East Cobb Pediatrics BLOG

Happy New Year!

2012-01-06T14:50:00.000-05:00

Welcome to 2012! It's sure to be an exciting year here at East Cobb Pediatrics! Dr. Barr gave birth to a beautiful baby girl in December and while she is out on maternity leave we have Dr. Wynn Kallay filling in for her. We're so happy to have him here and we're proud to report that we have had many patient compliments for him!
In February we're looking forward to the addition of Dr. Lee Belvin. Dr. Belvin is coming to us from a practice in South Carolina.
We hope that everyone had a great holiday season and wish everyone the very best in 2012! We thank you for continuing to let us care for your children and look forward to seeing all our little patient's this year!!

Holiday Safety tips from The Academy Of Pediatrics

2011-11-15T12:12:00.000-05:00

The following is an exerpt from an article from http://www.aap.org/

HOLIDAY SAFETY TIPS

Trees

When purchasing an artificial tree, look for the label "Fire Resistant."

When purchasing a live tree, check for freshness. A fresh tree is green, needles are hard to pull from branches and when bent between your fingers, needles do not break. The trunk butt of a fresh tree is sticky with resin, and when tapped on the ground, the tree should not lose many needles.

When setting up a tree at home, place it away from fireplaces, radiators or portable heaters. Place the tree out of the way of traffic and do not block doorways.

Cut a few inches off the trunk of your tree to expose the fresh wood. This allows for better water absorption and will help keep your tree from drying out and becoming a fire hazard.

Be sure to keep the stand filled with water, because heated rooms can dry live trees out rapidly.

Lights

Check all tree lights-even if you've just purchased them-before hanging them on your tree. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections.

Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights, and a person touching a branch could be electrocuted.

Before using lights outdoors, check labels to be sure they have been certified for outdoor use. To hold lights in place, string them through hooks or insulated staples, not nails or tacks. Never pull or tug lights to remove them.

Plug all outdoor electric decorations into circuits with ground fault circuit interrupters to avoid potential shocks.

Turn off all lights when you go to bed or leave the house. The lights could short out and start a fire.

Decorations

Use only non-combustible or flame-resistant materials to trim a tree. Choose tinsel or artificial icicles of plastic or nonleaded metals.

Never use lighted candles on a tree or near other evergreens. Always use non-flammable holders, and place candles where they will not be knocked over.

In homes with small children, take special care to avoid decorations that are sharp or breakable. Keep trimmings with small removable parts out of the reach of children to prevent them from swallowing or inhaling small pieces. Avoid trimmings that resemble candy or food that may tempt a young child to eat them.

Wear gloves to avoid eye and skin irritation while decorating with spun glass "angel hair." Follow container directions carefully to avoid lung irritation while decorating with artificial snow sprays.

Remove all wrapping papers, bags, paper, ribbons and bows from tree and fireplace areas after gifts are opened. These items can pose suffocation and choking hazards to a small child or can cause a fire if near flame.

Toy Safety

Select toys to suit the age, abilities, skills and interest level of the intended child. Toys too advanced may pose safety hazards for younger children.

Before buying a toy or allowing your child to play with a toy that he has received as a gift, read the instructions carefully.

To prevent both burns and electrical shocks, don’t give young children (under age ten) a toy that must be plugged into an electrical outlet. Instead, buy toys that are battery-operated.

Children under age three can choke on small parts contained in toys or games. Government regulations specify that toys for children under age three cannot have parts less than 1 1/4 inches in diameter and 2 1/4 inches long.

Children can have serious stomach and intestinal problems – including death -- after swallowing button batteries and magnets. Keep them away from young children and call your health care provider immediately if your child swallows one.

Children under age 8 can choke or suffocate on uninflated or broken balloons. Remove strings and ribbons from toys before giving them to young children.

Watch for pull toys with strings that are more than 12 inches in length. They could be a strangulation hazard for babies.

Parents should store toys in a designated location, such as on a shelf or in a toy chest, and keep older kids’ toys away from young children.

Food Safety

Bacteria are often present in raw foods. Fully cook meats and poultry, and thoroughly wash raw vegetables and fruits.

Be sure to keep hot liquids and foods away from the edges of counters and tables, where they can be easily knocked over by a young child’s exploring hands. Be sure that young children cannot access microwave ovens..

Wash your hands frequently, and make sure your children do the same.

Never put a spoon used to taste food back into food without washing it.

Always keep raw foods and cooked foods separately, and use separate utensils when preparing them.

Always thaw meat in the refrigerator, never on the countertop.

Foods that require refrigeration should never be left at room temperature for more than two hours.

Happy Visiting

Clean up immediately after a holiday party. A toddler could rise early and choke on leftover food or come in contact with alcohol or tobacco.

Remember that the homes you visit may not be childproofed. Keep an eye out for danger spots.

Keep a list with all of the important phone numbers you or a baby-sitter are likely to need in case of an emergency. Include the police and fire department, your pediatrician and the national Poison Help Line, 1-800-222-1222. Laminating the list will prevent it from being torn or damaged by accidental spills.

Traveling, visiting family members, getting presents, shopping, etc., can all increase your child's stress levels. Trying to stick to your child's usual routines, including sleep schedules and timing of naps, can help you and your child enjoy the holidays and reduce stress.

Fireplaces

Before lighting any fire, remove all greens, boughs, papers, and other decorations from fireplace area. Check to see that the flue is open.

Use care with "fire salts," which produce colored flames when thrown on wood fires. They contain heavy metals that can cause intense gastrointestinal irritation and vomiting if eaten. Keep them away from children.

Do not burn gift wrap paper in the fireplace. A flash fire may result as wrappings ignite suddenly and burn intensely.

2010 - American Academy of Pediatrics

Shared by: Jennifer Collins
Technical Support Coordinator

FALL IS IN THE AIR!

2011-10-03T14:55:00.000-04:00

I could tell by the chill in the air and the crisp breeze blowing all weekend that fall is officially here! It's been absolutely beautiful here in north Georgia the last few days! I only hope it lasts!
With the changing of seasons comes the threat of flu season and many coughs and colds! If your child hasn't already caught a "bug" you can, unfortunately be pretty certain that something is right around the corner. East Cobb Pediatrics is here for you!
Did you know that starting October 1st we have a Walk-In clinic at our Kennesaw location from 8:30am to 10:30am on Saturdays? This clinic is for our established sick patients only. This is not a clinic where we would be able to do physicals/well visits. This time is set aside for those sick children who need medical attention over the weekend. This is only offered at our Kennesaw location, however patient's of both the Kennesaw and Marietta location are welcome to Walk-in.
If you need directions, please visit our web site, click About Us and the Locations tab for all the information you should need.
Welcome to Fall!!

Jennifer Collins
Technical Support Coordinator
RX/Immunization Dept.
Referrals Coordinator

Confirmation of Appointment Calls...

2011-09-16T10:27:00.000-04:00

You may have noticed that East Cobb Pediatrics now has automated confirmation calls going out. This would be the call that you received two days prior to your child's appointment confirming the date and time.

This is a new service for us and we're very excited! Soon the service will provide the opportunity to confirm, reschedule or cancel your appointment with the push of a button. Currently confirmation calls are sent out two days ahead and If you need to cancel or reschedule this gives you plenty of time to call the office and avoid a "No-Show" fee!

If you have more than one child scheduled on a particular day you will receive more than one call as this service confirms each and every appointment. Be sure to pay close attention to each call and the date and time specified. Be sure to show up at the appointment scheduled earliest to avoid missing an appointment.

