Are medical forms part of your child's back-to-school checklist? Parents, you can use our secure patient portal to log in and access your child's records. You can print out immunization records (the KCI form) and recent physical exams (in school-friendly format) all prefilled with your child's information, ready to submit to your child's school! Just go to redbudpediatrics.comand click on "patient portal" right next to the "home" button on the top menu. Check it out!
We had a great Saturday morning getting dozens of Teddys, Bunnies, Snakes, Seahorses and other assorted stuffed animals and Dollies ready for school this fall! Not one of them cried with their shots :) The staff and I had a great time with all the kids and parents - thanks for a fun morning!
Many thanks to my cousins Sandra and Eric Denneler for "freshening" my office with some wonderful new decor! Sandra is responsible for our Redbud logo and all the cute designs we use in our office and correspondence. You can see many more photos of the updated rooms (and all her other great creative projects!) at her blog projectdenneler.com. Then see it all in person at your child's next visit, or at our open house tomorrow. Be sure to tell any interested parents about our Teddy Bear checkup tomorrow morning!
Kids are often nervous about going to the doctor's office for a check-up. Having a medical home for your child means having a place where they are not afraid to go. Check-ups really can be fun for kids! Bring your child and their teddy bear or other favorite stuffed friend to Redbud this Saturday for a check-up that they help with! They can even give their bear all the "shots" needed to start bear school this fall. Meet me and my staff at Redbud, and see the new artwork designed by Sandra and Eric Denneler. See this article in "Parents" online for some extra tips on how to make your child's check-up go well!
I just read a blog entry from one of my recommended links (Motherlode) on the right side of this page. The entry is entitled "Let Them Climb Trees (and Fall)." The idea is to let your child make mistakes (and achieve successes) on their own while young and learn from them while under your roof and your guidance.
Kansas is currently having a whooping cough outbreak. KDHE announced earlier this month that Kansas is having an increase in pertussis, with 156 cases recently reported in Johnson county by health providers and 56 of them so far confirmed by laboratory studies. I have been trying to remind all of the expecting parents I see to "cocoon their infant" away from whooping cough by making sure that all persons who will be near their newborn is vaccinated against pertussis.
Whooping cough (pertussis) is an infection of the respiratory system caused by the bacteria "Bordatella Pertussis". It's characterized by severe coughing spells which sometimes end in a "whoop" sound when the person breaths in. It mainly affects infants younger than 6 months old, before they have been adequately protected by immunizations. About 3,000 cases of infant pertussis are reported per year in the US, with more than 19 deaths yearly according to the CDC. Most of these deaths and hospitalizations are in infants younger than 2 months old, who have yet to receive any vaccine to protect them from the disease. Most of these infants contract the disease from a close family member.
Even persons who were fully immunized as a child can contract pertussis as an adult, because immunity to the disease wanes over time. That is why the CDC recommends "cocooning" your infant. "Cocooning" is the strategy of immunizing all the persons around a newborn so as to protect them from contacting pertussis. This includes the expecting mother-- immunization with the Tdap vaccine is recommended after the 20th week of pregnancy or immediately after delivery.
As is the case with all immunization schedules, there are important time intervals, exceptions, and circumstances for receiving the Tdap vaccine. Expecting families should talk to their obstetric provider or pediatrician to find out who needs to receive the vaccine.
Childhood obesity is a widespread problem in America. Obesity is becoming a normal part of American culture. Just this week there have been two publications, one national and one local, addressing this issue. The CDC now projects that 42% of Americans could be obese by 2030 and that multiple strategieswill be needed to prevent this. The latest CDC data found 17% of US children obese, which is at least triple the rate of one generation ago. Meanwhile, the Wichita Eagle carried an article yesterday about nutrition for kids active in sports. I liked most of what this article had to say, but was disappointed at the photos in the article which featured sports drink and juice as part of a healthy diet for athletic children.
