Children's Oasis Pediatrics

Misconceptions #1 Baby Teeth

2012-02-21T13:08:00.001-07:00

I commonly find that parents have outdated information or misconceptions and so I thought I would start a series of posts addressing some of the more common ones that I hear.

First off we are going to talk about baby teeth. I find that some parents think that since baby teeth fall out there is no need to take care of them. Baby teeth are actually quite important so we are going to discuss some reasons why.

1. Some baby teeth won't fall out until age 12-13. That's a long time to have teeth that are not cared for.

2. Cavities hurt and can lead to serious infections such as abscesses. If your child's mouth hurts he will be fussy, not sleep well, do poorly in school, and won't eat very well.

3. Good habits start early. Is your child suddenly going to start brushing and flossing when his permanent teeth come in? Probably not. It is best to start good dental habits when young so that they are part of the daily routine for your child's lifetime.

4. Dental work is expensive. I commonly find parents (with dental insurance) that have to spend hundreds to thousands of dollars to fix their child's teeth.

So, how to protect your child's teeth? Start brushing them as soon as they come in. Help your child with their brushing until they are doing a good job (commonly about age 5). Visit a dentist regularly. Avoid sugary chewy foods such as fruit snacks, roll ups and candies. Avoid drinks with sugar in them such as juice, soda, lemonade, and sports drinks. Lastly don't let your child graze all day long or carry a cup around with them.

Myth busted! Next up, the idea that kids don't have to watch what they eat because they are kids.

SOAP (Organization of a Doctor Visit)

2012-01-31T14:27:00.000-07:00

I recently had a college student observe me in the office because she wants to be a pediatrician. I spent a few minutes explaining to her how a visit is organized so I thought I would also share that information with you. One of the first things a medical student learns about seeing patients and charting is "SOAP" This stands for Subjective, Objective, Assessment, and Plan. This is the order in which the visit and the charting is done.

Subjective means the information that we get from the patient. This includes history of the present illness, past medical history, family history, medications, allergies, etc. Some of this we ask every visit and some of it we review in the chart before coming into the room. It is very helpful if you voice all of your concerns and problems at this point in the visit.

Next is the objective part of the visit. This means the physical exam as well as vitals signs such as weight, temperature, blood pressure, etc.

For the next step, assessment, the doctor takes the information that she gathered in the first two steps to come up with a differential or list of what things the patient might have. Sometimes this is very easy, for example a bulging red ear drum means you have an ear infection or sometimes there are several possibilities of what you might have. I sometimes don't say a lot when I am examining a patient because I want to collect all the information and then I think while I am washing my hands before I sit down to talk with you.

The last step is the plan. Together the doctor and patient discuss treatment recommendations.

Since September the assessment and plan for all of your child's visits are available for you to view online (securely of course). The front desk has the directions on how to access this information for you.

Frost the Cupcake (Sunscreen)

2012-01-20T13:10:00.001-07:00

I know that sunscreen is not a very popular topic in the winter time but sunscreen is important year round. I recently attended a continuing education conference where I heard a dermatologist (Dr. Wagner) speak on this subject so I thought I would share some of it with you.

I'm sure I don't need to tell you about why sun protection is important. Skin cancer, wrinkles... who wants them? (By the way teens don't care about skin cancer so they are more likely to protect their skin if they think that the sun will make them ugly!)

It is best to get in the habit of applying sunscreen every morning. Make it part of your morning routine such as brushing your teeth. Then if you are going to be in the sun such as going to the pool or park reapply the sunscreen 20-30 minutes beforehand and every two hours after that. Dr. Wagner related applying sunscreen to "frosting a cupcake." You want to apply a lot and to not miss any part of the cupcake, er, skin. It is safe to use sunscreen on babies less than 6 months of age.

So, what sunscreen to buy? Dr. Wagner recommends a sunscreen with the SPF of 30. There is little benefit to the higher SPF sunscreens and as the SPF increases there are increased chemicals in the product. You also want to pick a sunscreen that is waterproof and protects agains UVA and UVB (aka broad spectrum). Some of the best ingredients include mexoryl and zinc oxide. Also if possible get a sunscreen that is perfume free.

Let's not wait until summer. Let's start frosting the cupcake now!

What ER Do I Take My Child To?

2012-01-13T11:56:00.000-07:00

You think your child broke their arm or that they might have appendicitis so what do you do? First of all, give our office a call. Sometimes we can help avoid an ER visit. Then if you need an ER we recommend a children's hospital such as Phoenix Children's Hospital or Cardon Children's Medical Center.

So, why a children's hospital. I know that there is probably another hospital closer to your house or one that advertises shorter wait times but we strongly urge you to go to a children's hospital. At a children's hospital you will get a doctor and staff that specializes in pediatrics. Children are not just small adults and they have different problems and different needs. I commonly see my patients receive unnecessary tests or medications from "adult" ERs.

Another reason to go to a children's hospital is for the specialists. For example, if your child might have appendicitis the results of tests such as ultasound or CT can be dependent on the tech or radiologist's experience with children. Then if your child needs surgery they will have to be transferred to a children's hospital for the surgery and admission.

Lastly, I would go to a children's hospital for the Child Life specialists. These therapists help make your child's stay less stressful and painful.

What To Do Instead of New Year's Resolutions

2011-12-29T16:18:00.000-07:00

Once again it is that time of year for New Year's resolutions. Quite frankly I wouldn't make one. Large or vague goals are hard to keep and tend not to last long. Then you get discouraged and give up.

So, why am I blogging about this? Every day I advise families about healthy habits that they need to adopt for a healthy child. Unfortunately I have to give a lot of advice all at once since I may only see your child once a year. Do I really expect you to make all those changes at once? No, I am in fact delighted when I see a patient who tells me that they have been able to make a small change and stick with it.

Instead of New Year's resolutions I would recommend making small goals throughout the year. Once one thing is accomplished then move on to something else. For example instead of the goal of eating healthy tackle one step at a time. Some examples of goals to make instead would be to eat at home one meal a week more or eat one extra serving of fruits/veggies a day or replace 1 can of soda with a cup of water instead.

It takes 30 days for a new behavior to become a habit. If you can incorporate the change into your existing routine it will be easier. Also if everyone at home can make the same change there will be less arguments. ("Why does Dad get to drink soda and I don't?") And if you tell others about your goals or have them join you then you will feel accountable and are more likely to stick to them.

Feel free to ask me what my current goal is that I am working on when you are in the office. Also, share with me your recent successes. We love to hear about them!

Top Things Dr. Krieg Says

2011-12-22T14:30:00.000-07:00

I enjoy reading Seattle Mama Doc's blog and last week she posted the Top 5 thing she says. http://seattlemamadoc.seattlechildrens.org/5-things-i-say-in-clinic/ I loved the blog and often say a variation of these same things. But I got to thinking, what are some of the things that I say all the time. So here's my list:

1. "Let me wash my hands and then I will sit down and talk to you." Handwashing (and using sanitizer) is how I keep healthy. Of course I also don't want to give any germs from one patient to another either!

2. "I can't believe how old you are!" and "It seems like yesterday you were a little baby!" I absolutely love watching my patients grow up but I don't know how they can be getting older because I certainly am not!

3."That's a good question." I love it when my patients and parents ask me questions. It helps remind me what issues are important to them as well as making sure I have addresssed all their concerns.

4. "Remind me..." I'm getting old and thus forgetful. I find that I tell patients that I will get them something like a dentist's number or a note and then promptly forget. Never fear I do remember, it is just 5 patients later or in the middle of the night! So, don't be shy about reminding me!

5. "Keep up the good work!" This is my favorite saying because I absolutely love it when my parents are offering healthy foods, encouraging their kids to exercise, taking them to the dentist, etc. It makes my patients healthier and makes my job easier.

Medical Home

2011-12-18T15:53:00.000-07:00

The current buzzword in medicine is medical home so I thought I'd take a few minutes to discuss what it is and why it is important. Quite simply the medical home is our office. We synthesize and coordinate all your child's health information and care. This is not new. This is what we have been doing for years. It is just getting attention now as a way to improve care and decrease costs.

So, why is this important? In medicine a lot of what we do is based on information and the more complete and accurate the information the better. It can better direct our care so that we order appropriate medications and tests. For example, a child that has had two recent ear infections is in my office with another one. If I know what dates the previous ear infections were and what antibiotics he was on I can better choose the treatment for this ear infection decreasing the likelihood of a return trip to my office.

How can you help foster the medical home? First of all, call us and come to see us when your child has a problem. That way all your child's records and information is in one place. Second, if your child is seen at an urgent care, ER, or specialist make sure they have our office information and send us a record of your child's visit. It doesn't happen automatically. Third, follow up with our office when recommended by these providers. Last, visit us yearly for your child's well child check. At that time we can review any issues over the past year and we can make sure we are on track for good health for the coming year.