The service now gives the opportunity for you to identify the best way for you to be reached regarding your child's appointment. This can be by voice call, text, or email. You can let our front desk know which way you would like to be notified.

If you have questions about this service, just let us know.

Jennifer Collins
Technical Support Coordinator

Back to school, the flu vaccine, etc.

2011-09-12T14:12:00.000-04:00

By now, most all of the kids in the Atlanta and surrounding areas are back in school. And we all know what that means! Cough and cold season will be upon us before we know it! East Cobb Pediatrics offers walk-in appointments Monday through Friday for our established patients. So, if your child comes down with the dreaded sniffles or fever, we're here for YOU! Starting in October our Kennesaw office will have Saturday morning walk-in hours as well. Be sure to check back on our website for the times we offer walk-in's at each location.

We have started giving out the Flu-Mist vaccine. Flu-Mist is available for our healthy kids with no chronic conditions. Click the Flu Info button on the home page of our website for all the details. We also have supply availability for parents, and caretakers as well. We're unable to file insurance for parents or caretakers though so there is a cash price of $25.
Soon we will also be giving out the Flu Shot. Our shipment is due to arrive at any time. Make sure you've signed up for an account with our "Online Services" so that you'll get the email we send out alerting you when we're ready to start scheduling flu shot visits.

Our website design changed back in July and we hope you're liking it and are able to find everything you're looking for. Do you have comments or suggestions? Feel free to email me, Jennifer Collins at jcollins@eastcobbpeds.com if you know of something we should add or you have a suggestion. We just recently changed the forms in the Referral section and also the Medical Records section, hopefully you'll find that those are easier to work with. We sincerely hope that the website is informative and easy to navigate!

Be sure to check our blog often! Thanks for reading!

Jennifer Collins
Technical Support Coordinator
RX/Immunization Dept.
Referrals Coordinator

Nobody Told Me I Would Get This Bill!?

2011-08-01T11:42:00.000-04:00

I can hear the frustration in the voice on the end of the phone. Her little girl was seen because she was crying with ear pain. The doctor removed some wax from her ear so that the ear drum could be seen and a diagnosis made. She was given a prescription for an antibiotic, her little girl got a lolly and a sticker, and they both left—well, relatively happy. But what is this bill she got in the mail? She has insurance after all. And what is this deductible the bill talks about? Nobody told her she would be billed!

For many people, healthcare is a maze of rules and regulations that can be almost impossible to understand. But not being clear on what your policy pays may lead to misunderstandings, and sometimes hard feelings, between you and the doctor’s office that you love.

The one question I’m often asked is: “Why didn’t the doctor or nurse tell me my insurance wouldn’t cover this?” The simple answer is that our clinical staff has no way of knowing the particulars of your individual policy. Yes, they can see that you have Aetna or Cigna. But your Aetna plan can be completely different from your next door neighbor’s Aetna plan. There is no one size fits all coverage.

Another often asked question is: “Why wasn’t this included in the office visit?” The procedures your child may need during a visit take the skill of a clinically trained person. Take the removal of a bit of wax from the ear. It takes clinical skill to reach into a child’s tiny ear canal to remove the wax without damaging the ear canal or eardrum. And it’s not a normal part of an office visit. So you should expect that procedures, labs, flu tests, strep tests, and other services will be a separate charge.

So what can you do to try to relieve your frustration? As a billing manager, the advice I always give to people is—get to understand your insurance coverage. If you receive a bill and think it’s incorrect, call your insurance carrier and ask them to explain it. Look at the explanation of benefits your insurance company sends you. Many times the information there is all you need to understand why you’ve received a statement. And take a look at the back of your statement. We’ve listed a glossary of insurance terms that dovetails with both your statement and your explanation of benefits.

But above all, be assured that our primary concern here at East Cobb Pediatrics and Adolescent Medicine is to do everything necessary to maintain and restore your child’s good health!

Carole Sterling

Billing Manager

BIG CHANGES IN AMERICAN ACADEMY OF PEDIATRICS CAR SAFETY SEAT GUIDELINES

2011-07-07T16:52:00.000-04:00

As parents, and as the health care providers for your children, their safety and well being is of utmost importance to us. A new policy statement has been made by the American Academy of Pediatrics regarding car seat safety. The policy states that:

1. Infants and toddlers should ride in a rear facing car seat until they are TWO years old or reach the weight and height limits for the car seat.
2. Children should sit in a forward-facing car seat until they reach the
weight and height limits for the car seat.
3. Use a booster seat until they are 4 feet 9 inches ( 57 inches ) tall and
are between 8 and 12 years of age, when regular seat belts are most
likely to fit properly.
While many parents are used to transitioning to forward-facing car seats once their babies are 12 months and 20 pounds, it is important to keep in mind that the AAP has long recommended that “for optimal protection,” toddlers stay rear-facing until they reach the limits of their car seat. The automatic transition to a booster seat at 4 years or 40 pounds has also not been an AAP recommendation lately, as they have said that kids should sit in a forward-facing car seat with a full harness as long as they fit, which is well after 40 pounds.
CHANGES TO THE GEORGIA BOOSTER SEAT LAW:
Effective July 1, 2011, children under age 8 must be properly secured in
an approved car seat or booster seat while riding in an automobile, van
or pickup truck. There can be a fine issued by police for not following this law.
http://www.gahighwaysafety.org/childpassengersafety/
Please read these recommendations carefully…We care about you too much and want to be sure you stay safe!!!! Have a great summer!

By Sharon Lebedin, CPNP, CFNP

Welcome!

2011-07-07T10:48:00.001-04:00

Welcome to the East Cobb Pediatrics BLOG!

We hope you will find this blog informative and educational as well as occasionally entertaining. In the coming months we’ll be bringing you articles from Physicians and Nurse Practitioners as well as members of management and staff. Everyone has a story to tell, everyone has a question they’d like to ask or answer. We hope you check back here often for our news, information, and things to look forward to.

We want to hear from you too!

Do you have a topic you would like to see us cover? Do you have a question for a doctor or member of staff you would like to see answered here? Email me, Jennifer Collins at jcollins@eastcobbpeds.com I’ll do my best to get those topics and questions answered here on the blog. Thanks for taking the time to check us out!

