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Doctor's In-box Archive
This page contains archived information from previous Doctor's In-box and home page stories.
Fall 2011 - The A, B...Z's of Back To School
The A,B...Z’s of Back to School
An Apple a day keeps the doctor away!
Dr. Garnett says: "With kids back in school, it’s time to pack snacks and lunches again. It’s easy to get into a rut of packing the same thing day in and day out, especially if you have picky eaters. It’s all too easy to throw in prepackaged processed foods and juice boxes when you’re rushing in the morning and making multiple lunches. However, those foods and drinks are loaded with sugar and fat, not what you want your kids to be consuming during the day. What they need is protein, complex carbohydrates and fiber to keep their bellies full and minds focused on learning and play. Try to limit juice intake to only 4-6 oz per day, and if possible make it 100% juice and no added sugars.
Even better is to eat the whole fruit. Be sure to pack at least some fruit or vegetable every day. Ideas include sliced apples, a whole banana, or even dried fruits. Also on the menu should be some complex carbs such as whole grain bread or crackers, and a protein such as deli meat or dairy. Many schools are now prohibiting nuts and peanuts, so PB&J’s are a no-no. However, to get the same protein, you could try soy nut butter or sunflower seed butter and whole fruit spread on whole wheat.
Definitely send the kids off to school having had something to eat. High fiber/low sugar cereal with skim or 1% milk and fruit is a good choice, as is oatmeal, but beware the high sugar content of most instant oatmeals. What I like to do if I’m in a rush and don’t have time to make oatmeal from whole oats is to use one packet of flavored oatmeal and one packet of plain. Add your own nuts, fruit and maple syrup or honey if you can get away with unflavored! Kids (and grown-ups too) need to eat something every few hours to keep our bodies running at full steam, so plan on three meals plus two snacks over the course of the day. In the mix should be at least 5 fruits/veggies, 3 servings of dairy, 4 servings of grain and 7 servings of protein.
A couple of resources for new ideas can be found at the following websites:
http://www.easy-kid-recipes.com/kid-lunch-box-menu.html
http://www.laptoplunches.com/healthy-lunches-bored.php
Buckle Up!
It’s hard to keep up with the myriad changes to car seat recommendations that have taken place in the last few years. For the younger set, it used to be that you could switch infants to front facing when they reached 20 lbs or 1 year old. Then it was that the child had to meet both of those criteria. The newest recommendation, based upon European crash test data, is to keep infants and toddlers rear facing until age 2, or until they outgrow the rear-facing limits of whatever seat you have (and they are all different)! Most babies will outgrow their infant bucket seat at some point during their first year. The next step is a convertible car seat, meaning one which can be positioned either facing rear or forward. This seat, which contains a five-point harness, should be used at least until age 4. Between age 4 and 5 is somewhat of a gray zone. In order to move to a belt-positioning booster, kids must be 40 lbs according to Massachusetts law. However, the longer you can keep your child in a five-point harness, the safer. Check the height and weight limits of your seat, and be sure that the shoulder straps hit at or above the level of your child’s shoulders (as opposed to rear facing shoulder straps which should come over the shoulder and enter the back of the seat below the level of the shoulder).
Up next is a belt-positioning booster, required in Massachusetts for all kids age 5-7 unless he or she exceeds 57 inches (4ft 9 inch). I prefer the type with the high back, especially for the younger kids in this age range, since it keeps the shoulder strap of the seatbelt across the chest and prevents from hitting at the neck which is the whole point! Now you ask, what about my child who has turned 8, but is still not 4 ft 9 inches? Well, according to the law he or she can graduate to a regular seatbelt. However, I would perform the following quick check to be sure they are ready. Have your child sit in the seat with her low back against the backrest. Her knees should be able to bend at a ninety degree angle over the edge of the seat, not be sticking out in front of her; and the shoulder strap should land squarely across the chest. If not, keep using the booster!
Now I know your older kids are bugging you to sit in the front seat, but really they need to be at least 13 years old for this to be safe. Even so, the front passenger seat is the most dangerous seat in the car, so preferentially have them sit in back! If you’re still confused, you can check out the Massachusetts booster seat laws for yourself or ask your pediatrician!
http://www.mass.gov/Eeohhs2/docs/dph/com_health/injury/booster_seat_faq.pdf
ZZZZZ’s
We all crave sleep, but probably don’t get enough on a nightly basis, and this is true for the younger set as well. After the newborn period, infants and toddlers up to age 2 require about 13-15 hours of sleep a day, broken up into nighttime sleep and daytime naps. Children aged 3-5 need 10-12 hours a day also divided into night and day sleep. Some 4 and 5 year olds still need a nap, but most this age do not still nap. A good habit to get into, though, is some quiet time in the afternoon- resting, reading, drawing or other quiet activity. The evening rush is just that, a rush. Trying to get through dinner, bath, PJ’s and bedtime routine is chaotic, especially with multiple children and the tendency is for bedtime to be pushed back.