Many concerned parents of overweight and obese children try to increase their healthy habits by getting their child involved in athletics. This is a great idea. However, there are several pitfalls for well-meaning parents. The worst offender is the "snack and drink sign-up sheet". If getting your child on a soccer team means downing a Gatorade during game play (310 calories in 12 oz), and eating a Quaker chocolate chip granola bar as an after-game treat (100 calories), then your child just ate more than double the amount of calories burned during their soccer game (about 150 calories for a 30-45 minute game). This is obviously a problem. It's a cultural problem. Why would the local YMCA encourage this habit by providing copies of the snack and drink sign-up sheet for volunteer coaches? Why do we as a society of parents allow the snack and drink sign-up sheet system? Why can't our kids just drink water like we did when we were children?
A second pitfall is allowing a child to eat more if they become more physically active. It's true that kids may feel hungrier if they are more active, but parents have to recognize that an overweight child should not increase their already too high daily calories if they become physically more active. That can undo all the good you are striving to help your child accomplish.
If you are struggling with finding ways to get your child to a healthy BMI, it can help to visit your pediatrician and/or a dietician, who might offer a step-wise approach and check on growth at regular intervals to gauge your progress. But it also might help to be the brave parent who suggests at the next practice that your kids' team be a "water bottle" team, and not a "snack and drink sign-up sheet" team.
Last month two of my little patients underwent general anesthesia in an operating room to have dental work done on their teeth! One had a dental abscess, and the other had 7 rotten baby teeth. Both of these children have behavioral problems and developmental delays which make it difficult to brush their teeth. Their parents try --but even with special toothbrushes, there is only so much they can accomplish.
Two other toddlers showed signs of early decay that I noticed during their well-child check-ups-- white chalky areas of discoloration on the top front baby teeth near the gum line. Their parents were surprised because "but we help her brush her teeth!" However, our culture of toddler snacking on goldfish cracker and sippy cups of juice must have outweighed their brushing efforts.
I can't help but wonder which of my patients would not have these problems if Wichita had a fluoridated water supply. Statistics from other communities show that the incidence of dental decay decreases by 25% with water fluoridation. Fluoride is a mineral that already exists in Wichita water supplies, but at a concentration of less than what is needed to prevent dental decay. If we could just increase the fluoride in our water slightly from our natural mineral content of 3 parts per million to 7 parts per million, this would be enough to save many of the children in our community from dental disease.
Water fluoridation is a safe and preventative measure that is supported by every single large reputable group of public health and medical authorities: the CDC, the WHO, the AAP, the AAFP, the ADA, . . .
It's time the citizens of Wichita stood up for a safe and proven public health measure which would benefit EVERYONE, from infants to elderly citizens of all income groups. For more information on the subject, see the website www.ilikemyteeth.org
As soon as a baby is born, the parents know to worry about the poop! But it doesn't seem to stop once your child is older-- one of the top reasons for toddler visits to the pediatrician is constipation problems.
Constipation is the passage of infrequent hard large or
small pebble-like stools. If your child has
struggled with severe constipation since birth, they may have a serious condition
that requires specialty evaluation and care. Most
toddlers, though, are constipated because of several factors: 1.) the physics involved in having a normal
little toddler body, 2.) diet, and
3.) activity level.
1.) the toddler body: Toddlers have a bigger belly than older
children. Their belly sticks out because extra room is needed to store the
important large organs of the body—the liver, spleen, kidneys, and intestines. As toddlers grow, their whole torso grows as well,
making more room for the organs in the belly. By about age 5-6 years old, most kids have a
flatter belly and stronger abdominal muscles.
This makes it easier to have a bowel movement. Therefore, mild constipation problems will often resolve at about kindergarden age.
2.) the toddler diet: Some
toddlers drink a lot of milk. Too much
milk can be constipating. Limiting your
toddler’s milk intake to no more than 12 – 16 oz of milk daily (2-3 child sized
glasses) is helpful in improving constipation.