Jennifer Collins

Technical Support Coordinator
Rx’s and Referral Coordinator

Constipation

2011-03-03T11:24:00.003-05:00

This is one of the most common issues that parents are concerned about. Less than 2% of constipation in children is due to an abnormality. This blog will only address the cause and treatment of functional constipation: which is the passage of less than two stools per week without any evidence of structural or biochemical explanation.
The true definition of constipation varies with the age of the child. It is more variable in children under 1 year. Infants frequently grunt and strain while stooling as they are learning to coordinate the muscles needed to defecate. Breastfed infants may have multiple stools per day the first month of life, and then go several days without a stool and still be normal, not constipated. Formula-fed infants average two to four stools per day. Treatment for constipation under one year of age can include glycerin suppositories, but do NOT use more than 3 days without a medical evaluation. Barley cereal and vegetables as well as pear, apple or prune juice are dietary measures to ease bowel movements as instructed by your provider. Please do NOT use mineral oil, stimulant laxatives or enemas in infants unless your provider has ordered this.
Pain with stooling is the main reason for developing constipation in young children. The child makes an unconscious decision to withhold stools after having a painful or frightening bowel movement. Delaying the act of stooling makes the stool build up and become dryer and harder so the next stool is painful and unpleasant. Children then tighten their pelvic floor, contract the anal sphincter and engage in behaviors (crossing legs, stiffening legs, standing up, refusing to squat) that prevent passing that stool. A common complication of prolonged constipation is called fecal soiling. This occurs when overflowing and leaking of loose stool occurs around retained, hard stool.
Prevention of these problems is the number one goal. This is usually accomplished by good toilet training habits such as readiness of the child, making the toilet comfortable (a footstool may help) and the bathroom a pleasant environment. Too much dairy can slow motility of the intestine and fill the child so he takes in less vegetables, fruit, whole grains and water. Physical activity, adequate dietary fiber, decreased dairy products, and increased fluid intake all contribute to good bowel habits.
Treatment of functional constipation can be a long process and needs family compliance. A positive attitude and a strong supportive nature are necessary. Reward systems such as sticker charts, toileting calendars, and rewards for successes play a key role. Laxatives are often used to relieve a child of constipation. There is no evidence that the long-term use of recommended laxatives causes dependence. The goal of managing constipation is complete evacuation, sustained evacuation and weaning from medications.

Please contact your provider at East Cobb Pediatrics if you have concerns about constipation. Other resources that may help include: http://www.pottymd.com/, The Colorectal Center at the Cincinnati Children’s Hospital, and http://www.naspghan.org/, which have excellent handouts available online.

by Darlene Coyne, FNP

Fever Reducer Medication Dosage Chart

2011-02-07T08:46:00.001-05:00

ACETAMINOPHEN (Tylenol)

Each dose will last 4-6 hours.

Use weight if possible. Always use the dropper or cup provided with the bottle.

Weight	Age	Infant’s Concentrated Drops 80mg/.8ml	Children’s Suspension Liquid 160mg/5ml	Children’s Soft Chews Tablets 80 mg each
6-11 pounds	0-3 months	.4 ml (½ dropper)
12-17 pounds	4-11 months	.8 ml (1 dropper)	2.5 ml (½ teaspoon)
18-23 pounds	12-23 months	1.2 ml (1 & ½ dropper)	3.75 ml (¾ teaspoon)
24-35 pounds	2-3 years	1.6 ml (2 droppers)	5 ml (1 teaspoon)	2 tablets

IBUPROFEN (Motrin or Advil)

Should not be used under 6 months of age

Each dose will last 6-8 hours.

Use weight if possible. Always use the dropper or cup provided with the bottle.

Weight	Age	Infant’s Concentrated Drops 50mg/1.25ml	Children’s Suspension Liquid 100mg/5ml	Chewable Tablets 50 mg each
12-17 pounds	6-11 months	1.25 ml (1 dropper)
18-23 pounds	12-23 months	1.875 ml (1 & ½ dropper)
24-35 pounds	2-3 years		5 ml (1 teaspoon)	2 tablets

Parents as "Equippers"

2011-02-07T08:21:00.001-05:00

The following outlines some of our department management philosophies. It can also be the model for parents with their children. As parents we can equip our children for the adult world as they mature. Your healthy examples will have your child believing in and listening to you. That puts you in a position to teach and empower them in their tasks.

You empower them to do their best by equipping them with the “tools” they will need to do their tasks. Always start with the vision of where you are leading them. What do you want them to accomplish each day? What is your long term vision for your child and your family? What do you need to do to make that happen?

You, the “equipper”, are a “Model” to your child – You know what they need to do because you have already learned it and understand the importance of it from the adult perspective.

You, the “equipper”, are a “Mentor” – you are the counselor who has the vision of where you hope your child is in five, ten and twenty years from now. As your child matures, you will want to communicate that vision to them. You have the experience to impart practical advice to them to keep them on track.

You, the “equipper”, are an “Empowerer” – by teaching your child what they need to know to be successful in their daily lives, they will enjoy each day more as they have successes. If they know “why” something is done in addition to “how”, they will eventually internalize the long term goal too. Your child will buy into the tasks that need to be done because they understand why. These positive experiences will lead to a happier and more stable child. By constantly training and helping them to improve their results, you empower them to take charge of their future as they grow and develop.

by Debbie Rodriguez, Practice Administrator

Blocked Tear Duct or Dacrostenosis

2011-01-13T09:54:00.001-05:00

Tears are formed at the outer corner of the eye and they travel across the eye to moisturize it. Then they go into the tear duct at the inner corner of the eye, near the nose, and into the nose. The tear duct is a very, very small hole. In newborns, the tear duct is a tiny opening that can get clogged up quite easily. Once it is clogged, the tears have no exit and back up in the eye causing a goopy discharge that can be easily seen. The discharge can also prevent the newborn from opening the eyelid fully. The tear duct tends to open up spontaneously at nine months of age.
Until then, a simple massage can be done to keep the duct open daily and prevent the discharge. Using your index finger with nails clipped short, place it between the eye and the nose and then while pushing down, drag your finger towards the end of the nose. Do this massage on the affected side 10 times in the morning and 10 times in the evening. The massage gently 'pops' the tear duct open and prevents the goopy discharge. By preventing the discharge, you can prevent the need for antibiotics and possibly the need for surgery.
Schedule an appointment with East Cobb Pediatrics to be seen for a sick visit and for a simple demonstration of the massage if you feel that your newborn has a blocked tear duct.

By Shefali Chheda, MD

Recipes for Constipation

2010-12-27T22:54:00.003-05:00

If your child is being plagued by constipation which is unusally hard stools, here are some recipes that you can try that may help. These recipes are kid tested and approved!
Laxative Cookies
1 box Jiffy Bran Muffin Mix
1/2 cup applesauce
1 egg
1/3 cup prune juice
3/4 wheat bran or wheat germ
1/2 raisins (optional)
Mix together. Drop on a greased cookie sheet. Bake approximately 10-12 minutes at 350.

Bran Muffins
Pour 1 cup boiling water over 2 cups All Bran cereal and one cup Bran Buds cereal.
Let set until mushy and room temperature.
Add: 2 cups buttermilk
2 beaten eggs
1 cup of sugar
1/2 cup canola oil
2-1/2 cups of flour
1/2 teaspoon salt
2-1/2 teaspoon soda
Mix together.
Bake at 350 for approximately 20 minutes for regular sized muffins or approximately 12 minutes for mini muffins.

by Deanna Fetsch, RN, CPNP

Creating and Keeping Healthy Eating Habits Part 2

2010-12-03T20:41:00.003-05:00

When your babies reach their second year of life, they become pickier eaters expressing strong feelings about what they like and what they dislike. Naturally, you will go along with what they like to eat (since you would like to see them fed) but don’t let them dictate what is for dinner every night; just keep reasoning until they start eating as much of a healthy variety as possible.

From 1 to 2 years of age, we recommend offering whole milk in a cup. The fat of the milk is necessary for brain development, so that is why we stick with whole milk until the age of 2.

After 2, your child should drink the same type of milk that the whole family drinks. Limit milk to 3 servings a day since many toddlers would rather drink milk than eat actual food. More than 3 servings of milk can cause the development of severe anemia.

Pre-school years are also very challenging; some children become very picky and erratic eaters. Please don’t force your children to eat when they are not hungry. If your pre-schoolers are not hungry at mealtime, have them join you at the dinner table anyway. Ask them how their day went and carry on normal conversations with them. Later, when they feel they want to eat, give them the same food the family had for dinner instead of offering them a snack.