Most preschoolers and young grade school kids really should be going to bed by 7:30 to 8:30 at the latest. Getting enough sleep will not only help your child grow, stay healthy and fight off illness, but also have energy, feel good and reduce cranky tempers. In school he/she will be better able to pay attention, concentrate and remember what they learn, solve problems, think of new ideas and respond more quickly to questions. Plus, as an extra bonus, if you get your child to bed at a reasonable time, you’ll have some extra time in the evening for yourself, to spend with your spouse, or even catch up on some zzz’s yourself! If you are having trouble with sleep, be sure to check out the parenting section at your local bookstore or ask your pediatrician for some recommendations!
"
Summer 2011 - How To Avoid Summer Pitfalls
Dr. Núria says: "
As the warm weather approaches (finally!), we will be spending more time outdoors with our families. It’s wonderful to enjoy the fresh air together, and here are some safety tips for the coming months.
Sun protection
For infants 6 months or younger, keeping them out of direct sunlight is best. Wide-brimmed hats that cover their faces are great, and shady areas under trees help them stay cool as well. Dress babies in light weight clothing that covers the arms and legs. It is okay to apply a small amount of sunscreen on infants under 6 months if there is no way to avoid the sun. For older children, sunscreen used correctly helps prevent burning of exposed skin. Sunscreen should be applied 30 minutes before going outside to give it time to absorb into the skin. Using SPF of 15 or higher as well as a “broad spectrum” sunscreen (screens out UVA and UVB rays) is a must. Also, for sensitive areas of the body, like the nose, cheeks, shoulders, and top of ears, a zinc oxide or titanium oxide sunscreen adds extra protection.
Wearing SPF bathing suits, rash guards, and protective clothing helps decrease the surface area of exposed skin (and makes it a bit easier to apply sunscreen on moving targets!). Whenever possible, limit the family’s sun exposure between the hours of 10 am and 4 pm. And remember that UV rays still get through on cloudy days. Protecting children’s eyes from UV rays is important as well – look for child-sized sunglasses with at least 99% UV protection.
If your child does get a sunburn, expect the signs to appear six to twelve hours after exposure. The greatest discomfort is usually in the first 24 hours. If the skin is red and warm to touch but does not have blistering, you can treat it at home. Applying cool compresses to the skin or bathing in cool water helps soothe. Also, using acetaminophen every 4-6 hours for the first day will help with the pain. If there are blisters or if your child gets a fever, chills, headache or other symptoms, call your pediatrician.
Insect bites and stings
Prevention is the first step in protecting your family against insects and ticks. It is important to know that insect repellents protect against biting insects (including ticks) but not against stinging insects such as bees or wasps.
Here is some information on repellents:
- DEET-containing repellents are considered the best defense against biting insects. It is not safe for use on infants 2 months or younger. The amount of DEET in repellents varies, and repellents protect for longer periods of time at higher concentrations. Studies show, however, that products with DEET over 30% do not really offer extra protection. The American Academy of Pediatrics recommends that products with amounts of DEET no greater than 30% be used on children older than 6 months.
- Picaridin is an alternative to DEET more widely used in Europe, and is becoming more available in the US. The AAP recommends using products with 5%-10% of picaridin.
- Repellents made from essential oils such as citronella, eucalyptus, and cedar, generally are much less effective, giving only short term protection.
- Chemical repellents with permethrin kill ticks on contact. These are best to use on outdoor equipment and clothing.
Safety guidelines when applying DEET repellents include: follow the directions of the product, do it in an open air space to allow for ventilation, use just enough to cover exposed skin and children’s clothing. Wash your children with soap and water to remove repellent when they return indoors. Using a combination DEET / sunscreen is not advised as sunscreen needs to be applied more frequently and DEET may decrease the effective sun protection factor (SPF).
Avoiding areas where there is a higher concentration of biting insects helps reduce exposure but this is not always possible. Still, avoiding being near bodies of still water, garbage, heavily wooded areas, and flower shrubs can be helpful. Also, bright colors and flowery clothing as well as scented soaps can attract insects – best to forego these when going for a hike!
First aid for bites and stings
Insect bites can be irritating, and your child’s reaction to a bite will depend on his or her sensitivity to that insect’s venom. Often the bite begins to disappear by the next day. If bites are itchy, applying a cool compress or calamine lotion can help. Depending on the child’s age and level of discomfort, an oral antihistamine may be used – ask your child’s pediatrician. Watch for signs of skin infection (the bite becomes larger, redder, more swollen and painful, yellowish fluid, or a fever) – try to keep your kids’ nails short and minimize scratching to prevent this. Have your pediatrician examine any infected bite right away.
Stings can be quite painful, and removing the stinger as soon as possible helps decrease the amount of venom that enters the skin. If the stinger is visible, try scraping it horizontally to remove it. Avoid squeezing the stinger as this may release more venom.