So, this is where Dr. Krieg gets up on her soapbox... As many of you know I do not like urgent care. I see an over prescription of medication which leads to an increase in cost and side effects. Also, many times a follow up is needed which leads to an extra doctor visit and cost for you. Because we have a relationship with you and know your child we do not prescribe as many medications and we have the ability to follow up by phone in many cases.

And that summarizes the medical home. Welcome to our Home!

Prevention of SIDS

2011-11-17T09:55:00.001-07:00

The American Academy of Pediatrics recently updated their policy about SIDS and other sleep related deaths in infants. Most of the recommendations are familiar but I thought I would discuss some of the newer updates.

First, a review of the familiar. It is well known that infants should sleep on their back (not side or stomach) on a firm surface without fluffy blankets, pillows, or bedding around them. This includes nap time as well as at night. Also breastfeeding, avoidance of tobacco smoke, and avoidance of overheating the baby decrease the risk as well.

The new policy addresses co-sleeping. It recommends that your baby sleep in your room with you but not in bed with you. Sharing a bed with your infant does not decrease the risk of SIDS and many co-sleeping arrangements increase the risk of death from suffocation or strangulation. Also sleeping with your child in an armchair or couch is not recommended either.

The AAP reiterated that sleep positioners are not recommended. There is no evidence that any device or positioner decreases the risk of SIDS. Also monitors or apnea alarms do not decrease the risk of SIDS either.

Something new I learned is that it is not recommended for an infant to regularly sleep in a swing, sling, car seat, or carrier. They are at risk for airway obstruction.

If you have questions about these recommendations please feel free to give me a call.

Electronic Medical Records

2011-11-02T11:28:00.002-07:00

It has been almost a year since our office transitioned to electronic medical records (EMR) and I thought I would take a minute to reflect on the good versus the bad.

So, let's start with the good.
1. The best part is by far and away the electronic prescribing of medications. Fast, paperless, and no need for the pharmacy to have to try and read my handwriting any more! Best of all your prescription is ready and waiting by the time you get to the pharmacy!
2. Visit summaries are now available online. When you want to review the visit or can't remember what shot was given you can view it online any time of day. What's not to like about that?
3. We have access to your child's chart at home. So we are able to check incoming labs and if a question comes up at night we can check your child's chart.

Now the bad.
1. It is time consuming. I now spend an extra 1-2 hours a day working. Even though I am now more efficient I still will never be as fast as I was with paper.
2. It slows us down in the office. Once your child is weighed and measured I still have to wait until the information is entered in the computer and then I review the chart before I go into see your child. All slower than paper.
3. It is harder to make eye contact. I try hard not to be glued to my computer screen but sometimes it happens as I am trying to be fast and efficient.

That sums it up for now. It will be fun to see what new things are coming up!

Car Seats -- There's an App for That!

2011-10-30T21:32:00.000-07:00

Who would have guessed that there is an app for car seats? Well, there is now a free app from Phoenix Children's Hospital called Car Seat Helper. It provides information about the different car seat types. It also helps you choose a seat based on your child's age, height, and weight. Too cool! You can get it from the App Store or Android Market or from PCH's website. Did I mention that it is free?

www.phoenixchildrens.com/carseat

On a related note I discovered the coolest thing while checking this out. Phoenix Children's Hospital has a recycling program for old car seats. Each Earth Day volunteers dismantle old car seats and the parts are recycled. You will find the info at the above link.

If you use Car Seat Helper let me know what you think. Since my kids are now adult sized I don't think Car Seat Helper is going to help me much!

How Do Doctors Stay Up to Date?

2011-10-24T16:12:00.000-07:00

I have been trying to write this post for awhile. Quite frankly this a boring subject. I think it is important though because who wants to go and see a doctor that is 20 years out of date in their training?

At our office we keep up to date through several different ways. We read 8 monthly journals. (I have discovered that if you don't read some every day then suddenly there is a large pile on the bedside table!) We attend 1-2 lectures a month. We also attend a 2-4 day conference once a year. Then on the computer we attend webinars and do a program called Compuprep that takes about 25 hours a year and tests us on our knowledge.

We also learn from each other. We talk to specialists and drug representatives (yes, they do sometimes have valuable information!). Also we teach a pediatric resident from Phoenix Children's Hospital one half day a week. She keeps us on our toes!

I'll end here before you are comatose! If you hear about a medical subject in the news or online and want to talk about it give us a call -- we want you to keep us on our toes too!

Diaper Rash

2011-10-21T15:39:00.000-07:00

The drug representative from Desitin was visiting the office this week and I learned some "fun" facts. The company Johnson and Johnson has noticed that since the recession sales of diapers have decreased but the sales of diaper cream have increased. Also on the parent discussion board parents report that they sometimes will wait to change a diaper to see if their spouse will do it!

So, what does decreased diaper changing mean? Diaper rash!! Most diaper rashes are caused by urine and stool being held against the child's skin. When the diaper isn't changed right away the child is more likely to develop a diaper rash. Unfortunately diaper rash can happen even with the most diligent parents because it doesn't take long to develop.

So, what is a parent to do? I would recommend putting large amounts of a thick diaper ointment on your child's bottom. Creams that have a high concentration of zinc oxide or petroleum jelly are the best. You want to put enough of it on so that it is still there the next time you change their diaper. The diaper cream helps protect the skin from the next time you child stools or voids.

Sometimes a diaper rash is caused by yeast. The diaper area is a nice warm wet place that yeast likes to grow in. It can happen in either boys or girls. It looks like red patches or bumps that are not painful. Often times they are in the fold of skin where the leg meets the body. If you suspect yeast you can use over the counter clotrimazole on the rash three times a day. (you find it in the store with the athlete's foot medicines)

As always if these things aren't helping then it is time to make an appointment for us to look at the rash.

Desks That Let Kids Stand

2011-10-07T20:28:00.001-07:00

This post is a little different from some of my previous. I just read a summary of a study in Texas and I found it interesting so I thought I would share it. The study was published in the American Journal of Public Health and I am taking my information from a summary of it in the AAP News.

The study looked at 1st graders to see if desks that give kids the opportunity to stand and work could help reduce obesity. The desks are taller than usual desks and have a stool with them so kids have the ability to sit if they want. The study found that kids who use these desks burn more calories than those who use traditional desks.

What I found interesting about the study is that they found that 12 weeks into the study 70% of the kids chose to stand all the time. While the remaining 30% choose to stand most of the time. Also, parents and teachers of the kids with the standing desks reported improved behavior and school performance!

I have read about executives who choose to stand and work instead of sit but this is the first I have heard about kids trying it. I believe that it does improve efficiency and attention. I now do much of my work standing at my computer and I find that I get a lot more work done than when I sit down at my desk.

It will be interesting to see if any follow up studies result from this.

Constipation

2011-09-28T08:45:00.001-07:00

In continuing our discussion of poop I thought I would address constipation. This is a common problem that I seem to be seeing a lot more of in the past few years. By definition constipation is infrequent stooling. Once past infancy most children stool 1-2 times a day. If it is less freqent, hard, or painful then they are constipated.

So, what causes constipation? Most commonly it occurs because someone does not have enough fiber and water in their diet. In young children there can also be a behavioral part as well. If a child is scared to stool in the toilet or they have 1 or 2 painful stools then they start holding their stool in. Then of course it hurts to stool so they continue to hold it in.

How to treat constipation?
1. Increase fiber in the diet. We are supposed to eat 5-7 servings of fruits and veggies a day. (juice doesn't count!) You can also get extra fiber in beans, bran cereals, whole grain bread, and products that have fiber added such as the brands Fiber One and Fiber Plus. To see if something has fiber read the side of the box that has the nutrition information. The line that says fiber should say 5 grams or higher for cereals and granola bars and 3 grams or higher for bread.
2. Drink more water. If your body doesn't have enough fluid it steals it from your intestines and dries your stool out.
3.Take time to poop. I know this sounds funny but in today's fast paced society many children do not want to stop playing or watching TV to sit on the toilet long enough to stool. Keep magazines or books (not small toys unless you want to go fishing for them!) by the toilet and encourage your child to sit on the toilet for about 10 minutes after eating.
4. Use a step stool. If your child's feet do not reach the floor when sitting on the toilet then get a step stool for them to put their feet on. It is harder to stool if your legs are dangling.
5. Give mineral oil. If your child is older than 12 months of age you can give 1 Tbsp of mineral oil once daily to help keep their stool soft.

If these things don't help then it is time to come and see us.

The Poop on Poop

2011-09-21T13:26:00.000-07:00

I don't know of any other profession that spends as much time talking about poop as pediatricians do so I thought I would do a series of posts about the subject. (If anyone is worried I will NOT be posting any pictures with these posts!) The subject of poop brings about brings about such varied reactions in our office. The new parent is anxious and worried about it, the school age child bursts out in peals of laughter when discussed and the teenager has the "Really, do we have to talk about this" response.

Let's start off talking about baby poop.