When your children are school aged, get involved with them in the meal selection process and decide with them what to pick for lunch. Look for your school cafeteria menu and help your children pick nutritious meals ahead of time. When a school lunch does not seem appetizing, prepare lunch from home; have your children participate in buying the ingredients and preparing the meal.

Teenagers are also very challenging. They have different time constrictions. Do not let them skip any meals, especially breakfast. Adapt your schedule as much as possible so that you can still enjoy your meals together. We discourage the consumption of energy drinks or supplements besides daily vitamins. Sometimes, a great protein meal before sports activities is simply a peanut butter and jelly sandwich (with whole grain bread) instead of a more expensive protein bar/shake. Also, make sure that your kids drink plenty of water; something that is extremely important as activities get more demanding and exhaustive at this age.

We strongly recommend having meals together as a family. This usually creates a family tradition and an open communication that will last forever. Family gatherings around the dinner table, sharing stories, and carrying conversations about the day’s activities tend to keep relationships strong. Besides the stronger family ties, many studies have shown that such discipline make the teenage years less challenging.

When both parents work, planning ahead is vital. Getting the groceries on weekends and having simple but nutritious meals is also pocket smart. By all means, avoid fast food. You can always prepare something semi-homemade that is less expensive and healthier. It is easier to do so if you plan this ahead of time.

Make sure your menu has plenty of fruits and vegetables, appropriate portions of complex carbohydrates, whole grain pasta, and rice when possible, with variations in the type of protein that is offered at meals. Avoid animal fats and encourage healthy vegetable fats. Make sure you offer appropriate size portions so that sometimes your child can ask for seconds.

Encourage the consumption of water as a day-to-day beverage. With dinner, we don’t recommend offering milk since milk does not allow for iron to be absorbed. Always, at the end of the meal, offer dessert. However, be smart about it. Present fruits and avoid sugary treats. Remember, “treats are only treats”, and should only be offered on certain occasions.
Avoid praising behaviors with sweets. As much as possible, keep meals for mealtime and reduce snacking.
Teach your children by example:

Eat right
Enjoy the food preparation
Teach your children how to prepare simple meals
Set up and pick up the table with everyone’s help
Never watch TV while eating a meal.
Praise and thank the person who cooks
Excuse yourself if you have to leave the table.

Leading by example not only will teach your children good manners but also will make them always feel comfortable even when having a meal somewhere else.

I hope this blog can help you and your family eat right and enjoy each other’s company for many breakfasts, lunches, and dinners to come!

Bon appétit!

By Marisa Gadea, MD

Restoring Faith-Vaccines and Autism

2010-11-07T21:46:00.002-05:00

Vaccines are one of the most contentious issues in medicine and particularly in pediatrics. Due to the success of vaccines, the number of vaccine-preventable diseases has fallen dramatically. Second, only to clean water, vaccines have saved more lives than any other public health measure. Thankfully, you don’t hear about children dying of diphtheria as parents did in the 1920s when 15,000 children died of the disease per year. You don’t hear about death or neurologic damage from measles. On the other hand, as the number of children diagnosed with Autism (and Autism Spectrum Disorder) has risen, it has understandably received a great deal of media attention. Not surprisingly, parents are worried and they are worried about what is familiar to them. Autism, not diphtheria, is familiar to parents today. In addition, because children are receiving vaccinations around the time that Autism is being diagnosed; many claim there is a causal relationship. Numerous scientific studies have disproven this and have shown that subtle signs of Autism can be seen before vaccinations (specifically the MMR) are given.
Consider this: An infant was in the waiting room of her pediatrician’s office for her 2 month-old check-up and first set of vaccinations. While waiting, she had a grand-mal seizure and went on to be diagnosed with epilepsy. Had the seizure occurred 30 minutes later- after her vaccinations, it would have been easy to blame the vaccines! Although the exact rise and cause of Autism is not completely understood, it is clear to the majority of medical professionals, including the doctors at East Cobb Pediatrics, that Autism is not caused by vaccinations. I personally vaccinated my children as recommended by the CDC without hesitation and recommend the same to my patients. Sadly, as more and more parents choose not to vaccinate or to space out vaccines, the rise of vaccine preventable disease is inevitable. My hope is to restore your faith in vaccinations and in your pediatrician as your source of vaccine information. Please ask any of the providers you see at East Cobb Pediatrics for more information on vaccines and Autism.
Visit http://www.historyofvaccines.org/ and http://www.shotofprevention.com/ as well as http://www.cdc.gov/ and http://www.aap.org/ for more information.

By Tracy Barr MD, FAAP

Driving While Distracted Part 2

2010-11-02T22:15:00.002-04:00

Hello everyone. It is nice to be back. After my last entry, I am writing to check in on how you are all doing regarding distracted driving. This whole issue has really made me open my eyes as to my own actions regarding this issue. Just to update everyone again as to the new laws:
1. Anyone under the age of 18 can not text or use their phone in any way while driving - $150 fine.
2. No one, regardless of age, is allowed to text while driving…not at stop signs or traffic lights if waiting - $150 fine.
OK…so now that we have that out of the way….what is it that causes us to want to look at our phone while driving. There are so many other distractions without the phone issue…think about it…digging out your lipstick and putting it on, looking at your palm pilot or daily task list/calendar, picking up the sippy cup off the floor of the car…changing out the DVD for the kids….etc, etc, etc…
Since I last spoke of this subject, I have become keenly aware of my own distractions while driving. I speak on the phone less, and if I do, it is on speaker. I am more conscious of other little things I do, some that have almost caused accidents. I am also less tolerant of when I see someone driving poorly and look to see that they are speaking on the phone.
Basically, just try to be more vigilant of paying attention while you are driving. If you need to speak on the phone, just pull over…it takes no time to do that….Most of these phone calls can wait…Right? So thanks everyone…thanks for helping keep your kids (and ours), safe! See you next time!!!!!!

by Sharon Lebedin, CPNP, CFNP

Bedwetting

2010-10-13T21:44:00.007-04:00

Bedwetting is a common and frustrating problem in many families. Many children continue to have occasional nighttime wetting up to age 5 yearsand a significant number may continue to experience bedwetting until the pre-teen years.
Statistics show that 1 in 4 children still have occasional bedwettingup to age 5 years, 1 in 5 up to age 7 years and 1 in 20 until age 10years. Children who have a problem with bedwetting frequently have a close family member who also experienced this issue.
Reasons for bedwetting include an immature nervous system so that the messages from a full bladder are not recognized or acted upon by the brain to wake the child in time to make it to the bathroom. Some children have a small bladder and must void more frequently than average.
Most children who wet the bed are described as very deep sleepers who are hard to awaken. Constipation may also play a role in bedwetting because stool in the colon may press on the bladder.
When a child is old enough to want to stop wetting the bed, to want to stop wearing pull-ups at night, and to take part in efforts to stop bedwetting, then the family can work together to try and help the child wake up dry.
Limiting water or other drinks during the last 2-3 hours before bedtime is sometimes but not always helpful. A more successful method maybe an alarm that is worn on the child's underwear or pajamas, which will alarm if the sensor becomes wet. This will hopefully awaken the child so he can go to the bathroom to finish urinating in the toilet. This method works by making the child more aware of the feeling of having a full bladder and, hopefully, will learn to awaken on his own when his bladder feels full.
There is also a medicine taken by mouth, called DDAVP or desmopressin, which works to decrease bedwetting. It is a synthetic form of a chemical made by the body, which decreases urine production at night. DDAVP is useful for times when a child is away at camp or at a sleepover, but it only helps the child remain dry while he is taking the medicine. Once the medicine is stopped, if the child's body has not matured to stop bedwetting on its own, the wetting will recur.
If a child has had a fairly long period of remaining dry at night- 6months or more- and starts bedwetting again, there may be other reasons for the relapse. A bladder infection, constipation, anxiety or a stressful event may be the cause. Therefore, if wetting starts back after a long dry period, a search must be made for the cause and an office visit should be scheduled to discuss the situation.
The most important thing to remember is that children do not wet the bed on purpose and are frequently very distressed and embarrassed when it occurs. The caregiver can provide support, acceptance and encouragement as the child tries to become dry at night.
For further information, a helpful source is Dr.Howard Bennett's book: Waking Up Dry: A Guide to Help Children Overcome Bedwetting.