Tick bites are hard to pick up. Daily tick checks are a must and do not take too long. Check your children from head to toe (including scalp, under arms and in skin folds) nightly before bath or before pajama time. We live in an endemic area for Lyme disease, which is caused by the bacteria Borrelia Burgdorferii (carried by deer ticks). Luckily, the transmission of this bacterium to the human host does not start until the tick has started to feed – this usually occurs after it has been attached for 24-36 hours or longer. Thus, doing a daily check around the same time of day will diminish the risk of getting Lyme Disease.
Remove the tick with tweezers holding as close to the head of the tick as possible, and pull back towards the tick’s body so as to avoid breaking it and leaving the head of the tick imbedded. Someteims there can be a localized reaction to the tick bite. As with other types of bites, it is important to watch for signs of local infection. Recognizing the type of tick is important – you can check online or bring the tick to your pediatrician’s office.
Monitoring for Lyme Disease after a deer tick bite is recommended for the following 30 days. Unfortunately, the blood tests available for Lyme are not very good and are not helpful until 30 or more days since contracting the infection. Look for a localized rash at the site of the tick bite that is circular or oval and expands with time, fever, malaise, joint pains/swelling. Call your pediatrician if you notice any of these symptoms. Remember that not all deer tick carry Lyme and if you get the tick out promptly, the risk of contracting Lyme is quite reduced.
With all bites and stings it is important to call for medical help immediately if your child has any of the following as they can be signs of a severe reaction: sudden difficulty breathing, weakness, collapse, hives or itching all over the body, extreme swelling near the eyes, lips, or genitals.
Following these safety tips will help keep you and your family healthy this summer. Hopefully we can all enjoy the warmer weather soon!
"
Winter 2011 - Stay away: How to Avoid your Pediatrician's Office This Winter
Dr. Julie: "
No one's happy when a child gets sick--especially in the winter, especially when the illness might have been prevented. On behalf of Lexington Pediatrics, I'd like to offer a few suggestions for keeping your child OUT of our office this season.
1. Keep clean: I'll be quick about this one, since by now I think everyone knows that frequent hand-washing and common sense cleanliness will greatly decrease transmission of germs and subsequent illnesses. In addition to washing hands before and after eating, after playing outdoors, etc., I also recommend washing hands and faces (and perhaps a change of shirt) after preschool or day care, to decrease exposure to germs that a child might have picked up from the group...also, consider wiping down phones and doorknobs with an alcohol swab as well. These are such simple maneuvers, but they really work to keep germs away, so still worth mentioning.
While I'm on the subject of hand-washing, I wanted to mention two common skin infections: ringworm and MRSA (a staph infection that's resistant to many antibiotics). These infections are quite common in older kids who play "mat sports" (gymnastics, wrestling), and in younger kids who participate in play groups, tumbling, etc. If you can't wipe the mats down before using them, try and clean your toddler's hands, face, and whatever else came in contact with the mat once class is over.
2. Prevent the flu: Okay, this suggestion doesn't totally keep you away from the doctor's office. But it works. Study after study confirms that the flu shot, or the nasal mist for eligible kids, is safe and very effective for all kids over the age of 6 months. For households with newborns, it's clear that everyone who is eligible should receive their flu shot, not only to protect themselves, but also the newborn. And there was also a recent study that showed that infants born to pregnant women who got the flu shot during their pregnancy were about 40% less likely to become seriously ill with influenza; if you are pregnant, you should check with your doctor to make sure you're eligible for a flu shot this winter.
Lexington Pediatrics has flu clinics weekly during the season for our patients; check our website flu page for times and dates; check with your child's doctor for times and dates.
Last year the vaccine manufacturers didn't have sufficient lead time to add H1N1 ("swine flu" strain) to the annual vaccine, so we had to give out two vaccines: the "regular" flu shot, and the H1N1. One bit of good news this year: the H1N1 strain has been included in the "regular" vaccine, so most kids only need one shot this year. If it's your child's first year getting the flu shot, and he is younger than 9 years of age, he will need two half-doses, one month apart. Another bit of good news is that we have plenty of vaccine this year, so we don't have the long lines in the cold and dark fall evenings during our clinics.
3. Salt water: this is a great tip for do-it-yourselfers. You can make the correct concentration of salt water yourself (dissolve about 1 teaspoon table salt into 4 cups of warm water), and it does wonders for clearing out the upper respiratory tracts. A recent article looking at salt water gargles---where patients rinse the back of their throats with warm salt water and spit it out--found that people who gargled regularly were far less likely to become ill during the wintertime. Most kids age 5 or older can probably be taught this simple technique.
You may have heard of "neti pots" or nasal rinsing, a technique used to rinse and clear the sinuses by gently pouring salt water into one nostril, allowing it to circulate up through the sinuses, and rinsing it out the other nostril. This, too, has proven benefit for preventing and limiting upper respiratory infections.
For very young children, nasal saline spray does a wonderful job clearing mucus from Little Noses (that's one of the brand names sold in pharmacies, by the way). Clearing a baby's nose before she nurses or goes to sleep may help her to eat and sleep for longer periods, which in turn gives her own body a better chance to recuperate and heal itself of minor sniffles and congestion.