Sometimes, changing from cow’s milk to soy milk will improve constipation immensely . Keep in mind, though, that it is important to limit any type of milk intake to less than
20 oz per day for a toddler. Otherwise, they will not eat the other healthy foods that their body needs. Many toddlers are "picky" eaters, and prefer processed carbs (Goldfish crackers, anyone?) and processed meats and cheeses. Eating a
healthy diet full of fruits and veggies (at least 5 servings daily) and whole
grains (oatmeal is a great breakfast for toddlers!) will have a big impact,
too, in improving constipation. While in
general juice is not good for children, it can be helpful in relieving constipation
in toddlers if given once daily, at one sitting, with a meal (and it helps to water it down - one part juice plus one part water).
3.) Toddler activity: Make sure your toddler has the opportunity to
have physically active playtime for more than one hour per day. This type of exercise helps in developing
abdominal muscles and keeps the body moving the food in the right direction.
Sometimes children need medication to help relieve constipation. Usually it is best not to give a medicine
that stimulates the bowels to move, like Maalox or senna. The medicines that work best are fiber
substitutes. Fiber substitutes are not
habit forming, and work naturally to keep more water in the gut so that the stool
Fiber substitutes are
available over the counter as Benefiber or Miralax. Usually 1 to 2 teaspoonsful, dissolved into a 6- 8 oz
glass of liquid, once daily, will do the trick.
These fiber supplements are odorless, textureless, and tasteless. Your child won’t even know they are drinking it! The amount given can be tapered down or up
by the parent as needed to get the desired outcome of one soft stool
Plan to always give the
fiber substitute at the same time each day, dissolved in milk, water, or watered-down juice, with the meal that your child usually eats
the best. Then, when the meal is over,
your child may feel their gut moving and have the urge to use the toilet. You can encourage developing a regular bowel habit by establishing the
routine of sitting on the toilet and
reading a book after the meal that your child drinks the medicine. This will give your toddler time to sit, relax, and let nature take it's course. Soon, your
child may be one of those “regular” kids who poops in the toilet after dinner
Spring allergy season is arriving! March in Wichita usually is the start of the allergy season, with itchy eyes, runny or stuffy noses, sneezing, dark under-eye circles, itchy skin, and for some kids, asthma flare-ups. Kids who are known to suffer from spring time allergies in Wichita typically need to start their allergy medications in the middle of February. We have had such a mild winter that I'm expecting Wichita's pollen counts to explode anytime now. . .
Do you feel unsure if your child might have allergies, or is it just cold symptoms? It is often hard to tell in young children. A few good points to make: children less than 2 years very rarely have seasonal allergies. Allergies never cause fever, and never cause muscle aches and pains. If you are concerned that your child may have allergy symptoms, and if they are severe enough that sleep is disrupted or your child is expressing their annoyance at these symptoms, see your child's doctor to discuss the best treatment plan.
Spring time allergy treatment plans for children may include:
An over-the-counter, long-acting antihistamine medication (such as Zyrtec, Claritin, or the generic equivalents) taken every night.
A prescription nose spray (such as Flonase or Nasonex) made of a low-potency liquid steroid that is squirted one spray into each nostril once or twice daily. A benefit of using a nose spray for spring allergies is that it helps control both runny/congested noses PLUS it relieves itchy eyes.
Singulair is another prescription medication that is used in controlling allergies. It is not often helpful in controlling allergies if used alone, but when combined with an antihistamine medication, it can be very effective.
For itchy, watery eyes, sometimes a prescription antihistamine eye drop such as Patanol can provide great relief.
Kids with asthma may require a daily "maintenance" medication during these allergy months, or if they are already on a daily medication for asthma control, they may need to increase their medication dosage temporarily.
Make sure your child bathes or showers every night and washes their hair. This washes off any pollen that has stuck to their skin and hair over the course of the day.
For kids with dry, rash-prone skin or eczema, make sure they are moisturizing their skin nightly after baths with a thick, "greasy" moisturizer, such as Vaseline, Eucarin, Aquephor, or generic equivalents.