by Elizabeth Kemp, MD, FAAP

2010-2011 Flu Season

2010-09-23T09:04:00.002-04:00

At East Cobb Pediatrics and Adolescent Medicine, PC., our mission is to safeguard our patients, their families and our staff at all times, especially during cold and flu season. To keep you well informed and to prevent the spread and seriousness of infection, we have listed several resources on our website www.eastcobbpeds.com for additional flu information.
It is likely, though not certain, that both H1N1 and Seasonal Influenza viruses will cause illness in the U.S. during the 2010-2011 flu season. The CDC recommends a yearly flu vaccine as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the flu vaccine protects against the three main flu strains that research indicates will cause the most illness during the flu season.
Both H1N1 and Seasonal Influenza viruses are contagious and spread from person-to-person. The symptoms of H1N1 flu virus in people are similar to the symptoms of the seasonal flu and include fever, chills, cough, sore throat, stuffy or runny nose, headache, body aches, fatigue, and some report diarrhea and vomiting. Many people with these flu viruses are able to recover at home without treatment. If your child has flu-like symptoms, please keep him or her at home for at least 24 hours after his/her fever is gone except to get medical care or for other necessities. His/her fever should be gone without the use of fever-reducing medicine.
As always, the providers at East Cobb Pediatrics and Adolescent Medicine are here to answer your questions about influenza and other health topics.

by Salathiel Kendrick, MD, FAAP

Manners Never Go Out Of Style

2010-09-02T09:01:00.004-04:00

Manners are the grease that makes the gears of society run smoother. Although it sounds old fashioned, manners make the world a nicer place in which to live - for all of us. In Atlanta, the epicenter of the South and great bastion of good manners, we have always been known for gentility and proper manners.
I am very fortunate to have chosen a career that allows me the opportunity to work with children. The honesty and joy that they offer is an amazing gift to those of us who have this opportunity of working with children for a living. I would like to partner with our parents by offering a few suggestions on how to make office visits with your children more pleasant for us all.
I think that all parents are looking for ways to improve their skills in dealing with the daily conflicts with their children. These are a few suggestions that might help parents encourage better behavior while at the doctor’s office:
Prepare your child before he comes to the doctor’s office. Tell him what you think will probably happen and what you expect from him.
Buy a doctor’s kit and role play with him.
If he has a painful procedure, take him to the park afterwards or let him choose something to do that he really enjoys.
Teach your child to make eye contact when spoken to and answer questions clearly.
Don’t allow your child to touch the computer or the medical equipment.
Let him know that it’s OK to play with electronic games while he is waiting, but when he is called upon to answer questions, he should immediately put them down.
Lastly, tell him that the doctors and the nurse practitioners are his friends and only want to keep him healthy and make him well.
Good manners may seem unimportant to children but they pay big dividends later on, in school, in the business world, and in life generally.

Good manners are cool!

by Barbara Cossman, RN, CPNP

International Travel with Children

2010-08-18T21:52:00.004-04:00

If you are traveling internationally with your child, have fun!
There are several safety tips you need to keep in mind, though. Please visit http://www.cdc.gov/travel to make sure there are no travel restrictions or vaccines you may need prior to travel. This website is updated regularly so check before each trip.
Most babies less than 6 months of age do well travelling by car, boat, or plane. As long as they have their caregiver with them, they don’t feel anxious. We don’t recommend travel between birth and the first set of immunizations. These are typically given at the 2 month check-up.
Unless your child has fluid in the ears, traveling by plane does not bother the ears until after they are 2 years old. Take-off and landing are the hardest on the ears, with landing being the worst time. Chewing, swallowing, and yawning during these times will help with pressure equalization in the ears. Make sure your child has age-appropriate drinks or food that they can take during take-off and landing. Refer to this website by the TSA about traveling on airlines thru and out of the U.S. http://www.tsa.gov/travelers/airtravel/children
You can go to this website by the American Academy of Pediatrics for further information on traveling with children: http://www.aap.org/advocacy/releases/travelsafetytips.cfm
MEDICATIONS
From 2 months of age to 6 months of age, you can only give acetaminophen. Ibuprofen and Benadryl can only be used after 6 months of age.
Acetaminophen and ibuprofen can be helpful for fever and pain. These are always handy to have on hand.
We do not typically prescribe antibiotics ‘just in case’. If you child becomes ill while abroad, he or she needs to be seen and evaluated by a medical provider. This may seem like an inconvenience, but it is the best approach to take.
Please talk to a provider about any further information before you travel internationally with your children.

by Shefali Chheda, MD, FAAP

Creating and Keeping Healthy Eating Habits

2010-08-02T07:51:00.002-04:00

When do I start solid foods? What do I feed my baby first? How do I feed a "picky eater"?
We as pediatricians answer these questions on a daily basis as we strive to create generations of healthy eaters.
I strongly believe that we can become a much healthier society if we teach our kids simple rules of nutrition. Both providers and parents need to lead by example and demonstrate better eating habits and a more active lifestyle. Simple changes can make big differences!
Fighting obesity and abnormal relationships with food is an ongoing process that starts right at the beginning. You should eat healthy before your baby is born; create a taste for fruits and vegetables, and take in appropriate amounts of proteins and grains from pregnancy on. You should also stay active throughout gestation and avoid pregnancy complications related to excessive weight gain.
After your baby is born, breastfeeding is ideal. Babies get everything they need for their forming bodies and brains. They also learn easily when to stop a meal by simply knowing when they are full! Recognizing early that a meal should be stopped once satiety has been achieved.
If breastfeeding is not possible, we will guide you on what formula to choose.
We recommend starting solids between 4 to 6 months and in general, your baby will let you know when he or she is ready; usually following those cues will make eating solids a success! We like to start with rice cereal but veggies can also be an option. Offer pureed foods to your baby with a baby spoon but never in a bottle.
Preparing your own vegetables is very easy even if you are a busy parent! Start by steaming single veggies (i.e.: sweet potatoes, zucchini, and squash). Puree the veggies in the food processor and place them in an ice cube tray. Freeze the pureed veggies and keep them for a week or so in a Zip-lock bag. Thaw what you need and feed your baby good quality homemade baby food.
You can mix and match your veggies as your baby grows and develops a taste for them!
When your baby is around 7 months old, you should introduce another source of protein besides breast milk or formula. Meats: beef, chicken, turkey etc., or a non-animal source like tofu or lentils. I recommend cooking the proteins together with your veggies. Also, give your baby fresh fruits as desserts.
It is after 8 months or so that we recommend some simple finger foods that will encourage your baby to self-feed, (plain cheerios, teething biscuits, veggie puffs).
We recommend offering water in Sippy cups at about that age so that your baby can master the technique in a few months.
When your baby is 9 months or so, he or she should be eating 3 servings of pureed foods and 3 servings of breast milk or formula.
Also by 9 months, you can introduce table foods: healthy meals with a combination of proteins, grains and vegetables mixed with spices; also, use fruits as desserts. Basically, your baby can eat what you eat for the most part; therefore, keep your own meals healthy and well balanced!
Stay away from the following until after the 1st birthday: honey, egg whites, shellfish, peanuts, and choking hazards like hot dogs!
We will continue our healthy eating series in my next blog. Stay tuned…

