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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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What Does A Growth Chart Tell The Pediatrician?

Today, we have a great video from Dr. Wendy Sue Swanson. In this video, she explains what are important things one, as a parent, should look for and what are the not so important things to look for when checking your child’s growth. She also explains when to be concerned and what the chart actually tells your pediatrician.

The video is just 2:49 seconds, but it has a lot of great information. Make sure to check it out.

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My Child Has a Cold, Should I take Her the ER, Urgent Care or the Pediatrician?

Written by Kristen Stuppy MD

As cold and flu season approaches, I have been thinking about how our kids are managed when they become sick. Not only what we do to treat symptoms, but how, when, and where patients get medical advice and care.

We are a busy society. We want things done now. Quickly. Cheaply. Correctly. Resolution so we can get back to life.

Illness doesn’t work that way. Most childhood illnesses are viruses and they take a few weeks to resolve. There’s no magic medicine that will make it better.

Please don’t ask for an antibiotic to prevent the runny nose from developing into a cough or ear infection.

Don’t ask for an antibiotic because your child has had a fever for 3 days and you need to go back to work.

Don’t ask for an antibiotic because your teen has a big test or tournament coming up and has an awful cough.

Antibiotics simply don’t work for viruses. They also carry risks, which are not worth taking when the antibiotic isn’t needed in the first place.

Urgent Cares are not always the best choice

Many parents in this community have grown accustomed to using after hour urgent cares because they are convenient.

Convenient isn’t always the best choice. Many times kids go to an urgent care after hours for issues that could wait and be managed during normal business hours. I know some of this is due to parents trying to avoid missing work or kids missing school, but is this needed? Can it hurt?

Some kids will get unnecessary tests, xrays, and treatments at urgent cares that don’t have a reliable means of follow up. They attempt to decrease risk often by erring with over treating. Our office does have the ability to follow up with you in the near future, so we don’t have to over treat.

Urgent cares don’t have a child’s history available.

They might choose an inappropriate antibiotic due to allergy or recent use (making that antibiotic more likely less effective). They might not recognize if your child doesn’t have certain immunizations or if they do have a chronic condition, therefore leaving your child open to illnesses not expected at their age.

We know that parents can and should tell all providers these things, but our own new patient information sheets are often erroneous when compared to the transferred records from the previous physician… parents don’t think about the wheezing history or the surgery 5 years ago every visit. It is so important to have old records!

To treat or not to treat?

There is some evidence that treating things too soon does not allow our bodies to make immunity against the germ. A great example of this is Strep throat. Years ago we would go to a doctor when our sore throat didn’t get better after a few days. They would swab our throat and send the swab for culture, which took 2 days. We would treat only after that culture was positive. That delay in treatment allowed our bodies to recognize the Strep and begin making antibodies against it.

Now kids are brought in the day they have symptoms, and if the rapid test is positive, they immediately start antibiotics. The benefit? They are less likely to spread Strep to others and they can return to school 24 hrs after starting the antibiotic. The negative? They might be more susceptible to recurrent illness with Strep, so in the end are potentially sick more often and end up missing more school.

Receiving care at multiple locations

Receiving care at multiple locations makes it difficult for the medical home to keep track of how often your child is sick. Is it time for further evaluation of immune issues? Is it time to consider ear tubes or a tonsillectomy? If we don’t have proper documentation, these issues might have a delay of recognition.

Urgent cares and ERs are not always designed for kids.

I’m not talking about cute pictures or smaller exam tables. I’m talking about the experience of the provider. If they are trained mostly to treat adults, they might be less comfortable with kids. They often order more tests, xrays, and inappropriate treatments due to their inexperience.

This increases cost as well as risk to your child. We have been fortunate to have many urgent cares available after hours that are designed specifically for kids, which does help. But this is sometimes for convenience, not for the best medical care.

What About Cost?

As previously mentioned, cost is a factor. I hate to bring money into the equation when it comes to the health of your child, but it is important. Healthcare spending is spiraling out of control. Urgent cares and ERs charge more. This cost is increasingly being passed on to consumers.

Your co pay is probably higher outside the medical home. The percentage of the visit you must pay is often higher. If you pay out of pocket until your deductible is met, this can be a substantial difference in cost. (Not to mention they tend to order more tests and treatments, each with additional costs.)

So what kinds of issues are appropriate for various types of visits?