4. Vitamin D: We are just beginning to understand just how important vitamin D is for many, many different bodily functions. Everything from calcium metabolism and bone strength to heart disease seems to be critically affected by vitamin D levels. There are even some recent studies which suggest that childhood onset (type I) diabetes, multiple sclerosis, and some mental illnesses are more common in people with chronically low vitamin D levels.
Vitamin D is not actually a vitamin. It is a hormone which is best absorbed through the skin from sunlight. However, as we all know, doctors have long recommended sun avoidance because of the risk of skin cancer. Also, in the New England winter, there isn't sufficient vitamin D anyway from the sun. And the American Academy of Pediatrics recently DOUBLED the recommended dose of vitamin D for all children, starting in infancy and continuing through adulthood. The recommended daily dose is 400 IU's of vitamin D.
There are many easy ways to get the recommended dose of vitamin D. Getting outdoors and enjoying the fresh air and sunshine, though it might not be sufficient, is a terrific plan: you get the additional benefits of fresh air, exercise, and sunlight, all of which can help boost one's mood during the long, dark winter season. Your kids may well need a supplement in addition to these natural sources, though.
Buying supplements can be quite confusing, especially with vitamin D, which has many chemical forms. The American Academy of Pediatrics recently published guidelines about taking supplements of vitamin D and suggested that the "D3" form is the most bioavailable, that is, it's most likely to be properly absorbed and utilized in the body. There are very basic "D drops" which can be purchased at health/whole food stores as well as some pharmacies. When you turn the bottle upside down, it dispenses a pre-measured drop of vitamin D which has no taste and can be taken directly on the tongue, placed on the nipple of a bottle for a baby to suck off, or mixed into a spoonful of food.
As with all medical advice, check with your doctor to make sure these suggestions are right for your family. And of course, bring your child in if you have any questions or concerns about his/her health.
On behalf of all of the doctors and nurse practitioners at Lexington Pediatrics, I wish you all a wonderful winter. Enjoy the crisp clear air, the cozy evenings at home, and hopefully, many restful nights.
"
Summer 2010 - Important Information Regarding Consumer Product Recalls
Dr. Julie: "
As many of you may have heard, there was recently a massive recall of virtually all infant Tylenol and Motrin medications. The reason for the recall is that, basically, the medicines were not monitored closely during preparation, and the company could not guarantee that an accurate dose would be given when following the directions on the box. As I understand it, there is very little concern about overdose, but to be safe, the company recalled most batches of Tylenol and Motrin. For a complete list of recalled lot numbers go to http://www.fda.gov/safety/recalls/ucm210443.htm
In the meantime, I thought this would be a good opportunity to talk about ways to manage a sick child's fever WITHOUT medications. One of the "clinical pearls" that pediatricians like to share with our patients is the idea that "fever is your friend". If your child has a fever, it's usually a reassuring sign that he or she is mounting a healthy and effective response to a viral infection. So if your child develops a fever, but is otherwise cheerful, running around, able to eat and sleep comfortably, you don't necessarily have to treat the fever. You can try many non-medicinal approaches first: give your child a lukewarm bath, put wet washcloths on his head and chest (as the water evaporates it cools the child off), give cool clear liquids to drink or ice pops if you like.
If, however, your child is in pain (from an earache, teething, headache, etc) or unable to eat/sleep, a dose of Tylenol or Motrin may help get him the rest he needs. At the moment, since the main brands are off the shelves, you can use the generic (store brand) which are perfectly acceptable preparations. Please feel free to call our office if you have any questions.
"
Late Winter 2010 - New Things - New Spring
Dr. Julie: "
Well, I'm delighted to be writing about something besides influenza! Also delighted to report, before I leave the topic of influenza behind completely, that this season was not as bad as many experts predicted. Was this because of increased levels of immunization in the community? Increased vigilance with hand washing? More willingness to isolate children who were sick, and care for common colds with common sense? Perhaps. We may never know, but I think it speaks to the power of simple preventative efforts. We're not out of the woods yet, though: typically we see influenza well into April/May in the greater Boston area. And we have plenty of vaccine (both H1N1 and seasonal). If your child hasn't received the second dose of either vaccine, please consider coming in for it.
New Doctors, Hours at Lexington Pediatrics
I am very excited to let you all know of some upcoming changes at Lexington Pediatrics. In January, we welcomed our newest doctor to our team: Dr. Andrew Sinder (click for bio). Dr. Sinder and his family moved here from western Pennsylvania, and are looking forward to settling in the Lexington area. All of our newer doctors (Drs. Sinder, Garnett, and Gine-Nokes) are accepting new patients, and they are taking turns leading our monthly prenatal meetings for expectant parents. Click here to sign up for one of our upcoming dates.
With our newest doc on board, we are now able to offer evening hours FOUR nights per week! This is a tremendous boon for working parents looking to attend their children's checkups, late afternoon sick visits, and quieter, later office hours for consultations. Dr. Sinder will be taking over my long-standing Thursday evening clinic, and I will be running a Monday evening clinic instead. For those parents who appreciated my Thursday afternoon/evening hours (many kids have a half-day on Thursdays), I will still see patients on Thursday afternoon...thanks for the feedback!