by Marisa Gadea, MD, FAAP

Driving While Distracted Part 1

2010-07-08T21:35:00.003-04:00

As I was deciding what to write for this month’s article, I pondered over several different ideas. One day I watched the Oprah special on distracted driving….What an impact that show made on me! Lives ruined and such sadness, all because someone was talking or texting while driving. It had seemed like the perfect time to use your phone while the kids are in their car seats, watching a movie or sleeping, it is quiet....you’ve got so many calls on your list to make for the day….right? Wrong!!!!! I began to reflect on my own habits regarding this issue, and I realized I was among the many who kept their phone in their lap while driving, often using driving time to “catch up” on phone calls. I, too, work all day, and am tired in the evening, so on my way home or during lunch, I may return calls or check on my “grown” kids. I decided I needed to change this habit that I had become accustomed to doing.
I made my own pledge to truly limit my calls, to not hold the phone while driving, to not dial or receive any calls while driving, and, of course, to never read or respond to text messages while driving. How can I expect to look in my mirrors or safely turn my head, if needed, to change lanes for example, while holding a phone to my ear? How many times have you noticed someone making a driving error and you look over and they are on their phone? I had experienced a few near misses regarding this and I realized it was just a matter of time before I created an accident. To my surprise, I feel so much better. I am much more aware of my surroundings, feel much more in control and realize most of my car phone calls really are unnecessary. This is just a habit that needs to be broken. I know this is just a beginning step, but at least it is better than before.
I encourage you to try this. Just be aware of your driving habits: try to make one simple change in what you do while driving and I guarantee you will be safer for yourself and those you love, as well as anyone around you on the road. Maybe you can pledge not to talk on the phone while driving at all! Be a role model for your kids here…especially those of you that have teens who will soon be driving or already are. This is not a topic to be taken lightly.
Surprisingly the very next week I discovered that Senate Bill 360 has now passed the Georgia legislature. It will prohibit individuals from using wireless telecommunications devices for sending or receiving text messages while driving. In addition, the new law also prohibits drivers under the age of 18 from using a wireless communication device…Period….It will be against the law for our new, inexperienced drivers to talk or text while driving. This is a good thing. Speak to your teens. Show them you are following the rules. There are just too many unnecessary accidents. Eventually, maybe things will return to the way they used to be. Cell phones for car emergencies, not for everyday use while driving. Think about it. Give it a try…….

By Sharon Lebedin, CPNP

Calcium and Strong Bones

2010-07-08T21:24:00.004-04:00

Strong, healthy bones form the framework for your child's body. Bones are living tissues that are constantly changing as small portions of bone
are removed and new ones added.
Calcium is necessary for building healthy, strong bones, but calcium is
also important for building teeth and for other body functions. Therefore, if
your child does not consume enough calcium, calcium may be taken from the
bones to be used in the rest of the body. The years from age 9-18 years
old are the most important in building bones and if children do not
receive enough calcium during those years, they are at increased risk for
osteoporosis, or brittle bones, as they enter middle age.
Parents may think that their child is getting enough calcium from their
diet, but studies have shown that for many children that is not true.
Children ages: 0-1 year need 210-270mg calcium per day
1-3 years need 500mg calcium per day
4-8 years need 800mg calcium per day
9-18 years need 1300mg calcium per day
Low fat and nonfat milk products are the easiest source of calcium
because they are high in calcium and it is easily absorbed. One cup of
milk provides 300mg of calcium. For calcium rich snacks, try cheese,
pudding, yogurt, cereal with milk, broccoli with yogurt dip, calcium
fortified orange juice, tortillas and almonds.
If your child's diet does not contain enough calcium, calcium
supplements are available. However, no more than 500mg of calcium
should be taken at one time because too much taken at one time cannot
be used efficiently.
Some foods like cola drinks decrease the calcium available for bone
growth. Caffeine, tobacco and alcohol also cause calcium loss from bones.
Weight bearing exercise like walking, tennis, soccer, jumping rope,
gymnastics and dancing are also important for building strong bones and
muscles.
For more information, check out these websites:
http://www.mypyramid.gov/
www.niams.nih.gov/Health_Info/Bone/Bone_Health/Juvenile/default.asp

By F. Elizabeth Kemp, MD, FAAP

Fireworks Safety

2010-06-20T22:14:00.003-04:00

Fireworks can lead to severe injuries including burns, scars, and defects. As a result, many states have banned their use except by professionals. However, some fireworks such as sparklers are still permitted in many states like Georgia.
What type of fireworks cause injuries?
One study in 2005 showed that firecrackers (26%), sparklers (17%) and rockets (17%) caused most of the injuries from fireworks. Sparklers were the cause of more than 50% of the injuries in kids under the age of 5. They can reach temperatures above 1000 degrees Fahrenheit and burn users and bystanders. Firework injuries usually affect the hands, face, head, and ear. They most often (45%) occur in kids less than age 14 during the month around Independence Day (July 4th).
Are there any safe fireworks?
There really are no “SAFE” fireworks so families are encouraged to enjoy community fireworks displays run by professionals instead of using them at home. Of note, the AAP (American Academy of Pediatrics) recommends prohibiting public sale of all fireworks, including those by mail or Internet.
How can I use fireworks as safely as possible if I choose to try them at home?
• KEEP A FIRE EXTINGUISHER CLOSE BY
• Only use fireworks that are legal in your state (In Georgia: firecrackers, bottle rockets, sky rockets, and roman candles are ILLEGAL)
• Fireworks should only be lit by responsible adults
• Once lit, get to a safe distance from the fireworks as soon as possible
• Never use fireworks if you are under the influence of alcohol or drugs
• Select an area that is wide open, flat, and away from housing and combustible materials such as gasoline, propane tanks, dry leaves, and chemicals.
• Be sure that all spectators (especially children) are a safe distance away from the fireworks.
• Use long matches or fire starters to light fuses
• NEVER hold lit fireworks in your hand
• If using roman candles, bottle rockets, or sky rockets be sure to ground them in a stable heavy base (such as a heavy can or 2 liter soda bottle filled with gravel, sand, or dirt) and point them AWAY from spectators
• NEVER relight a fuse that has gone out, you may not have enough time to get to a safe distance
• If a firework fails to go off (i.e. is a “dud”), douse it with water before approaching it, some fireworks may malfunction and ignite long after the fuse has burned out
• If you or anyone else is injured by a firework seek immediate medical attention (Call 911)
Resources: www.cdc.gov/HomeandRecreationlSafety/fireworks/fire_spot.html