Newborns start off life with the tarry dark stools called meconium. These last for about 2-3 days. Breast fed babies may then have 1-2 days of no stool while mom's milk is coming in. Once her milk is in the baby's stool then should be loose, seedy, and watery. If you are changing more diapers than you can count it means your baby is getting plenty of breast milk. Formula fed babies have more variation in their stool. Some babies may go many loose stools a day like a breastfed baby while others will have a formed stool every other day. The color of the stool can be yellow, green, brown, tan, dark. Quite frankly we really don't care! So when to call us? Please call if you are seeing blood or mucous in the stool, the stools are white for more than a couple of days, or if your baby is going more than 2-3 days without stooling. (As always, if your child is acting sick then call)

As babies get older often times their stooling patterns change and they stool less often. Breast fed babies can sometimes go 1 week without stooling. (This really freaks parents out!) When cereal and baby food are introduced parents notice that stools can change in color, frequency, and consistency. This is normal as well.

That's enough poop for today. Stay tuned for my next post on constipation.

Encouraging Your Child's Creativity

2011-09-15T10:08:00.001-07:00

I wanted to take a moment to talk about creativity. It is a valuable trait that can easily get lost if not fostered. So what is creativity? By definition it the use of the imagination or original ideas. Some parents might think that since their child is not going to be an artist they don't need to be creative. This is not true, creativity is useful in most professions. Such as leaders and business professionals who develop new ideas or engineers who design better products.

So how to encourage your child to be creative? Here are a few suggestions:

1. Allow time for play. In our fast paced society often times our days are full of structured and planned activities and time to play is lost.

2. Provide materials. These include craft materials, Play Doh, boxes.

3. Provide opportunities for movement and music. These activities can be things such as playing with streamers, banging pots with spoons, dancing to different types of music, or making an obstacle course.

4. Limit electronic toys. They can be restrictive in how they can be used. Toys that can used in unique ways or involve the imagination encourage creativity. Some suggestions include blocks, Legos, and dress up clothes. I discovered with my kids that the electronic toys seemed to be popular but then they only would play with them for a short while. The non electronic toys were the ones played with over and over again.

5. Provide a variety of children's book selections. Reading to your child stimulates use of their imagination. The library is a great place to find books to interest your child.

6. Limit screen time. (here is where Dr. Krieg gets up on her soapbox!) Computer, tv and video games all have little opportunity to use creativity.

I hope you find these suggestions helpful and that you and your child have fun doing creative activities together!

Scorpion Stings

2011-09-08T21:39:00.001-07:00

This is the time of year that we see more scorpions so I thought I would blog about scorpion stings. Just to be clear scorpions STING not bite!

So.. what's all the fuss about scorpion stings. Well, they sting you with a neurotoxin (that means it is a chemical that is toxic to your nervous system). Scorpion stings are rarely fatal and do not have long lasting effects but are quite unpleasant. One feels immediate pain and burning. The area where the sting occurs also can be sensitive to touch and can have numbness and tingling. Less common side effects include blurry vision, muscle twitching, eye roving movements, drooling, and restlessness.

What should you do if you get stung? First wash the area with soap and water. Then apply a cool compress or ice. If you are stung on an arm or leg elevate it. Next, I would recommend calling poison control (800-222-1222). They are a wonderful resource and they can give you advice as to whether or not you need to go to the ER. Most people do not need to go to the ER. If you do they will likely give you medication to make you more comfortable and may give you antivenin if your symptoms are severe.

New Infant Tylenol Dosing

2011-09-06T21:57:00.000-07:00

Studies have found that many parents are confused about how much fever reducer to give their child and thus many children are given too much or too little medication. To help decrease overdoses Tylenol and other manufacturers of acetaminophen (generic name for Tylenol) have reformulated their infant suspension. The strength of the infant is now the same as the children's suspension (160mg/5mL).

So... what dose to give? The children's liquid has dosing on the side of the box. Give the dose based on your child's weight not their age. For an infant check the last handout our office gave you. Up until age 5 the dosing is listed at the top under your child's height and weight. Still uncertain of the dose? Then call our office. We would rather you call us than given an incorrect dose.

A general rule of thumb is that if a medication comes with a medicine dropper then that is what you should use. Don't use that dropper for any other medication. If you want to use a dropper or syringe for the children's liquid (which comes with a cup) then use a dropper with the same dosing markings. For example if your child's dose is 1 tsp in the cup then use a dropper with a 1 tsp mark on it.

Still confused? Then bring the product you have to your child's next visit and ask us to help you out. We are always happy to help you!

Don't Forget Your Own Health

2011-08-25T15:51:00.000-07:00

I had the day off yesterday and took the time to get some overdue appointments taken care of. It occurred to me that as parents our children are our first priority and our own health gets neglected. So I thought I would review the reasons to take care of your own health.

1. If you don't feel well you can't be a good parent. If you are in pain from a toothache or you have the flu how can you have the patience to care for your children.

2. It sets a good example for your children. If they see you getting a flu shot or visiting the dentist they are more likely to do these things with less complaining. These good habits often times comtinue on into adulthood.

3. You provide safety for your child. When we have children do the eye chart in the office I am astounded at the number of parents who say they can't read the chart. It worries me that they driving their child around without a current eye exam or glasses! Also keeping your immunizations up to date can help prevent your children from getting sick.

So, let's make the time for our regular appointments and continue our healthy habits for our children's sake as well as our own!

Obesity and the Media

2011-08-24T13:52:00.000-07:00

Regular readers of this blog know that I have already done several posts about the media and children but I thought I would revisit the topic. This month the American Academy of Pediatrics put out a policy statement "Children, Adolescents, Obesity, and the Media" so I thought I would summarize it.

Research shows that there is a strong correlation between excessive TV viewing and obesity. Also research shows that a bedroom TV is a significant risk factor for obesity.

There are several ways in which watching TV can contribute to obesity.
1. The more time a child spends watching TV the less time they spend doing a physical activity.
2. Unhealthy eating habits are learned from the programming as well as the advertisements.
3. Increased snacking while watching TV. Not only do the ads make you think you are hungry when you are not but when you eat in front of the TV you tend to eat more than when you sit at the table without the TV on.
4. The TV disrupts normal sleep patterns. When a TV is in a child's bedroom they are often watching it instead of sleeping. This leads to more of numbers 2 and 3 above but also makes the child more tired. When you are tired you often inclined to eat to help boost your energy level.

So, what is a parent to do. First of all take the TV out of your child's bedroom. (Tell them that Dr. Krieg is making you!) Then make rules about TV viewing that include how much, when, and what they are allowed to watch. It is recommended that children (over age 2) spend no more than two hours a day in front of a screen (computer, TV and video games). Also make the rule that all food belongs in the kitchen or at the table. (your house will be neater!) Turn the TV off when you are eating. You are the parent and are allowed to make rules. Do not give in when you children complain!

Have questions or are uncertain what to do? We are more than happy to talk about media usage at your child's well child check as well as review their body mass index (BMI).

Roll Baby Roll!

2011-08-08T14:34:00.000-07:00

As a pediatrician I get many phone calls about injuries to my patients so I thought I would take a few minutes to discuss how to prevent them.

The most important thing to remember is that if something has a strap then use it. It was put there for a reason. This includes straps in shopping carts, swings, strollers, high chairs, car seats, changing tables, etc.... Even if you don't think your child can get out strap them in anyway!

Our most common calls involve children rolling off beds or sofas. Even newborns can roll and putting pillows around them doesn't help. With my children I put them on a blanket on the floor to play and also changed their diaper on the floor. You can't fall off the floor!

Also we get calls about children that are put in car seats or bouncers on the counter unsecured. The child not only falls out of the seat but then also off the counter! Again I would recommend putting them on the floor.

I will end the post with a tip from my mother-in-law. If your monkey child can climb out of the grocery cart seat even when strapped in try tying their shoes together!

New Crib Safety Standards

2011-08-04T11:52:00.000-07:00

For the first time in almost 30 years there are new federal safety standards for cribs. These changes are to protect the safety of infants and to decrease the suffocation deaths that occur in unsafe cribs.

The biggest change is that drop sides are no longer allowed. Also stronger slats and better mattress supports are required as well. Also crib manufacturers are to do more rigorous testing on their product before it goes on sale.

Unfortunately this means that when you need a crib you need to buy a new one. Ones from garage sales, thrift stores and friends are not to be used. Old cribs need to be dismantled and thrown away. I know it seems wasteful but it is for your infant's safety.

http://www.healthychildren.org/English/safety-prevention/at-home/Pages/New-Crib-Standards-What-Parents-Need-to-Know.aspx

International Travel -- Mosquito Spread Illness

2011-07-30T20:33:00.000-07:00

In many parts of the world mosquito spread illnesses cause much death and illness. Travelers are susceptible as well. In fact there are 1200 cases of malaria and 13 deaths a year in the United States from travelers who caught malaria.

