sick more than normal. With each illness there can be fever (though not always.)

What you can do?

  1. Be prepared at home with a fever reducer and know your child’s proper dosage (especially with the recent dosing changes to acetaminophen!)
  2. Use fever reducers to make kids comfortable, not to bring the temperature to normal.
  3. Have an electrolyte solution at home in case of vomiting.
  4. Teach kids to wash their hands and cover coughs and sneezes with their elbows.
  5. Stay home when sick to keep from spreading germs. It is generally okay to return to work/school when fever – free 24 hours without the use of fever reducers.
  6. Help kids rest when sick.
  7. If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen. A physical exam (and sometimes labs or xray) is needed to identify the source of illness in these cases. A phone call cannot diagnose a source of fever.
  8. Any infant under 3 months or immune compromised child should be seen to rule out serious disease if the temperature is more than 100.5.
Dr. Stuppy is a practicing pediatrician in Kansas. I feels privileged to be able to help families keep their children healthy and she loves watching entire families grow!  Dr Stuppy is active on Facebook and puts a more personal touch to pediatric topics on her blog.