www.aap.org/healthtopics/safety.cfm

by Salathiel Kendrick, MD, FAAP

Earaches

2010-05-25T21:35:00.003-04:00

Why can’t East Cobb Peds “just call something in” for little Johnny’s earache?
Earaches can be caused by a variety of problems; fortunately, not all of them require the use of oral antibiotics to get better. An earache can be a symptom of excess wax, teething, strep throat, or an actual ear infection. The following lists a few of the several kinds of ear infections that a child may have:
1. AOM (acute otitis media) is an acute infection of the middle ear which typically presents with sudden ear pain, which can be severe, and often leads to sleep disturbance and may be accompanied by fever. Generally these symptoms emerge a few days after the onset of a cold. Infants may swat at their ears, refuse to lie down, or simply become atypically whiny & clingy compared to their usual happy nature. Pain management can be achieved by using acetaminophen in infants under 6 months of age; or either acetaminophen or ibuprofen for those over 6 months of age. Topical anesthetic ear drops can be especially helpful for middle-of-the-night pain awakenings. Antibiotics and an ear re-check after 2 weeks is usually warranted for children less than 2 years of age. For the child who is 2 years or older and is asymptomatic, a “watchful wait” may be the best course of action, with an ear re-check in 2 weeks.
To help prevent AOM, minimize exposure to others who are sick, wash hands frequently, and never smoke around a baby or in the car. Breastfeed as much as possible; your baby is “getting a passive dose of natural antibodies” with every meal. Avoid, or delay daycare, if possible; more sick-baby-exposure means more sickness for your baby, too. No bottle “propping”, no putting baby to bed with a bottle or allowing baby to “co-sleep / comfort nurse” throughout the night, as these can also contribute to middle ear infections.
2. OME (otitis media with effusion) is essentially a “stuffy ear” which is not acutely infected and will generally resolve without treatment. Pain tends to be more intermittent, and less severe than in AOM, and often sleep is not adversely affected. Addressing underlying nasal congestion with the use of saline nasal mist & bulb suction is suggested. Pain that persists beyond 48 hours warrants an ear check. Topical anesthetic ear drops can be prescribed to help with discomfort. Unfortunately, oral decongestants such as Sudafed, homeopathic “candling” and chiropractic adjustments are ineffective, and therefore, not recommended. An effusion which persists and adversely affects hearing and/or speech development warrants further evaluation.
3. OE (otitis externa) is most commonly known as “swimmer’s ear” and typically follows a lot of recent swimming or an injury to the ear canal, by a Q-tip, for example. Pain is usually quite severe, and simply touching the ear can elicit tears. Generally, antibiotic ear drops are prescribed with avoidance of swimming through the duration of treatment. For prevention of swimmer’s ear, instill & “shake out” a 50/50 blend of rubbing alcohol and white vinegar at the end of the swim day, provided there is no current infection, and the eardrums are intact (i.e. no ear tubes or perforations).
4. FB (foreign body) can be “internal” such as excess hard earwax or “external” in origin such as a hair bead or popcorn kernel inserted by a curious toddler. The foreign body can become lodged and uncomfortable. Q-tip use is discouraged in all children, as it simply pushes the foreign body back down into the ear canal. Curettage at the pediatrician’s office is suggested, as some items can actually swell and become further lodged by attempting to “wash out” at home.
The providers at East Cobb Pediatrics are adept at treating all sorts of ear infections and earaches. If your child has an earache, please call us and we can start helping.

By Deanna Fetsch, CPNP

Raising Media Safe Kids

2010-05-12T22:58:00.004-04:00

Parents!
Did you know youth spend more than 7 hours a day using media, with most having access in their bedroom to a TV, video game, computer, internet, and a cell phone?? Some parents would argue what does it matter? According to research studies, media has significant negative affects on children and teens.
Violence and aggression in the media are often glamorized. The average teen has seen almost 200,000 acts of violence on TV by age 18. As a result, children come to see violence as an acceptable and appropriate way to resolve conflict. Children are often exposed to significant tobacco, drug alcohol, and sexual content through TV, movies, social websites (i.e. my space), and internet videos. Research shows this has an important impact on teens and leads to more permissive behaviors. A link has been noted between obesity and heavy TV viewing, likely due to decreased exercise, increased inactivity, decreased sleep, and increased thoughtless eating of unhealthy foods. Media, such as fashion magazines, have also been shown to have an influence on eating behaviors and body image issues often leading to eating disorders. Though still controversial, some research has indicated that more than 2-3 hours of TV per day for toddlers has been associated with attention-deficit disorder (ADD) during the early school years.
What can parents do?
1. Limit total screen time (TV, computers, cell phones, and video games) for children older than 2 years to no more than 1 to 2 hours per day
2. Avoid screen time for children younger than 2 years
3. Keep children’s bedrooms free of screen media
4. Co-view media with your children and discuss the content
5. Understand and know the ratings of the media your child is using (i.e. FV = Fantasy Violence, AC = Adult Content)
6. Do not allow your child to eat in front of the TV or computer
7. Monitor and limit your own media use
Reference: Pediatrics 2010; 125:756-767

Resources: www.aap.org, http://safetynet.aap.org/

By Salathiel R. Kendrick, MD, FAAP

Ankle Sprains

2010-04-10T21:59:00.005-04:00

Ankle injuries are the most common sports related injury seen by pediatricians. The ankle is most often injured as a result of “rolling” the ankle inward and spraining the supportive ligaments on the outside part of the ankle. This usually results in swelling, pain, and sometimes an inability for your child to bear weight. It is unusual in the older child for the ankle or foot bones to be fractured when rolling the ankle inward. However, you should seek medical care if your child’s ankle is swollen, tender, and/or she cannot bear weight on the ankle. The providers at East Cobb Pediatrics can examine the ankle and determine if an x-ray is necessary.

If you suspect an ankle sprain or your child has been diagnosed with an ankle sprain, you can begin care at home. Most sprains heal within 2 weeks. Your goal is to limit inflammation and swelling and keep the ankle flexible via: R.I.C.E. (rest, ice, compression, and elevation).
REST by stopping your child’s participation in sports and PE and using crutches if he cannot bear weight.
ICE by ice cup massage: fill a Styrofoam cup with water and freeze it, tear the top of the cup off and while holding the bottom of the cup, massage the ankle with the ice—do this several times a day for twenty minutes at a time.
Apply COMPRESSION with an ace bandage. An air cast or splint may be helpful as well.

ELEVATION by propping the foot up on pillows above the level of the heart. Lastly, limit inflammation by taking Aleve twice daily for two weeks. Rehabilitation by a licensed physical therapist or school trainer should be done to maintain flexibility and to improve strength in the ankle and prevent reinjury. Your child may return to activity if the ankle is not sore when touched, it is as strong as the uninjured ankle, and your child can stand with her eyes closed and balance on the injured ankle for 30 seconds.

By Tracy Barr, MD, FAAP

Diaper Rash

2010-03-28T17:37:00.001-04:00

Keeping your baby healthy and happy is every parent’s goal. Because diaper rash is so easy to get, it is the most common skin problem in infancy and it accounts for over one million visits to doctors each year!
Here are Barbara’s basic rules to help prevent this problem:

1. Change your baby’s diaper as soon as you see urine or stool (a minimum of every 2-3 hours).

2. You may use fragrance-free sensitive skin wipes if there is no rash. Pat skin dry with a tissue or dry washcloth after cleaning making sure that that all creases are clean and dry.

3. If there is a rash, use only water on a paper towel or soft washcloth to clean and again pat dry.

4. Use a barrier product that contains zinc oxide to apply to dry skin if there is any redness. Examples we recommend are Desitin Original (my favorite), Desitin Creamy, Boudreaux’s Butt Paste, Dr. Smith’s, Triple Paste, Balmex or Resinol Ointments. Apply generously! We also have a prescription product called Rosen’s Cream that is great for diaper burn (flat red diaper rash).