Coming Soon - Electronic Medical Records
The launch of this website was the first major step in "electrifying" our office and moving towards a greener, more efficient model to communicate with patients and conduct office business. Soon we will be making another even more major step forward: in August of this year, Lexington Pediatrics will "go live" with our Electronic Medical Record (EMR). Once we are using an EMR, you won't see us writing in charts, writing prescriptions, or running around looking for your medical record...all of that information will be at our fingertips on our new tablet-style notebook computers.
We'll keep you updated on the progress as we prepare for this transition. At the moment, the most significant impact the EMR will have on our patients is the very limited availability for routine appointments in August and September (more on this below).
Summer Physicals - Come on In!
Our EMR transition will make it necessary for us to have very limited hours in August and September. We know that many of our families with school-age children want to schedule their yearly physicals without missing school, and many of our college students want to schedule physicals and gynecologic exams when they return home for the summer. In anticipation of this, we will be setting aside a substantial number of early morning, after-school, and evening hours for the months of April, May, and June. We will be contacting everyone who had a physical examination between mid-July and mid-September of 2009 (by phone and mail) to "front-load" as many of these appointments as possible. We do appreciate your cooperation and understanding as we make this transition, and we will try our best to make the change a smooth one. Please note that some insurance companies will not allow a routine yearly physical examination until a full 365 days has passed since the last exam; in this case, we will need to schedule the routine physical exam for October 2010 or later. Please check with your insurance company if you're not sure what your insurance will allow.
Have a wonderful spring, get outside to enjoy the few extra hours of sunshine and fresh air, and be well!
"
Fall 2009 - Swine H1N1 Flu Outbreak
Dr. Julie: "
FLU CLINIC UPDATES
Greetings,
I know that many of you are concerned about the current widespread H1N1 influenza virus. We are all working hard to see a greatly increased volume of patients, respond to a huge increase in sick visits, and of course, continue to provide well-child checks and all the routine care that your family requires. Unfortunately, because of this dramatic increase in our clinical activity, it has been a challenge to keep up with the volume of phone calls and website requests for influenza information.
In the following Inbox, I've tried to answer some of the most common questions we have gotten about the seasonal flu, H1N1 ("swine") flu, the vaccines, and our office policies. Please take the time to read through this information. I hope it is helpful to you.
First, I think it's important that you all know that all of us at Lexington Pediatrics believe that the H1N1 vaccine is extremely important in maintaining our community's good health through this winter. We know already that the H1N1 virus targets young healthy children and adults, and that people with underlying respiratory conditions are especially at risk. Therefore, we strongly recommend that all our patients plan on receiving the H1N1 vaccine as soon as they are eligible. {As a side note, I will also say that all of us with small children have had them immunized against both seasonal and H1N1 influenza.}
We are trying our best to immunize as many patients as possible against both H1N1 and seasonal influenza. If you have a routine appointment in the next few months, you MAY, depending on availability, get your flu shot as well as your H1N1 shot at the appointment. Due to the high volume of patients needing flu shots, we are not able to offer appointments for flu shots alone. Please click here for a link to out upcoming flu clinic dates.
If your child has an egg allergy, we will NOT be able to provide the flu vaccine during the flu clinic. You will need to make private arrangements with our office or your allergist's.
H1N1 (Swine Flu) UPDATE
The H1N1 vaccine is recommended for ALL children ages 6 months to 18 years and their caregivers. Children under the age of 10 will need two vaccines separated by one month. There is a shot as well as a nasal mist option. It is possible to get the "regular" flu vaccine and the H1N1 vaccine at the same time, as long as they are injected. The nasal mists for flu and H1N1 flu must be given separately.
As of December 13, we have plenty of H1N1 vaccine for all patients. Please click here for a list of upcoming flu clinics. Please note: at times, we have thimerosal-free vaccine for infants younger than 36 months. However, we cannot control which vaccine is shipped to us, and at times cannot offer thimerosal-free vaccine. There is a version of the vaccine which contains trace amounts of mercury as a preservative, and this has NEVER been shown to cause any harm. The doctors and nurse practitioners at Lexington Pediatrics feel that the benefits of the vaccine far outweigh any theoretical risk.
Due to the high volume of patients wanting the vaccine, and the fluctuating supply, there is a chance that we will run out of a particular vaccine before a flu clinic is over. If this happens, we will notify those waiting in line as soon as possible to minimize frustration and waiting in the cold. Thank you in advance for your patience; we are reviewing our flu clinic protocols constantly to keep up with this unprecedented demand.
Please click here to check which of the H1N1 vaccinations your child is eligible for. We adjust this eligibility information based on how much vaccine we have available.