(note: I can’t list every medical problem, parental decisions must be made for individual situations)

After hours urgent care or ER:
  • Difficulty breathing (not just noisy congestion or cough)
  • Dehydration
  • Injury
  • Pain that is not controlled with over the counter medicines
  • Severe abdominal pain
  • Fever >100.4 rectally if under 3 months of age
Your Primary Care Pediatrician Visit:
  • Fever
  • Ear ache
  • Fussiness
  • Cough
  • Sore throat
  • Vomiting and/or diarrhea
  • Any new illness
Issues better addressed with an Appointment in the Medical Home:
  • Follow up of any issue (ear infection, asthma, constipation) unless suddenly worse, then see above
  • Chronic (long term) concerns (growth, constipation, acne, headaches)
  • Behavioral issues
  • Well visits and sports physicals (insurance counts these as the same, and limits to once/year)
  • Immunizations – ideally done at medical home so records remain complete

If your child gets a vaccine at any other location, please send us documentation (including the date, brand, lot number, and place administered) so we can keep the records complete.

Remember your pediatrician’s website might offer trusted answers to questions and many treatments to try at home for various illnesses and conditions! Be careful of surfing for answers though… the internet is full of bad advice! Go only to trusted sources (such as your doctor’s website or HealthyChildren.org).

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.  

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Making Healthy Food Choices For Your Children

Written by: Joanna E. Betancourt MD., FAAP

I have many parents that come to our clinic with concerns about their children’s weight. They complain that the children only snack on unhealthy things like chips and cookies and they don’t like to drink water or milk but rather drink sugar drinks.

I often ask parents, where do they get all this junk food and drinks? And they grin or smile back with a little bit of culpability because they know where I’m going with the question. Parents are the ones buying all this stuff and putting it in the pantry. So, it isn’t a big surprise that the child prefers the junk food over the healthy foods.

You don’t have to be a doctor to know that if you give a child a choice between an apple and a chocolate chip cookie, most kids are going to prefer the cookie.

A big part of living lifestyle is making the right food choices. And the responsibility lies within the parents, not the children, because the parents are the ones that make the food buying decisions.

The HealthyChildren.org provides excellent guiding principles to keep in mind when planning and preparing meals for your family. Below are just a few:

  • Vegetables: 3-5 servings per day. A serving may consist of 1 cup of raw leafy vegetables, 3/4 cup of vegetable juice, or 1/2 cup of other vegetables, chopped raw or cooked.
  • Fruits: 2-4 servings per day. A serving may consist of 1/2 cup of sliced fruit, 3/4 cup of fruit juice, or a medium-size whole fruit, like an apple, banana, or pear.
  • Bread, cereal, or pasta: 6-11 servings per day. Each serving should equal 1 slice of bread, 1/2 cup of rice or pasta, or 1 ounce of cereal.
  • Protein foods: 2-3 servings of 2-3 ounces of cooked lean meat, poultry, or fish per day. A serving in this group may also consist of 1/2 cup of cooked dry beans, one egg, or 2 tablespoons of peanut butter for each ounce of lean meat.
  • Dairy products: 2-3 servings per day of 1 cup of low-fat milk or yogurt, or l’/2 ounces of natural cheese.

Of course, the idea is not to overwhelm your children with drastic changes. However, little by little you can make a difference. For example, if your child wants chicken, it is better to “choose” baked or grilled chicken instead of a fried piece of chicken. Or when giving them a snack, consider pretzels or plain popcorn instead of potato chips.

Keep this in-mind when going to the grocery store next time. And remember, making healthy food choices is part of raising a healthy child.

Dr. Betancourt is a practicing physician. She is a mother of 3 young children (12, 8 and 5). She practices in the western suburbs of Chicago. 

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Vaccines: Truth and Experience Against False Fears From The Internet

Written by Walter Hoerman MD

Now that I am a “seasoned” pediatrician (greater than 20 years in practice), I have seen many changes all directly related to vaccines.

I used to worry about epiglottis with every child that has a cough. Now it hardly ever crosses my mind. I watched a child die of epiglottis, and I never want to go back there…

I used to have to do lumbar punctures at least a few times a year; now I haven’t done one in years and I am getting rusty (which is a good thing).

I have seen children go deaf from meningitis, have disabilities from meningitis, and even die from meningitis, and I don’t want to go back there…

I have never seen a case of the measles, and might have trouble diagnosing it. I don’t want to have to….