5. If rash does not improve in 2-3 days, yeast has probably developed. This rash is usually very red and bumpy. Use Lotrimin AF cream (over the counter) 2-3 times a day on dry skin; then cover with a barrier cream as above.

6. You may also soak your baby in the bathtub with warm water and baking soda or Epsom salt 1-2 times a day if rash is severe.

7. Do not use baby powder or corn starch in the diaper area. These products increase respiratory problems in your baby. They can cause pneumonia.

8. If the diaper rash does not improve with the above treatment, please schedule an appointment to allow one of our providers to keep your baby’s bottom happy!

By Barbara Cossman, MN, RN, CPNP, IBCLC

Pet Safety

2010-03-14T16:07:00.001-04:00

Children and pets can be a wonderful combination under the right circumstances. There are some precautions that can prevent an unfortunate incident. Consider waiting until a child is five before getting a pet if you don’t already own one. Never leave a child younger than five alone with any dog or cat. Send something home from the hospital with the baby’s scent on it before arriving home with the baby.
Children need to be taught rules on handling and respecting animals. They should be taught not to pull, tug, hug or sit on pets. General rules such as never disturbing one who is eating, sleeping or playing with a bone or favorite toy. Teach children to never approach a dog that is caring for her puppies or is growling or showing teeth. Both the children and the pets need and deserve lots of praise for good behavior.
Dogs need to be well-socialized and taught submissive behavior such as rolling over and dropping food on demand. Do not rough-play with a dog; having it neutered is a good idea. An animal trainer needs to be consulted if the dog shows any aggressive behavior.
Cats can be resentful of new babies since it may limit their territory. Sit up baby’s room several months in advance and let the cat investigate with boundaries set up. To prevent the cat from getting in the crib, you can apply double stick tape to the edges or use a net on the crib. Cat’s nails need to be trimmed regularly or covers applied such as soft paws.

Reptiles, such as lizards and turtles, can harbor salmonella, a bacteria that can cause severe vomiting and diarrhea. Remember that children always need to wash their hands after touching or cleaning up after any animal.

by Darlene Coyne CNFP, IBCLC

Your Nose - Why it is so important

2010-02-28T21:35:00.001-05:00

Don’t underestimate the importance of your nose!
1. Your nose is your built- in filter, warmer and humidifier of the air you breathe.
2. Obstruction of airflow through your nose can lead to sleep apnea, which can lead to chronic fatigue and even heart damage.
3. If you have trouble breathing through your nose, your defense against disease is reduced. Your asthma is more likely to flare up, and you are more likely to become tired and even depressed.
4. You need your sense of smell to enjoy the taste of food.
So, what can you do to ensure the proper functioning of your nose:
1. Use nasal saline to wash out the mucous that is obstructing your airflow (remembering to look down, squirt up and blow out of one nostril at a time).
2. Use nasal saline gel to moisten the lining of your nose if the air is very dry.

3. Use a nasal steroid spray (e.g., Flonase, Nasonex, Veramyst, Nasacort AQ, Rhinocort Aqua) to reduce the swelling and obstruction of airflow that is often the result of allergies or infection.

4. Take oral antihistamines (e.g., Claritin, Zyrtec, Allegra, Xyzal, Clarinex, Benadryl) to reduce nasal congestion resulting from allergies. There is even a nasal antihistamine spray available.
5. Watch for signs of obstruction of nasal airflow such as snoring and consult your doctor.

The providers at East Cobb Pediatrics can help you maximize the function of your nose and thereby prevent disease and speed your recovery from illness.

Eric Karlen, MD, FAAP

RSV

2010-01-31T12:13:00.001-05:00

Respiratory Syncitial Virus or RSV as it is commonly known can be a deadly virus for children under the age of 2, especially if they are premature or have other high-risk conditions such as asthma, or heart disease. Please watch this Fox 5 Atlanta newscast about one mom's encounter with RSV.

This is not supposed to scare you, but to let you be aware that we at East Cobb Pediatrics take RSV very seriously. If you feel your child may have RSV, please do not hesitate to contact us. You can also visit the Center's for Disease Control website on RSV at www.cdc.gov/rsv.

http://www.myfoxatlanta.com/dpp/news/health-watch:-rsv-risk-010609

by Shefali Chheda, MD FAAP

Electronic Medical Records in our office

2010-01-31T12:07:00.001-05:00

by Stephanie Patterson, RN

It is about to be a very exciting time for East Cobb Pediatrics. We are going green and will be implementing electronic medical records on March 8th 2010. Bye-bye paper and hello computers! As some of you have already seen, we have placed computers in every room in the office. This should help increase efficiency since the “chart” will now be available to the staff no matter where you are in the office. We will begin slowly so all the staff and the patients get used to the new system, so we will only see two patients a day per doctor for the first few months on the EMR. The rest of the patients for the day will still have a paper chart. This will prevent us from running too far behind schedule. The providers will have computer tablets that they will carry from room to room.

Since computers are faster than people, it will take much less time to get the “chart” to the nurses from the front desk. The content of the chart will be available to both the nurses and doctors at the same time and the record is continually updated. One of the most exciting features will be the e-prescriptions feature. All of the prescriptions can be e-faxed to the pharmacy of your choice or printed out with nice, neat, readable writing. The pharmacist will love us!

Overall, our main goal is to provide better quality of care to our patients and their families. We cannot wait to see you at your next visit.

Care of the uncircumcised penis

2010-01-18T09:22:00.000-05:00

by Shefali Chheda, MD FAAP

The infant should be bathed frequently and all parts should be washed including the genitals. The uncircumcised penis is easy to keep clean. No special care is required! No attempt should be made to forcibly retract the foreskin. Pull the foreskin back to a comfortable level and clean as you normally would. There is no need for special cleansing with cotton swabs, irrigation or antiseptics. Soap and water is all that is needed.
The foreskin and penis will develop as one tissue. Separation will occur over time and should not be forced. As long as you can see the urethral opening and there is a stream during urination, you should leave the foreskin alone. Normal separation of the foreskin can take several years, but will definitely take place during puberty.
After infancy, pull the foreskin back to a comfortable level and cleanse once a day in the shower. It is important to teach your son to do this himself, so when he starts taking a shower by himself, it has already become part of his normal routine to keep himself clean.

Why You Should Breastfeed

2010-01-02T22:16:00.000-05:00

by Darlene Coyne CNFP, IBCLC

“Babies were born to be breastfed” as the current Ad Council’s campaign states. This statement is a public-health message which means that breastfeeding is the normal process for mothers and babies.

Breastmilk is species specific, so only human milk has everything human babies need. It has many components necessary for normal body function and development. There are growth factors in your milk that help protect your baby’s gut from foreign particles and enzymes which improve the digestive process. Breastfed infants have better vision, straighter teeth and higher IQs. Breastmilk helps protect your baby from colds, stomach upsets, ear infections, bladder infections and even Sudden Infant Death Syndrome.

Breastfeeding also has health benefits for you. Your hormones help you bond with your new infant. Mothers who breastfeed have less bleeding after delivery, less bone loss, and fewer cancers of the breast, uterus and ovaries.

We are here to help you be successful with your breastfeeding experience.

We have two certified lactation consultations available. Please call the office to make an appointment.