We are offering the H1N1 nasal mist to children older than 2 years of age. In order to get the nasal mist, your child must also meet the following criteria:
- No history of asthma
- No wheezing in the past year
- No steroid use in the past 6 weeks
- No live vaccines (MMR, Varivax, seasonal flu mist) in the past 4 weeks
SEASONAL INFLUENZA UPDATE
As of 13 December, we have plenty of all three types of seasonal flu vaccine (preservative-free flu vaccine for children under 3 years of age, nasal "Flumist" for healthy children over 2, injections for children older than 36 months).
Thanks for your patience and for your understanding.
IMPORTANT: if you are coming to Lexington Pediatrics for a visit, please be aware that we are asking ALL patients with fever and cough, as well as their accompanying family members, to wear protective face masks while on the premises. We thank you in advance for your cooperation and understanding.
FLU READINESS "KITS"
Influenza can infect an entire family, and the symptoms can come on very suddenly. For this reason, we suggest you assemble an emergency "flu kit" at home. This should contain: Gatorade or other rehydration solutions (Pedialyte for babies); herbal tea bags and honey (for rehydration and soothing sore throats and coughs); ibuprofen and/or acetaminophen for treatment of fever and muscle aches; Purell or other hand sanitizing gel; tissues; saltine crackers; canned or frozen broth; freezer pops. [Families with college-age students might want to adapt this list for college kids and send along a care package. ]
Lexington Pediatrics is committed to keeping you and your family safe and healthy. We are receiving multiple updates weekly from the CDC, the Mass Department of Public Health, and from Children's Hospital Boston, and we will continue to update this site with information as we receive it.
"
Summer 2009 - Swine H1N1 Flu Update
Dr. Julie: "
You most likely have been following reports in the media about recent cases of H1N1, or “swine flu.” Swine flu is a new strain of influenza (flu) that has recently been identified in the United States and Mexico. It is called swine flu because it contains parts of flu viruses from pigs.
The symptoms are the same as those of regular influenza, including fever plus a respiratory illness (usually at least 1 of the following: cough, sore throat, or runny nose/nasal congestion).
As of June 12, it is becoming evident that this novel flu strain is quite widespread. However, we are pleased to report that most cases of H1N1 flu in this country are quite mild and self-limited, and require no more than the usual common-sense advice we give for all minor viral infections: get rest, drink plenty of fluids, take acetaminophen or ibuprofen to control fever and aches, and see the doctor if the symptoms worsen or last more than a few days.
"
Spring 2009 - Swine H1N1 Flu Reports
Dr. Julie: "
You most likely have read reports in the media about recent cases of “swine flu.” Swine flu is a new strain of influenza (flu) that has recently been identified in the United States and Mexico. It is called swine flu because it contains parts of flu viruses from pigs.
As of April 30th, confirmed cases have been identified in 10 US states including Massachusetts, and in several other countries. For a complete list of confirmed cases please check the Centers for Disease Control website
(www.cdc.gov/swineflu) or the World Health Organization (www.who.int).
The symptoms are the same as those of regular influenza, including fever plus a respiratory illness (usually at least 2 of the following: cough, sore throat, or runny nose/nasal congestion).
IMPORTANT: if you are coming to Lexington Pediatrics for a visit, please be aware that we are asking ALL patients with fever and cough, as well as their accompanying family members, to wear protective face masks while on the premises. We thank you in advance for your cooperation and understanding.
Known risk factors for exposure to swine flu are:
- travel to an area where there are confirmed cases of swine influenza A (H1N1) infection within the 7 days prior to onset of illness. As of April 27th, confirmed cases have been identified in 5 U.S. states (California, Kansas, New York (Queens), Ohio and Texas) as well as Mexico.
- contact with persons who had a fever along with a respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset, or who had contact with a patient with a confirmed case of swine flu.
If your child is sick with flu-like illness, and if you have travelled to one of the areas known to have swine flu, your child may need to be evaluated. Please note that current recommendations are that ONLY people who have travelled to areas where there is swine flu need to be tested. If your child has a fever and upper respiratory symptoms, but no significant risk for swine flu, you may treat this illness as you would any other upper respiratory illness.
If you are concerned that your child may have been exposed to, or have symptoms of, swine flu, please call our office and we will assist you.
At the moment, the only recommendations for avoiding swine flu are as follows: avoid travel to areas known to have swine flu; use good hand-washing hygiene at all times, and cover your nose and mouth with a tissue when you cough or sneeze.
Lexington Pediatrics is committed to keeping you and your family safe and healthy. We are receiving muliple updates daily from the CDC, the Mass Department of Pulbic Health, and from Children's Hospital Boston, and we will continue to update this site with information as we receive it.
"
Winter 2009 - Winter In New England
In this issue of Doctor's In-box, Dr. Julie talks about staying active during the winter during the cold weather.