My mother used to tell me about terrible summers made tragic by polio. I don’t want to know it first hand.

These are all things I know personally. And most importantly, I can say I have never seen a child permanently damaged by a vaccine.

This is the message we need to get out.

Dr. Hoerman founded Lilac City Pediatrics in 1996. Since completing Medical School and his Pediatric Residency Training at the University of Connecticut, he has been practicing pediatrics in Rochester since 1988. Dr. Hoerman blogs at Lilac City Peds News

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For Pediatricians, Giving Vaccines Is An Ethical Dilemma

Written by Brandon Betancourt, MBA

One aspect of the vaccine controversy that doesn’t get discussed as often as I would like, is the notion of vaccine economics. Vaccine economics has to do with what I refer to as the distribution, consumption, management and cost of vaccines.

I was happy to see a blog post on the NPR that discusses some of the challenges, with regards to vaccine economics, many pediatricians face. Here is what they had to say:

After looking at what insurers paid more than 1,400 doctors for eight different vaccines, athenahealth concluded that almost half the time the payments weren’t large enough to cover estimated costs.

You don’t need to be an economist to know that loosing money isn’t good for anybody and certainly unsustainable; no matter how altruistic your motives maybe.

The blog post also highlighted that the problem might be worse than the research indicated.

The American Academy of Pediatrics came up with estimates for indirect expenses, concluding they range from about 17 percent to 28 percent of the purchase price of vaccines. So at least 17 percent should be tacked onto the purchase price for doctors to have a shot at breaking even, the group concluded.

By that measure, 47 percent of immunizations are money-losers, the athenahealth data show. If the 28 percent figure for indirect costs is used to calculate break even, then it’s an even grimmer picture: 79 percent of vaccination payments fall short.

This puts pediatricians in an ethical dilemma. On one hand, pediatricians will always do what is in the best interest of children. And there is overwhelming scientific evidence that vaccines are among one of the greatest medical innovations of our time.

On the other hand, preventing illnesses like Polio, Rubella and Measles in children cause pediatricians to actually lose money. In other words, pediatricians are in essence subsidizing – at their expense – the wellbeing of children.

The anti-vaccine movement

One of the anti-vaccine movement arguments is that vaccines are a profit center for doctors and that pediatricians are putting profits over the well-being of children. That is simply not true. And the research published by Athenahealth (click here to go the the study) clearly shows that profit is certainly not an issue.

When payment to physicians for vaccines often does not even cover the costs associated with administering those vaccines, this claim is so ludicrous as to be non-sensical.

The benefits of vaccines

  • The rate bacterial meningitis declined by 55%  in the US in the early 1990’s, when the hemophilus influenza type b otherwise know as Hib was introduced. (NEJM 364.21, May, 2011)
  • Varicella mortality declined 88% overall and 96% among subjects younger than 50 years (Pediatrics 128:2, August 2011)
  • Current immunization practice and herd immunity have virtually eliminated many infectious causes of serious morbidity and mortality in the USA.

It’s almost ironic that immunizations have done so much for public health, yet their value has not been recognized.

What is most frustrating to doctors is that immunizations are perhaps most cost effective preventive measure available to the pediatric population; especially when one considers the long term benefit in the equation for payment.

Yet insurance companies, driven by their bottom line, fail to view the long term benefits. For example, they reimburse a doctor for a polio vaccine below the doctor’s cost in an effort to improve the bottom line without considering the cost of a child actually getting Polio.

At what cost?

What would happen if pediatricians, driven by the cost of vaccine and poor reimbursement, decide they can’t immunize children any longer?

The poor and inadequate payment for immunizations could potentially create a public health problem if one considers that the lack of immunizations in children could break our developed herd immunity.

In fact, in the US, we’ve already seen over 150 cases of measles in 2011 and in California there were 9,500 cases of pertusis in 2010; and 10 infant fatalities which are attributed to lower vaccination rates.

As doctor Richard Oken said recently, “immunizations are perhaps the most cost effective preventive measure available to the pediatric population” thus me must consider the “long term benefit in the equation of payment.” Otherwise, “Inadequate payment could force pediatricians to outsource this healthcare benefits and bankrupt our developed herd immunity”

Perhaps more than any other physicians, pediatricians believe in, and focus on, PREVENTION of disease, stopping illness even before it has a chance to strike. If an ounce of prevention is really worth a pound of cure, skimping on spending for prevention today will surely result in spending much more tomorrow–not to mention causing more people, at all ages, to suffer from what are easily preventable diseases.