Mosquito spread illness is passed by a mosquito biting someone who is infected. The mosquito becomes infected and then passes it on to those that they bite in the future. Dengue fever and malaria are the most common illnesses spread that way.

To prevent both illnesses it is recommended to try to avoid mosquito bites. It is suggested that you wear long sleeves and long pants. Also when sleeping one needs either netting for the bed, screened windows, or air conditioning. There are many different mosquito repellants. It is recommended to buy it before you leave and purchase one with the ingredient DEET.

If you are traveling to an area where there is malaria it is recommended to take medication to help prevent it. There are several different medications that can be used. They all need to be purchased before you leave. They are continued while you travel and then continued for a few weeks upon returning home.

As discussed in my last blog it is important to talk to your child's doctor or a travel medicine clinic 4-6 weeks before traveling. The Center for Disease Control has great information on their webiste as well. www.cdc.gov

Lastly, after you return home it is important to remind your child's health care provider of your travel if your child is sick. Things your child may catch abroad are not found in the United States and so they won't be on the forefront of their doctor's mind.

Immunizations for Kids for International Travel

2011-07-24T19:42:00.000-07:00

International travel is very common and easy these days and so one might forget that extra planning is needed before you leave. It is recommended that you check out what immunizations are needed 4-6 weeks before you are planning to leave. The Center for Disease Control is a great resource for travel information. Also you can call our office or visit a travel medicine clinic such as Passport Health.

First you want to make sure your child is up to date with routine immunizations. If your child has not received two doses of the Measles, Mumps, Rubella vaccine (MMR) you need to talk to our office about getting it for them. This applies to travel to most places in the world.

The typhoid fever vaccine is needed for children over age two who are traveling to India and Southeast Asia. It only provides partial protection so you still need to be careful to eat cooked food and drink bottled or boiled water.

The yellow fever vaccine is required for travel to tropical Africa and South America. Some countries will not let you enter unless you have a valid International Certificate of Vaccination or Prophylaxis (ICVP) completed by a certified travel medicine clinic.

The meningococcal vaccine is recommended for travel to Sub Saharan Africa and those making the Hajj pilgrimage.

The Center for Disease Control has a great website to check out before travel.
www.cdc.gov

In my next blog I will continue with information about malaria prophylaxis.

Valley Fever 101 Continued

2011-07-19T07:25:00.000-07:00

Let's continue on today with information about diagnosis and treatment of Valley Fever.

The symptoms of Valley Fever include cough, chest pain, rashes, fever, fatigue, night sweats, headache, and weight loss. About 35% of those who catch it develop pneumonia. (remember from the last post that 60% of those who catch it do not have any symptoms) Only about 5% of people present with a rash. Even though it is called Valley "Fever" many people do not have a fever. If you have a prolonged cough and fatigue you might want to consult your doctor.

How is Valley Fever diagnosed? Most commonly it is diagnosed by serology. This means your blood is drawn and the lab looks to see if your body is developing antibodies to Cocci. If it is checked too early in the illness you might be falsely negative since your body hasn't had a chance to make antibodies yet. Chest Xray and sputum cultures can also be helpful in making the diagnosis.

How is Valley Fever treated? Most people do not need any treatment at all. The illness goes away by itself. Once you have had Valley Fever you cannot get it again. If someone is having prolonged symptoms then the medication fluconazole is commonly used. Often it is used for many months when someone needs treatment.

Well, that concludes Valley Fever 101. I learned some new things. I hope you did too.

Valley Fever 101

2011-07-16T07:28:00.000-07:00

With last week's dust storm the health department is predicting a rise in cases of Valley Fever so I thought I would brush up on my knowledge about it. Here is a summary of what I learned.

Valley Fever is caused by a fungus ("cocci") that lives in the soil of hot dry areas. It lives in the top 2-8 inches of the soil so things such as dust storms and construction stir it up. 60% of all cases occur in Arizona. It also can be found in Mexico, California, and New Mexico.

One contracts Valley Fever by inhaling the spores. It is not contagious from one person to another. You also cannot catch it from or give it to your pet. It takes 1-4 weeks for someone to develop symptoms after being exposed to Valley Fever.

The good news is that most people do not get seriously sick from Valley Fever. In fact 60% of people who catch it have no symptoms and don't even know that they had it. 35% of people do have symptoms such as fatigue, cough, and fever. Many of these people again do not know that they have Valley Fever because many of them get better without treatment. Only 2-4% of people with Valley Fever get seriously sick.

Who is at risk for Valley Fever? Any age can get sick from Valley Fever from an infant to an older adult. It does occur more often in males and in those over 65 years of age. More serious symptoms are more likely to happen in those who are Native American and Hispanic.

That's enough for now, I don't want to bore you! I will continue this next week.

Common Food Misconceptions

2011-07-11T07:49:00.000-07:00

In talking to parents about what their child eats I have come across a number of common misunderstandings that I wanted to clear up today.

Fruit snacks are not a fruit.
Fruit snacks and roll ups are made with a small amount of fruit juice but otherwise are just sugar. They have no nutritional value and they also are hard on your child's teeth. Give your child a piece of fruit instead.

Yoghurt is not a fruit either.
Now, yoghurt is good for you but don't kid yourself that the fruit flavor or fruit at the bottom counts as a serving of fruit. Again, have a piece of fruit.

Yoghurt does not cure constipation.
There are probiotics in yoghurt that are good for your digestive system but they do not cure constipation. Constipation is best treated with more fiber in the diet which you get from fruits and veggies. The brand "Fiber One" makes a yoghurt that has added fiber but you have to buy that specific brand.

Natural and Whole Grain chips and soda are not good for you.
Advertisers have realized that we are becoming more conscious about our diet and so are relabeling junk foods to make them sound more healthy for you. Don't fall for it! Junk food is junk food.

Juice is not good for you.
Again the advertisers have worked hard to make juice sound good for you. It isn't. Many juices have just as much sugar as soda. Even if you squeeze the juice yourself you are missing out on the fiber and nutrients that you would get if you eat the fruit. We recommend that you eat the fruit or veggie and then have water to drink.

Reading to Your Child

2011-07-05T07:51:00.002-07:00

We all know how important it is to read to our children when they are young. It helps them improve their speech and has them better prepared when they start school. I've discovered recently though that many parents stop reading to their children once they are old enough to read themselves. The value of reading to your child doesn't stop once they can independently read. It is a great way to spend time together, increase their vocabulary, and continue to contribute to good school performance. Both my kids enjoyed my reading to them until the junior high years.

So, when to read to them? Continuing the habit of reading to them before bedtime is one option. Our family would also read while waiting at appointments, riding in the car, and at breakfast. My daughter also liked to have me read while she did chores such as emptying the dishwasher. Talk about a win-win situation!

Now, what to read to them? I loved reading to my kids as they got older because the books were more interesting and I didn't have to read "Goodnight Moon" yet again. Ask your child what they would like you to read to them. You can also ask the librarian or other parents for suggestions.

Here are some of my family's favorites:
For younger grades:
Junie B. Jones books by Barbara Park
Boxcar Children books by Gertrude Chandler Warner
The Wizard of Oz by Frank Baum

For middle elementary grades:
Doctor Doolittle books by Hugh Lofting
Pippi Longstocking by Astrid Lindgren
Mary Poppins books by P.L. Travers
Mrs. Piggle Wiggle books by Betty MacDonald

For older elementary grades:
Harry Potter series by J.K. Rowling
Pendragon series by DJ MacHale

Happy Reading!

Airline Travel with Young Children

2011-06-10T11:28:00.000-07:00

With school out, the family trips have begun. Some destinations require an airpline trip to get there. So here are some airline safety facts and tips to keep children as safe as possible.

Fact: The safest place for a child regardless of age is in a Child Restraint System (CRS) or carseat. Both the FAA and the Academy of Pediatrics recommend that children travel in an FAA approved CRS until they weigh 40 pounds.

Fact: We have all heard the stories of planes with holes in the roof in flight or severe turbulence that that occur without warning and led to near miss problems with landings. For this reason, it is NOT a good idea to travel with an infant less than 2 years old on your lap. Most car seats are tested to hold a child securely in an event such as this.

Fact: Using the carseat on board prevents it from being lost or delayed in checked luggage.

Getting Ready to Fly!

· Make sure the carseat has a sticker that says it is certified for use in motor vehicles and aircraft.

· Purchase your child a ticket to ensure they have a seat where the carseat can be installed. If not purchasing a ticket, try to fly off peak and ask the airline if there is an empty seat if you would be allowed to use one for the carseat to restrain your child. Remember in these days of full flights, this is an unlikely scenario.

· Install the carseat in the window seat the same as you would in your vehicle.

o Less than 20 pounds, use a rear facing infant carseat.

o 20-40 pounds, use a forward facing carseat.

o More than 40 pounds, this child can use the airline seatbelt and you need to check your carseat.