Dr. Julie: "I must confess--after 15 years living in New England, I still don't fully appreciate the lure of outdoor winter sports. It's beautiful outdoors, true, and I do love the quiet "crunch" of that first walk outdoors after a snowfall, and even the occasional cross country skiing or ice skating trip...but I will leave the appreciation of skiing and snowboarding to other, hardier souls. For the purpose of this newsletter, I'll remind everyone to make sure your kids dress in layers, and wear appropriate safety gear when going fast on any slippery surface. The Children's Safety Network has all the details:
http://www.childrenssafetynetwork.org/injury_news/shownews.asp?newsID=887
Part of my problem with winter sports is the huge amount of special equipment that seems to be required. On the other hand, it is important for kids to stay active, more of a challenge when it's cold and gets dark so soon after school lets out. If you're looking for ways to keep your kids active and enjoying the outdoors during this season, consider joining the Mass Audubon Society, which offers year-round nature programs at all of its sites, school vacation week programs, and low cost guided snowshoe hikes:
http://www.massaudubon.org/index.php
There are plenty of local opportunities to skate, ski, and snowboard; most places will rent equipment so you can try out the sport before committing to a lot of expensive gear. Be careful, though, when you rent shoes for your kids: my skating and skiing experts tell me that blisters are quite typical the first few times you "break in" a pair of skates or ski boots. If you're renting, wear two pairs of tight-fitting socks to alleviate the problem, and bring band-aids, moleskin, and some antibacterial ointment with you just in case.
For those of you looking for indoor activities until the weather heats up, you're in luck! Winter is a great time to start a book group, teach your kids how to cook (most kids will eat more of what you're serving if they've helped prepare it), or introduce your kids to board games and cards. Sure, video games encourage eye-hand coordination, but there is something perhaps more valuable to learn from board and card games. They encourage kids to learn strategy, fine motor skills, math and logic, as well as important social skills: playing fair, taking turns, and winning and losing gracefully. The following is a commercial, but good, site for finding board games both old and new:
http://www.areyougame.com/interact/default.asp
Or if you're crafty, you can help your kids make their own:
http://boardgames.lovetoknow.com/Board_Games_for_Kids_to_Make
Finally, if you need to get out of the house and want to keep warm, consider investigating some of the smaller museums in the area. It's a great way to keep warm, learn something, and broaden your kids' horizons!
Some suggestions: the New England Quilt Museum in Lowell (http://www.nequiltmuseum.org/), Harvard's Museum of Natural History (http://www.hmnh.harvard.edu/index.php), Museum of our National Heritage right here in Lexington (http://www.nationalheritagemuseum.org/), and--for older kids and parents who appreciate irony--the Museum of Bad Art, in two locations: Dedham and Somerville (http://www.museumofbadart.org/).
Enjoy the winter, and be well!
"
Fall 2008 - Fall Family Fun
In this issue of Doctor's In-box, Dr. Julie talks about Staying Centered and Healthy as the weather turns colder
Dr. Julie: "It's fall..crisp cool air, colorful trees, a new school year...the autumn season heralds many new and exciting changes for families, especially those with schoolage kids. Here are a few suggestions to keep your children healthy and happy as the days get shorter and cooler.
School stuff: for many families, the start of the school year means major adjustments in the family schedule. Suddenly there are music lessons, religious school, sports practices, and somehow, in between everything else, homework lessons to be completed (and dinner to be eaten).
Try and set aside time for the family to sit and eat dinner together each night. Sharing a meal is a wonderful way to connect with your kids at the end of the day. Also, studies have shown that children who share a family dinner each night are more likely to maintain healthy eating habits, less likely to use drugs, and less likely to develop eating disorders. It's a great way to connect with your growing child, and to teach him valuable social and communication skills, and to model healthy eating habits.
Speaking of food...we've had more and more parents asking about organic, sustainable food and its benefits. Eating fresh, locally grown food is a great choice for children and families. Locally grown food is available as soon as it's ripe, without a lot of delay or shipping costs. And buying local supports your local farmer. For a great list of local farmstands, farmer's markets, and dairy/meat sources, go to eatwellguide.org.
Organically grown food has the additional advantage of being free of pesticides, which are thought to be harmful to health. Buying organic can be pricey, though. If your budget is limited, you might want to try organic dairy products first, as well as some organic produce, to maximize the benefits. Check out foodnews.org for a list of fruits and vegetables with the highest exposure to toxins, and try buying organic instead of conventional produce that's high on their list. I think you'll find organic food to be notably more flavorful!
Fall is also the cold and flu season. This year, the AAP (American Academy of Pediatrics) is recommending that all children aged 6 months to 18 years receive the flu shot. We have walk-in clinics for our patients just about each week through December; clich [here] to see the flu clinic schedule.
Patients with asthma and allergies may find that the colder weather, and more time indoors, triggers their symptoms. If so, it may be time to renew your medications; just call our Nurse Triage line and leave a message requeseting refills. We also offer an "Asthma/ Reactive Airways" comprehensive office visit, provided by our nurse practitioners. Come in to see them and bring all of your current medications. They will take a careful history and make sure your child is on adequate and correct medication--and using it correctly-- as we enter the winter season.
Until next season, be well.
"
Summer 2008 - Sun Safety and Farmer's Market
In this issue of Doctor's In-box, Dr. Julie talks about Sun Safety with tips to keep your kids safe during the glorious sunny season.