Brandon manages a pediatric practice in the western suburbs of Chicago. He blogs regularly on practice management issues at PediatricInc.com
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Why does my child need to have a physical exam every year?

Written by Jesse Hackell MD

This is a question I am asked several times each year, especially during the annual rush to get overdue physical exams done in the weeks before the start of the school year. A large part of pediatric practice is, indeed, devoted to regular physical exams (and well child exams in the early years.)

What is it, exactly, that makes them such a necessary part of pediatric medical care?

School Requirements

One obvious answer is that these exams are required by one authority or another. Schools require physicals at certain grade levels, as defined by each state’s education law. Participation in school sports, in most states, also requires an examination and health history review, at least every twelve months (if not more often.) Summer camps, employment and working papers and other extra-curricular programs may also demand a physical exam for participation. The value of these exams is clear: If you want to participate, you must have an exam.

 In Search of Abnormalities

Outside of these mandated exams, however, why do we do annual exams when we most often do not find any physical abnormality? Abnormalities are, fortunately, rare in the pediatric population. But hernias, tumors, heart disease, abnormal growth patterns suggesting inflammatory bowel disease or endocrine abnormalities—they all do occur in pediatrics, and I have found all of them, more than once, during my career. Sure, these things would eventually manifest themselves, and prompt a visit for evaluation, but with regular examinations, they can often be found earlier, before they have had a chance to cause significant distress or dysfunction.

Healthy Eating Habits

Poor eating habits are all too common in children today. Obesity rates continue to rise, and while this may not cause an immediate health problem, difficulties are ahead for the child who does not bring his or her obesity under control. The opposite problem is also increasingly common: Eating disorders manifest themselves in adolescence, sometimes as early as nine or ten years of age, with anorexia and bulimia. These, too, can have life-long effects on the health of a child, and often the manifestations will be apparent on a regular annual exam well before severe wasting and weight loss which would otherwise bring a child to medical attention. Both obesity and eating disorders are very difficult to treat, but early diagnosis and intervention may make this treatment process easier.

Invisible Diseases

These are conditions which can have a very significant effect on a child’s well-being, yet not be manifested in a way which calls the parents’ attention to them. Depression, anxiety, peer relationship problems and ADHD may be having a major impact on a child’s life, and yet not be obvious to those closest to that child. These problems may be picked up simply by observing a child’s demeanor, or during the confidential discussion that we like to have with our patients as soon as they are ready and comfortable to do so. Even though we will not violate a child’s confidence, we can often help to provide a way for a child to discuss troubling issues with his or her parents, and enable the child to see that there are adults available to help him or her through any difficult times.

Behaviors

Finally, the annual exam gives the pediatrician a chance to address behaviors in the adolescent which may pose significant risks to health or well-being. Sexual behavior and substance abuse problems are questions we try to address with our patients. We hope to be able to provide guidance as the adolescent navigates through the minefields which are a normal part of growing up.

Pediatricians Know Your Child

One of the best things about pediatrics is the opportunity that we pediatricians have to know your child on a long-term basis, from infancy through young adulthood, and to watch that child grow and progress through many stages of life. Besides the enjoyment that many of us derive from this type of relationship, we also have the chance to monitor this growth and development, and be aware of any difficulties which may be occurring along the way. The annual physical exam gives us a chance to touch base with your child, and observe and monitor for any potentially harmful deviations from the normal developmental path. It gives us a chance as well to reassure both the child and the parent when things are going well, and suggest intervention when they are not.

My colleague Dr. Richard Lander has discussed why your child would be better served by seeking medical care in your pediatrician’s office rather than in a retail-based clinic. While many of these clinics may even claim to do “physical examinations,” and may seem to be very convenient in order to get that physical for the school sports team, these clinics do not have your child’s history at hand, may not have his or her immunization record available in order to provide any needed immunizations, and do not have the long history that many of us have with our patients. While they may be able to check off the proper box to qualify your child to play a sport, that clearance is only a small part of the value of the annual physical exam, as provided at your child’s medical home, your pediatrician’s office.

Dr. Hackell is a founding member of Pomona Pediatrics PC, a division of Children’s and Women’s Physicians of Westchester. He practices in the lower Hudson River Valley just north of New York City.