· Raising the armrest gives the seat more space.

· If your child is awake on take off and landing, have them suck on something or drink a beverage. This helps their ears pop easily and reduces discomfort.

· Have some small toys or snacks in your diaper bag to amuse them during flight.

· After the trip, your carseat is now with you to install in the vehicle you are using at your destination. You do not need to rent one that may be very old and doesn’t fit your child well.

Have a safe summer trip!

Having "The Talk" with your Pre-Teen

2011-05-30T08:06:00.000-07:00

Most parents dread discussing puberty and sex with their children. Many are happy to leave the teaching to health class at school but we all know that what we learn at school on this subject can be inaccurate and imcomplete. So... what's a parent to do?

First, I would recommend starting early. Teaching is an ongoing process not just one conversation when they get older. When young children ask questions about their body or yours answer honestly and simply. Use correct names for body parts. Your answer should be based on their level of understanding. As they get older become more detailed.

Second, I would be cautious about what they are seeing in the media. Make sure what they are watching on tv, YouTube, and movies are age appropriate. When they do see things in the media or if their favorite teen pop star is pregnant it is a great time to continue your discussion of sexuality. Ask your child questions such as "What do you think?" or "What other choices could they have made?"

Third, provide accurate written or online material for your child. This is especially important for the teen that does not want to talk about this subject. Read what you give them first and then provide it to them quietly so they can read it without the whole family knowing it.

Here is a link for parents of girls. There is also a Q and A for Girls on this website.
http://www.healthychats.com/?MomQnA

Fit Kid Challenge

2011-05-18T14:17:00.000-07:00

Cardon Children's Medical Center is sponsoring a Fit Kid Challenge this summer. If you sign up you will receive weekly health tips, healthy recipes, and fitness challenges. You can also enter to win prizes. To sign up you can "like" Cardon Children's Medical Center on Facebook, or send a text message that says Fitkids to 411987, or go to www.bannerhealth.com/cardonchildrensfitkid and submit you email for updates.

Fever 411 Continued

2011-04-15T11:06:00.000-07:00

Q: Does teething cause a fever?
A: No, teething does not cause a fever. Fever is caused by illness.

Q: What do I do if my child has chills?
A: Chills are common when a fever is going up. If you haven't given a fever reducer already then go ahead and do so. Dress your child however they are comfortable. It doesn't hurt to wrap them up if that makes them feel better.

Q: What is considered a fever?
A: A fever is a temperature of 100.4 (38.0 degrees Celsius) or higher. Your body temperature does not stay the same all the time. Your body temperature can range from 97.0-100.3.

Q: How should I take my child's temperature?
A: There are many choices to use to take a temperature. The most accurate way to take a temperature is rectally. A cheap digital thermometer from the drugstore works fine for this. This method is preferred in infants under 6 months of age. Temperatures taken under the arm are not very accurate. Adding a degree is not helpful; please tell us what the thermometer read and how the temperature was taken instead. Ear thermometers are fairly accurate if they are correctly inserted into the ear. Young babies' ears are sometimes too small for the thermometer. Temporal thermometers are fairly accurate as well. In a cooperative child you can also take a oral temperature. We do not recommend pacifier thermometers or the ones that are a strip that you place on the forehead.

Fever 411

2011-04-04T13:28:00.000-07:00

Fever is a popular topic in my office so I thought I would address some of the more common questions that I get asked.

Q: "At what temperature should I be worried?" Or "At what temperature should I take my child to the hospital?"
A: For a child over the age of 2 months there is not a particular temperature that we worry about. Fever is your body's natural way of fighting infection. So there is no need to go to the ER solely for a high temperature.

Q: "Why do we worry about a fever in a newborn or infant less than 2 months of age?"
A: Newborns have weak immune systems and a fever can be a sign of a serious illness. The fever won't hurt them but the illness might. If an infant has a rectal temperature of 100.4 or greater then you need to call our office right away.

Q: "When should I give my child a fever reducer?"
A: Fever doesn't hurt you. It just makes you feel bad so I would recommend giving your child acetaminophen or ibuprofen when the fever is high enough that they are uncomfortable.

Q: "What dose should I give my child?"
A: At every well child check our office gives you a handout that has the acetaminophen and ibuprofen doses listed for your child. The dose is based on weight not age. For older children the dose is listed on the package. Avoid using combination products that include acetaminophen along with cold or cough medications. These often lead to confusion and incorrect dosing.

Q: "How should I measure my child's dose of medication?"
A: If the package of what you bought includes a dropper then use that. Do not use that measuring device for any other medication. If you are using a product that comes with a cup you can use a syringe that has the same measurements on it (such as 1 tsp). You can also ask the pharmacist what measuring device they recommend. Do not use a silverware spoon to measure medicine. They are very inaccurate.

Q: "Can I alternate Tylenol (acetaminophen) and Motrin (ibuprofen)?"
A: This question is controversial. It is uncertain if this practice is safe and if it contributes to more patient comfort. The additional concern over this practice is that it increases the chance of inaccurate or over dosing of medication.

Q: "How do I prevent my child from havng a febrile seizure?"
A: Febrile seizures are not caused by an untreated fever or a certain height of fever. They are thought to occur due to genetic susceptibility and specific illnesses. Often the seizure occurs when the fever first goes up before the parent even realizes that the child is sick. Fever reducing medications do not prevent febrile seizures.

Q: "My child refuses to take medication by mouth so what do I do?"
A: My daughter went through this phase and it was quite frustrating. When she had a fever she was uncomfortable from the fever. Since fever isn't dangerous there is no need to give them anything, they will simply be uncomfortable like my child. (Thankfully this phase passes!)

Q: "When do I worry about my child?"
A: If your child acts like they have a high fever when they have no fever then it is time to be alarmed. When a fever goes up your child wants to lie around and not drink or eat. When the fever comes down then they should feel a little better and want to play. If they are lying around all the time or not drinking then it is time to be alarmed. If the fever lasts for 3 days or if it is accompanied by other things such as ear pain, sore throat, or difficulty breathing then it is time for us to see your child. Also at any time that your gut instinct tells you something is wrong then we will be happy to see your child.

Classes at Banner Desert Hospital

2011-03-08T18:42:00.000-07:00

Family Life Education Classes for March and April

Cardon Children's Medical Center and Banner Desert Medical Center offer health education and support for you and your family. Be prepared for the challenges of parenting and of keeping your family happy, healthy and safe with these upcoming classes for spring.

Safe Babysitter Class

This class will give you the skills and confidence you need to be a wonderful babysitter! This is a must for all babysitters! This 4-hour class will provide basic information about infant and child care, safety, what to do in case of an emergency, CPR for infants and children, first aid, activity planning and behavior. For ages 11 and older. This class is taught by an RN who is a CPR certified instructor.

Dates: March 13 or April 2

Time: 12:30 – 4:30 p.m.

Cost: $35 per person

RSVP: (602) 230-CARE (2273) or online

Just for Dads

This class is a must for all first-time dads! It is led by men for men, taught by a physician who himself is an experienced father. Topics include how to be supportive through labor, creating a Dad's tool box, what to do when the baby cries, what to expect postpartum, and balancing work and family. A certified car seat installation expert will be available during the last half hour of each class to help new dads install their car seats and answer safety questions.

Date: March 31

Time: 6 – 8 p.m.

Cost: $25

RSVP: (602) 230-CARE (2273) or online

OB Sibling Adjustment Class

An interactive class designed to help siblings prepare for the arrival of a new baby. We will read a story, sing a song and make a craft. The children will learn, with the help of a doll, about holding, gentle touch, feeding, diapering and safety. An adult must attend the class with the child/children; recommend for ages 3-9.

Date: April 9

Time: 10 a.m. – Noon

Cost: $20

RSVP: (602) 230-CARE (2273) or online

Infant/Child CPR and First Aid Class

This class is recommended for parents, grandparents, and caregivers. You will learn current CPR (Cardio Pulmonary Resuscitation) techniques for both infants and children, what to do if a child is choking and basic first aid. You will learn through instruction and hands-on practice with infant and child mannequins. This class is taught by an RN who is a certified CPR instructor. Note: A CPR course completion card is not issued for this class.

Date: April 13

Time: 6 - 8 p.m.

Cost: $20 per person

RSVP: (602) 230-CARE (2273) or online

All classes will be held at the Rosati Education Center on the campus of Banner Desert Medical Center, located at 1400 S. Dobson Road in Mesa.

Register for classes by calling (602) 230-CARE (2273). Class size is limited.

Questions: Call the Prenatal Education program manager, 480-412-5292.
Find a Class or Physician or call 602-230-CARE (2273)
Connect with us
1400 S. Dobson Road

Mesa, AZ 85202

www.BannerHealth.com/Desert

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When to Keep Your Child Home From School

2011-01-25T20:46:00.000-07:00

It is always a tough call for a parent whether or not to keep your child home from school. It often times feels like a lose-lose situation because school is unhappy if you send a sick child to school but then they are also unhappy when your child misses school. So... what's a parent to do? Here are some basic guidelines.