Our Shameless Plug for Our Local Market -
One of the best things about summer in New England is the phenomenal fresh food available!
This year Lexington Pediatrics is proud to be one of the main sponsors of the Lexington Farmers’ Market, held on Tuesdays at the corner of Mass. Ave, Woburn St. and Fletcher Ave.
Come sample locally grown fruits and vegetables, and locally made baked goods and crafts. Check out the Farmers’ Market website.
Sun Safety is very important this time of year. Now that the cold winter, and rainy spring, is finally over, here are some tips to keep your kids safe during the glorious sunny season.
Dr. Julie: "All children should wear sunscreen when outdoors for any length of time, even if it's overcast. Apply a good-quality, name-brand lotion frequently; the SPF (sun protection factor) should be 15 or greater. More important than the SPF number is reapplying lotion every 3-4 hours, or after swimming, since lots of lotion rubs off with sweating. Most people don't apply nearly enough lotion to achieve the promised protection; each quarter-sized dollop of lotion should only cover an area as big as the palms of two hands.
The eyelids, lips, and cheeks need protection too, but regular sunscreen drips into the eyes and mouth; consider a "stick" sunscreen (like an oversized lip balm) for these vulnerable places. If your toddler resists lotion, consider purchasing SPF-protective clothing. Most are manufactured in Australia, where the high rate of skin cancers has led to a well-regulated and high-quality range of products ranging from sunscreens to bathing suits.
Don't forget hats and sunglasses! Children's eyes are especially vulnerable to the harmful effects of direct sun. Teach children never to look directly at the sun, encourage them to wear brimmed hats, and if they'll wear sunglasses, they don't have to be expensive, but they DO have to say "100% UV protection." Cheap sunglasses that simply darken the view will cause a child's pupils to expand, letting in more of the harmful rays.
Special note for infants: there is research which suggests that some of the chemicals used for children's sunscreen (the oxybenzones) may not be safe for infants and young toddlers. Kids under 2 should use a name-brand, fragrance-free lotion containing zinc oxide and titanium dioxide as the active ingredients, and ideally should not be exposed to sunlight when the sun's rays are most damaging, from 10 am to 2 pm.
Remember to bring water whenever you take the kids outdoors; even if it's not too hot, children become dehydrated very easily. Encourage them to drink before they become thirsty, as thirst is already a sign of mild dehydration. Water is the beverage of choice; sugary drinks such as fruit juice, soda, lemonade, or sports drinks are fine in moderation, but not necessary. A better choice would be fresh fruits, which provide nutrients and fiber in addition to hydration.
Most importantly, set a good example yourself and show your kids how you apply sunscreen, wear hats and glasses, get outdoors to exercise and enjoy the summer weather, and drink lots of fluids every day.
Be well and enjoy yourselves!
"
Spring 2008 - Travel Preparations
In this issue of Doctor's In-box, Dr. Julie talks about travel and how to plan a healthy, safe vacation.
Dr. Julie: "Travel is terrific for the whole family! It's a great way to escape the cold (or go somewhere even colder, if you like outdoor sports), and a wonderful way to reconnect with family away from the daily grind. With some advance planning, your trip can be safe, healthy, and fun for everyone. I assume you all know the common-sense planning that goes into a big trip--check the weather, pack comfortable layered clothing, don't forget sunscreen and insect repellent--but here are some thoughts on how to enjoy your vacation without last-minute medical problems:
1. Is your child taking any medications? Call our office well in advance if you think you might need refills to bring with you.
2. If your child has asthma, make sure that you have a nebulizer machine for travel, and that your hotel/destination will be able to accomodate the electrical plug.
3. Don't forget a mini-med kit for minor cuts, scrapes, and fevers. Acetaminophen (Tylenol), ibuprofen (Motrin), and diphenhydramine (Benadryl) are good to have, as well as topical antiseptic ointment and some bandages. Bring moleskin patches if you'll be doing a lot of walking, and of course sunscreen and insect repellent.
4. Traveling overseas? Schedule a "travel clinic" appointment with one of our nurse practitioners well in advance of your trip. We can review your child's immunizations and make sure they have all the recommended travel vaccines; advise on medication for malaria, typhoid, and other tropical diseases, and give additional advice on water, insect, and food safety abroad. Please call at least one month before travel so that we can ensure that your child receives all necessary vaccines in time for the trip.
"
Spring 2008 - About Allergies
Spring is in the air, and in addition to finding terrific "outdoors stuff" to share with your kids (daffodils poking up, baby birds hatching) some of us will be starting to suffer our annual allergy symptoms.
There are many effective medications for seasonal allergies; please call or set up an appointment with one of us so we can help figure out the best treatment options. In the meantime, we hope you can get outdoors and enjoy the lovely weather and longer evenings!
If your child experiences coughing, itchy eyes, sneezing, wheezing, disrupted sleep patterns, or seems to have a cold or cough that just won't go away, consider that he or she may have allergies.
If your child has allergies, and takes prescription medication, please check to make sure you have enough on hand. You can request a refill here.
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