Your child needs to stay home if they have had a fever (temperature over 100.4) or vomited in the past 24 hours. If they have a fever overnight but then wake up without one you still need to keep them home because the fever is likely to go up later in the day. Your child also needs to stay home if they are having discharge from their eyes. If your child is diagnosed with strep they need to be on antibiotics for 24 hours before they return to school. Also, if your child is too sick to be at school they should not be going to the store, McDonalds or any public place because they are contagious.

It is a good idea to keep your child home if they do not feel well enough to participate. For example if they have an ear infection (which is not contagious) and were awake most of the night they need to stay home and rest.

Your child can attend school if they have a temperature of 99. It is not a fever. Also they can attend school if their runny nose is yellow or green. It is not a sign of infection. With a cold virus the congestion and cough can last 1-2 weeks and clearly they can't stay home that whole time. So, you can send them back to school when the feel well and are not running fevers.

If your child is missing a lot of school please come see us to see if we can help. We are also happy to write an excuse for school when you are in the office so please let us know if you need one.

Interviews about Nutrition and Obesity

2011-01-05T11:34:00.000-07:00

The American Academy of Pediatrics has a great section on their website with interviews with experts on nutrition and child health. They are designed for parents and are easy to listen to. If you don't want to listen to an entire interview the site shows you specific questions and you can pick and choose what you want to hear. Check it out!

http://www.aap.org/obesity/soundadvice.html

What NOT to buy at the drug store

2010-12-16T16:04:00.000-07:00

In continuing my series on what NOT to buy we are going to discuss the drug store. Many things are sold that don't work and they are just on the shelf because people spend money on them.

Let's start with lotions. The best moisturizer is petroleum jelly (vasoline). All the ones with fragrance don't work very well. Baby lotion in particular doesn't work at all and often times the baby gets a rash from the perfumes. If petroleum jelly is too greasy for your taste you might want to try Eucerin cream.

Moving on to medications. Cough and cold medications don't work in kids. The most useful medication is pseudoephedrine for kids over age 5 for nasal congestion. This is the Sudafed that you have to ask the pharmacist for. Don't buy the one off the shelf (it is a different ingredient). Also, there is no need to buy Vapo Rub. It doesn't help and makes many young kids more congested.

Have you ever read a Qtip box? It says on the package that it is not to be used in ears. We find that it pushes the wax further into the ear. We also sometimes see kids who have scratched the inside of their ear canal with the Qtip and then it bleeds and is painful. So unless you plan to use the Qtips for something else you can just leave them on the shelf.

Baby powder is also not a necessary purchase. A thick diaper ointment such as petroleum jelly works best to treat and prevent diaper rash. Also when you use baby powder it commonly gets into the air and you and your baby can breathe it into your lungs.

Lastly I would not buy the teething remedies. This includes Orajel and Teething Tablets. They don't work and often are used any time an infant is fussy so are significantly overused. Try giving your child a teething ring to chew on or a wet washcloth. Infants love to put things in their mouths.

I hope this helps you save your money!

Synthetic Pot

2010-12-07T13:17:00.000-07:00

I didn't know that there was such a thing as synthetic pot until I read this information from DrugFreeAZ.org. It is sold legally and can have horrible health effects. So, I"m passing the information on. Please discuss with your teens and preteens

ALERT: Synthetic Marijuana - Spice (K2) Fact Sheet

Marketed as incense.

use as incense. However, people are smoking the incense because it produces a high similar to

marijuana, but of longer duration. The incense is sprayed with JWH-018, a synthetic THC, before it is

packaged for sale. This spray is reportedly an "analgesic chemical which acts as a cannabinoid."

Spice/K2 is a legal substance marketed since 2006 as a dried, herbal blend for

More potent than marijuana.

brand, it can be more potent than marijuana.

Depending on the synthetic compound in the specific commercial

Not for human consumption.

colors/flavors-usually sold in foil packaging or in small glass containers. It is sold as incense and marked

Spice is sold in smoke shops and head shops in a variety of

“not for human consumption”. The

average cost is $30.00 a gram, more expensive than marijuana.

Most likely users:

14-27 yr. olds

Prisoners/probationers

Military (use now banned by all military branches)

Significant health risks.

unidentified toxic substances which contribute to various adverse health effects (also cause

hallucinogenic effects similar to effects of PCP. Symptoms/side-effects may include:

Spice is causing a significant health risk. Spice/K2 is often contaminated with

mimics marijuana “high” (often induced more quickly/more intense than “real” marijuana)

hallucinations

seizures/tremors

coma/unconsciousness

vomiting

numbness/tingling

increased respiration rate

elevated blood pressure (reported up to 200/100-medically dangerous)

elevated heart rate (reported up to rate of 150-medically dangerous)

increased level of anxiety/agitation leading to panic attacks (possible suicide attempts)

All effects of K2/Spice drugs may not be known for a very long time because of long time period that

body stores them.

Developed for research, never tested on humans.

Huffman, a Clemson University professor, as part of research for the National Institute for Drug Abuse

(NIDA) on endogenous cannabinoid receptors-but never tested on humans nor approved by the FDA. Dr.

Spice/K2 was developed by Dr. John W.

Huffman said in an interview to WebMD, “It is like Russian roulette to use these drugs. We don’t know a

darn thing about them for real. It shouldn’t be out there.”

Marketed under various names.

Spice, Spice Silver, Spice Gold, Spice Diamond, Smoke, Skunk, Yucatan Fire, Genie & Zohai Orange

Dragon Smoke, Black Mamba,Blaze, Red X, and Dawn.

It is marketed under a variety of names including K2, Spice, PepNot just smoked.

http://www.drugfreeaz.org/Spice is most often smoked but can be mixed in with food or drink.

What NOT to Buy Your Child

2010-11-24T12:00:00.000-07:00

Since the shopping season is upon us I thought I would take a few minutes to save everyone some money. First off I would avoid all infant/toddler DVDs. These include Baby Einstein and Your Baby Can Read.. They have very convincing advertisements but the research shows that they do not help your child. One study even showed toddlers who watched them learned fewer words than toddlers who watched nothing.

Also I would not buy a baby walker. The ones with wheels are dangerous. Do you really want to chase your child before they are walking! The walkers do not help infants walk faster. Instead the research shows they walk and TALK later if they use a walker. The ones without wheels are fine (such as an Exersaucer) but they do not help infants learn. They simply entertain your child while you do the dishes.

As parents we all think our children are advanced for their age but I would urge parents to pay attention to the recommended age range of a toy before buying it. Toys are usually targeted to a developmental level and children not at that level can become frustrated and not enjoy a toy. Also toys with small pieces are not labeled for young children for safety reasons.

Lastly I would urge parents to pay attention to the ratings of DVDs and video games before you buy them. There is a reason for T, M and PG-13 ratings. What may look just like a racing game may have inappropriate language or actions.

So... what to buy? Books, puzzles, board games are timeless and will get used. Also building (such as Legos) and craft supplies help a child's creativity. As my children have gotten older we have given gifts of activities such as tickets to a play. These have been some of the most popular and memorable gifts in our house.

Happy Black Friday!

Traditions

2010-11-18T13:36:00.000-07:00

Kids (and adults!) love routine. We all like to know what to expect and when it is going to happen. It is this love for routine that produces family traditions. These traditions produce great family time and wonderful memories.

The holidays are a great time for family traditions. Remember to schedule time for them this season. Your kids are more likely to remember things you do together instead of what toys they got for Christmas. If you don't have any traditions there is always time to start some. Try cooking or baking together or have a family game night.

I Love Fruits and Vegetables!

2010-11-01T20:37:00.000-07:00

I recently discovered Bountiful Baskets. I have never been so enthusiastic about fruits and veggies before. Bountiful Baskets is a food co-op where you get two laundry baskets full of fruits and veggies each week that you participate. It feels like Christmas to me because it is a complete surprise what you get in your basket. It has made me try new foods and gives me a challenge to figure out new recipes to use them in.

It's easy and cheap. On Tuesday or Wednesday you go to their website and place an order. It is $15 for the 2 laundry baskets (one of fruit and one of veggies). You select a pick up site and then on Saturday morning you show up at that time and pick them up. You need to bring bags or your own laundry basket to carry them home in. There is no commitment so you can participate every week or however often you want. Give it a try and let me know how it goes.

http://bountifulbaskets.org/

Adolescents and the Media

2010-10-21T13:02:00.000-07:00

"The easiest way to get teenagers to adopt a certain behavior is to make it seem as if everyone is doing it." This quote from Pediatric Annals sums up the effect of media on teenagers perfectly. For teens the media can have both positive and negative influences but unfortunately it is mostly negative.

Teenagers see 2000 beer commercials a year. Also violence and sex are ubiquitous in the media. The media portrays drinking, smoking, and sex as fun and commonplace. It rarely shows the negative consequences of these behaviors.

So, what's a parent to do? Actually the answer is the same as for younger kids.
1. Make sure your teen is watching / playing age appropriate tv / video games. Become familiar with the rating systems. Also there is often information available online or in the newspaper geared to parents as to what is in a movie that might be inappropriate for certain ages.
2. Talk with you teen about media pitfalls before they occur. Some subjects include "sexting", internet bullying, and what is appropriate to post on social media such as Facebook.
3. Consume media with your teens. Watch tv and movies together, listen to their choice of music with them, friend them on Facebook. Not only will you have fun with your teen but by doing these things together you can more easily discuss sensitive topics. Try not to lecture your teen instead ask them questions about what do they think about something. Or what would they do in a particular situation. You often get very entertaining answers!

Free Family Event on Saturday Oct. 16

2010-10-13T13:05:00.000-07:00

Chandler is hosting a Day of Play at Tumbleweed Park this Sat. from 8-12am. This is a free festival celebrating health. It is sponsored by Shape Up US. There will be inflatables, NFL Alumni, team mascots such as the Suns Gorilla and Diamondbacks Baxter, booths, and live entertainment. What a fun way to spend a nice morning with the family!

TV Viewing and Childhood Obesity

2010-10-06T12:26:00.000-07:00

I"m going to continue our discussion on the effect of media on children. This information was taken from Pediatric Annals September 2010.

Children are now spending more time watching TV than any other activity other than sleeping. There is evidence that increased TV viewing is related to increased weight in children. There are several reasons how TV contributes to weight gain.

For one, increased use of media (TV, video games, computer) displaces time spent doing more physical activities.

Secondly, TV viewing influences dietary habits. Children are exposed to 5,500 food and beverage advertisements a year. Most of these foods are high in salt, fat, and sugar. Studies show that children exposed to these ads eat 45% more regardless if they are hungry or not. My husband hates food ads on late night TV because he says they always make him feel hungry! Also, studies show an association of heavy TV viewing and frequent snacking. When watching TV while eating it is hard for a child (or adult!) to pay attention to how much they are eating and are less likely to stop when they are full.

Thirdly, TV viewing at bedtime can contribute to sleep problems. More than two-thirds of children have a TV in their bedroom. Many parents think that TV is calming and that it helps their child sleep but it actually contributes to problems falling asleep. Decreased sleep is a risk factor for obesity in children.

Experts recommend parents do several things.
1. Remove the TV from your child's bedroom. This decreases overall screen time and helps with sleep.
2. Turn the TV off while eating. This way children and adults can concentrate on what they are eating and increase family time.
3. Encourage mindful viewing. Have your child pick a specific show or two to watch and then turn it off. Watch TV with your child and discuss the content with them.

Infant Media Viewing

2010-09-29T11:58:00.000-07:00

Recently the pediatric journal Pediatric Annals devoted an issue to children and the media. Now I have to admit I don't read every journal but this one had me glued to it cover to cover. So I'm going to summarize some of it in my next few blogs.

If you have been to a baby shower lately you have seen how common baby DVDs have become such as Baby Einstein and Your Baby Can Read. A recent study was done on 1000 children under age 2. For children ages 7-16 months who watched baby DVDs it was found that they had poorer language than children the same age who didn't watch them. Specifically, for each hour of baby DVDs watched the children studied knew on average about 6-8 fewer words. Another study in Thailand found that infants who watch two or more hours of TV a day had a sixfold increase in the likelihood of speech delay.

I also found another study interesting. It found that when a TV is on (in the background, the infant is not watching it) the infant vocalizes less and has fewer parent-child interactions.

The Academy of Pediatrics recommends no TV or video viewing for children under age 2. This seems rather strict but when you consider the outcomes of these studies it makes more sense. So save yourself some money and don't buy baby DVDs. Then turn the TV off and play with your child!

Growing Lettuce in a Grocery Bag

2010-09-23T10:42:00.000-07:00

I am very good at raising children but I can't grow a plant if my life depended on it! But even I am intrigued about how you can grow lettuce in a reusable grocery bag. Turns out you can actually grow all sorts of things in containers, such as herbs, flowers, and tomatos. This way you can grow something without baking in the Arizona heat or trying to dig in the rock hard ground. This would be a great project to try with your kids and many kids are more willing to eat something that they grew themselves. Give it a try and let me know how it turns out.
http://containergardening.about.com/od/vegetablesandherbs/ss/LettuceBag.htm

TV Turnoff Week

2010-09-19T20:24:00.001-07:00

My family loves to play games.

This week is TV Turnoff Week. (Sept. 19-25) My daughter and I are going to give it a try. The idea behind this week is to spend more time with family. I have discovered that if I leave the TV off I get everything accomplished faster so that I have more free time.
So, what to do instead of TV. For one, don't replace it with other screen time such as the computer or video games. Instead try playing a game, going outside (it is supposed to cool down!), cooking together, reading to your child, going to the library, or going to the park. The possibilities are endless!
Today I saw a billboard on I-10 that was advertising fishing. It pointed out that your children are not going to have any lasting or special memories of days spent watching TV. So true!

Flumist Now Available

2010-09-16T07:53:00.000-07:00

We just received our shipment of Flumist in the office for patients with private insurance. Flumist is the live virus nasal immunization against the flu. Children can receive Flumist if they are older than age 2 and have no health problems such as asthma. If your child doesn't have asthma but has had an episode of wheezing in the last 2 years they should not receive Flumist because it can trigger wheezing.

Adult Flu Shots Have Arrived

2010-09-14T14:38:00.002-07:00

Our flu shots for adults are now available in the office. Cost is $30. You can call for an appointment or let us know you would like one when you are in the office with your child. Kids love to see their parent getting a shot just like them!

As an aside you might have heard in the news that the flu shot "Afluria" is not recommended in children. Our office does not use this brand. We use Fluzone (made by Sanofi Pasteur) for all ages and Fluarix (made by GlaxoSmithKline) for ages 3 and up. If you have a question please let us know.

Gun Safety

2010-09-09T09:53:00.002-07:00

Injuries are the leading cause of death and disability in children and teenagers. When I see you in the office I talk about car seats, bike helmets, teenage drivers etc. but then I always run out of time to talk about gun safety. Quite frankly, guns freak me out but I realize that guns are important to many people so let's talk about how to keep your child safe.

First of all, think carefully about whether you really need a gun or not. The easiest way to keep your child safe is to have no firearms in the house.

Second, if you do have a gun please store it unloaded and locked with the ammunition locked separately.

Third, ask if guns are present in the homes where your child is babysat or plays. If there are firearms there that are not safely stored consider having playdates at your house instead. My daughter tells me that I worry about her too much. I tell her that I trust her to make good choices but that someone else's choices can effect or hurt her. Such as a teenager who pulls out a parent's gun to show it off and someone accidently gets shot.

Fourth, remember that BB guns can be deadly as well. I have seen serious injuries from what is often considered a "safe" gun.

Happy Better Breakfast Month!

2010-09-03T13:08:00.002-07:00

Mom was right! Breakfast is the most important meal of the day. It gives your body and brain fuel for the day. Also, studies show that people who skip breakfast end up eating too many calories later in the day leading to extra weight.

So what is a better breakfast? A good breakfast includes some sort of lean protein. This includes yoghurt, skim milk, eggs (not fried), turkey bacon/sausage, nuts, and peanut butter. Also a good breakfast includes fiber and whole grains such as bran cereal, oatmeal, whole grain bread. Many products now advertise that they include whole grains but you might want to check the label. They label should read 5 or more grams of fiber. Protein and whole grains help keep your blood sugar steady throughout the morning and keep you feeling full longer.

Flu Shots are Here!

2010-08-31T20:52:00.002-07:00

Today we received our first shipment of flu vaccines. We have the inactivated flu vaccine available for our patients with private insurance. The live nasal flu vaccine should be available in the next few weeks and we are uncertain when our Vaccines for Children vaccines will arrive. (The Vaccines for Children (VFC) provides immunizations for children who are uninsured, underinsured, or have AHCCCS, Kidscare, or CMDP insurance) Call and make an appointment today.

Immunization Cards Save you Time and Money

2010-08-27T14:56:00.002-07:00

Whoever invented the immunization card deserves a Nobel prize in my eyes. My first child (now an adult) was born in Ohio and I accumulated a bunch of different papers that had his immunization dates on it. It was a pain to keep adding to the collection. Then my daughter was born here in Arizona and they gave me a blue card for me to take to the doctor each visit and have her shots written in it. I was delighted! I promptly had the doctor make up a card for my son as well. Those cards have gotten a lot of use over the years when kindergarten, jr. high, high school, and even college asked to see their records.

So, how does a simple blue card save you time and money. By having a current record of your child's shots it makes it unlikely that they will get duplicates of shots they have already received. Also by bringing it to the doctor each visit you also save yourself time by not having to make another trip back to the office to get it updated. Then, when school, day care, or camp asks for a copy you simply hand them the card. If you don't have your child's record you otherwise have to spend time calling our office, getting and signing a release (HIPAA rules), and then waiting for us to fax it.

Don't have a blue card for your child? Just ask and we will make you one! If we have time we will do it while you are in the office but if not we will put it in your child's chart for the next time you are in the office or in the area. Then put it in a safe place at home and your life too will be easier!

Adults Need Shots Too!

2010-08-19T12:34:00.002-07:00

I am frequently asked by parents, "When is my child done with their shots?" My answer is, "Never, you continue to need immunizations throughout your lifetime." Talk to your doctor about what you might need but I wanted to discuss two immunizations for adults that can help protect your children. The flu vaccine is now recommended for everyone older than 6 months of age. Also there has been a pertussis (whooping cough) vaccine available for adults since 2005 but it is not widely used. Both the flu and pertussis will make an adult very sick but are usually not life-threatening to you. The problem is when you give these diseases to a young child they can become very ill. By immunizing yourself you can help protect your child.

Whooping cough (pertussis) is an illness that we still see frequently. Our office generally sees several cases a year. Until 5 years ago there was no immunization for pertussis for people older than age 6 so most people lost their immunity to pertussis by the time they were teenagers. When an older child or adult has pertussis they have a chronic cough that lasts a month or more. Most people who have pertussis never know they have it unless they infect a young child who gets very sick and is then tested.

The immunization for pertussis is combined with the tetanus shot (Tdap). If you have had a tetanus shot in the past 5 years you might be protected. Unfortunately many hospitals and doctor's offices are using the old tetanus vaccine (Td) that does not protect you from pertussis. Ask your doctor which vaccine you received. The pertussis vaccine is especially important for adults who will have contact with young children and new babies. It can't be given to anyone older than age 65. It is not commonly given to pregnant women(ask your OB) but it is safe to receive while breastfeeding.

The flu vaccine is recommended for everyone every fall. The strains in the vaccine change each year based on what strains are expected. H1N1 is included in this year's vaccine. Even if you had H1N1 or the vaccine, it is recommended that you get a flu shot this fall.

Our office is now providing pertussis vaccines for parents and family members of our patients. In the fall (most likely October)we will be offering flu shots as well for adults. Please call the office for more information.

Parenting Classes for Parents of Teens

2010-08-12T19:48:00.003-07:00

You would think that parenting would get easier after you get past temper tantrums and waking at night. Noooooooooooo, the teenage years come along to challenge you. Here's information about some free classes. You can pick and choose which ones you want to attend. Contact information to register for the classes is at the bottom of the post.

New Parent Resources in Maricopa County – PARENT WORKSHOPS focusing on SUBSTANCE USE and ABUSE

Partnership for a Drug Free America – AZ Affiliate is excited to be able to offer this new free resource for parents. Our research has shown us that substance abuse is the greatest threat to our children and that parents feel inadequate when it comes to recognizing, understanding and helping their children with substance abuse and supporting their efforts to stay “clean and sober”. Our Parent Workshops address these issues and more in a series of 12 one-hour workshops. See below and attached for registration information and additional details.

AZ Parents Connect Presents its Parent Workshops

Parent Workshops are designed for those parents or caregivers of tweens and teens at risk for substance abuse to give them information and practical tools to assist them in their efforts to help their children. We are offering these Parent Workshops free of charge. The limited size of the workshop is designed for maximum participation and space is limited. Reservations are necessary.

Workshops are led by Master Level Professional Counselors and are held on Saturday’s from Noon to 1:00 PM in Central Phoenix.

Topics and Session Dates:

Session 1 It’s Just a Little Pot, Right?

Aug. 21 Find out if your child is at risk for Adolescent Substance Abuse and Dependency

Session 2 What’s in Your Child’s World?

Aug. 28 Identifying drugs and other chemicals most commonly abused by our children, and their effects

Session 3 What Happened to my Teen’s Brain?

Sept. 11 Understanding the mind of a teen and understanding the underlying reasons kids use drugs

Session 4 Is My Child Addicted or Just Experimenting?

Sept. 25 The four stages of addiction and the phases addicts go through

Session 5 My Teen Doesn’t Talk!

Oct. 2 Ways to get your child talking to you and how to make the conversations meaningful

Session 6 “We can handle it: It’s not like it’s a big problem or anything.”

Oct. 9 Understanding the effects of drug use on family, relationships, health, finances and legal issues

Session 7 The Toughest Assignment Your Child Will Ever Have: Staying Away From Drugs and Alcohol

Oct. 16 Re-thinking your expectations

Session 8 Will We Ever Have a Normal Life Again? Adding Fun Back into the Family

Oct. 23 Recreation and sporting activities, education in areas of interest, activities with family and (non-using) peers, learning to have fun sober

Session 9 “Stress?? – My Teen has stress?? I have stress!”

Oct. 30 How to help the family create a balanced life

Session 10 My Child’s Drug Use is Wreacking Havoc on Our Lives!

Nov. 6 Coping skills and family support systems to deal with the emotional roller-coaster of living with a child using drugs

Session 11 “Yes, I Believe in You! Now Tell Me the Truth – Are You Drinking or Using Drugs??”

Nov. 11 How you can support your child’s efforts to stay sober

Session 12 “Oh No! Not Again!” Don’t Miss these Warning Signs!

Nov. 20 Relapse: Keeping an eye out, what to do, and how to managing the disappointment

The 12 Sessions will be repeated 3 times over the next 12 months.

To Reserve your space contact Kim Obert at 602-264-5700 ext 103 or via e-mail to Kim.Obert@PartnerUpAZ.org. Please include your name, session dates and number of reservations you are requesting, phone number and e-mail address.

Seafood and Kids

2010-08-04T10:49:00.003-07:00

Is it ok for your child to eat fish? Such a simple question but without a simple answer. There is no consensus as to what seafood and how much is safe to eat. Seafood is very healthy for you. It is a great source of protein as well of omega 3 fat which is "good" fat. But there is mercury in seafood as well. What is a parent to do? It is recommended to avoid large fish for young and small children. Large fish such as shark and swordfish have lived longer and eaten more contaminants than smaller fish so they have higher mercury levels.

Here are some great resources to help you when deciding what kind of fish to eat.

http://www.kidsafeseafood.org/faq.php

http://www.montereybayaquarium.org/cr/cr_seafoodwatch/sfw_health.aspx

I hope you find these links helpful. I am delighted that my kids will eat seafood. Now we just need to work on the veggies!

New Computer System

2010-07-29T19:44:00.002-07:00

Our office is moving towards electronic medical records (EMR). Our first step was to change the system we use for appointments and billing. Change is never easy so please be patient with our staff. We have to update your address and insurance information for the new system. The new system comes with this nifty insurance card scanner that electronically attaches your card to your account. No more photocopying! The trees are smiling!

Headache Webinar at Phoenix Children's Hospital

2010-07-21T20:15:00.002-07:00

Have you tried a webinar yet? I have recently discovered them. They are a great way to learn without leaving your house (or office). And for those who like to multi-task you can fold clothes or do the dishes at the same time!

Phoenix Children's Hospital is offering this webinar for free for parents. It is Friday July 23rd at 12:00.

Speaker: Marcy Yonker, MD, FAHS

Pediatric Neurologist

Phoenix Children’s Hospital

Dr. Yonker will provide information on the following topics:

• Familiarize parents with common types of benign headaches in children

• Review concerning symptoms of headaches

• Recommend strategies to determine appropriate reasons for pediatric and specialty consultation

Online Presentation

Reserve your Webinar seat now at:

https://www1.gotomeeting.com/register/789826296

For more information please contact, Karen Pennington, Physician Relations,

at (602) 546-3300 or kpennington@phoenixchildrens.com

2010-07-13T21:17:00.000-07:00

Welcome Sean Kline, C.P.N.P.

2010-07-13T21:05:00.003-07:00

We are excited to welcome a new staff member. Sean Kline is a Certified Pediatric Nurse Practitioner. He has a great sense of humor and is a great addition to our office. Please ask to meet him while you are in our office. Here is his biographical info:

Sean is a native of Philadelphia and moved to Arizona in 1991. He obtained his undergraduate degree in nursing from Arizona State University in 1998. As a nurse, Sean has worked in many capacities with both adults and children. For the last four years Sean has worked for Phoenix Children’s Hospital in both the emergency department and East Valley Urgent Care Center. He obtained his graduate degree as a pediatric nurse practitioner from ASU in 2009. Sean is board certified by the Pediatric Nursing Certification Board as a Primary Care Pediatric Nurse Practitioner.
Sean is married and has 6 children ages 2 through 16. He enjoys watching his children grow and play. Having been a foster parent for over 9 years, Sean has a special interest in the care of foster children as well as adoptive / immigrant medicine.