Wash clothes every day, and wash jackets and sweaters often.
Keep windows in the house closed.
Take shoes off at the door. Not wearing shoes in the house will decrease pollen tracking onto floors, rugs, and carpets.
Don't forget housekeeping :) Dust, vacuum, and mop more frequently to keep settled dust and pollen in the home to a minimum. Wash your child's bedding at least once weekly and wash curtains or remove them.
Use a cool mist humidifier in the bedroom if the air is dry to help prevent dry sore throat from night-time mouth breathing.
Should your child see an allergy specialist?
Finally, if your child has severe allergy symptoms that are not well controlled despite using multiple medications, or if allergy symptoms are becoming more severe over the years, your may want your child to see an allergist. An allergist may recommend treatment with allergy immunotherapy(allergy shots). Allergy shotscan decrease your child's allergy symptoms, and may make them go away entirely. This can decrease your child's risk of developing asthma, or reduce asthma flare-ups if your child already has asthma. Allergy shots are usually done about once weekly, with a much smaller needle than is used in an immunization, and are very well tolerated by children.
Spring break is fast approaching, too! If you have allergy sufferers in your family and are planning on a spring break trip, just leaving Wichita may relieve your allergy symptoms for the duration of your time away. :)
At an infant and toddler well-child check-ups, I love to talk to parents about their child's sleep. Sleep is SO important to the current and future health of a child, and all too often, sleep is compromised due to lifestyle issues we have as parents. Young children thrive on consistent schedules, and the linchpin of this schedule is bedtime. This fall there was an important study published which showed that lack of adequate night-time sleep in a child less than 5 years old is associated with an almost 2-fold increase in their risk of being obese. Before that, there was a study that showed a link between ADHD symptoms and young school-aged kids who did not get enough night-time sleep. So, what is a good bedtime schedule for your child? Visit one of my favorite children's health websites-- healthychildren.org, or kidshealth.org to find out. But first, put your child to bed :)
Cereal with milk used to be a healthy, fast breakfast for school children. More and more, though, cereals are part of the "junk group", as my kids call it. Many cereals marketed to children have more sugar than store-bought desserts! I encourage all parents to read the labels of breakfast cereals before buying. Look for a cereal with 10 g of sugar or less, and at least 2 g of fiber. For some good suggestions and lists of the "best" and "worst" breakfast cereals, see the environmental working groupsreport on sugar in children's cereal.
There's a nice article about Redbud Pediatrics in today's Wichita Eagle, on page 3 of the Business section, by Joe Stumpe. You can also find it online here. Thank you Joe Stumpe for a great feature article!
The Finney County Health Department confirmed today a 6th case of measles in their county this month. Garden City is a short 4 hour drive away from Wichita. I'm feeling nervous. If any of you out there have children age 12 months or older who have not yet received the MMR vaccine, or age 4 years or above who haven't had the 2nd MMR booster shot: don't delay-- go and get the MMR vaccine for your child today.
Measles is a scary illness for several reasons:
1.) It's highly contagious. It's so contagious that if an unvaccinated person is sitting in the same room with someone who has the measles, they are likely to catch it simply by breathing the same air that was coughed in. This is why it causes "outbreaks". Large outbreaks result in epidemics in areas with poor vaccination rates.
2.) Measles has a high risk of complications including hospitalizations with dehydration, pneumonia, encephalitis, and death.
3.) Persons who have Measles infection can spread it for days before they themselves even show signs of illness, and continue being able to spread the disease for days after they have recovered. The time period of contagiousness is lengthy-- about 3 weeks. (Think of the implications of the burden to a family from time missed from school and work alone.)
Measles usually starts with a high fever, more than 101 degrees. This lasts for a few days before the other symptoms start: cough, sore throat, very runny nose, watery and red eyes, and a rash. The rash starts at the head and neck, then heads down the body over the next week to eventually include even the hands and feet. Persons with the measles feel miserable.
We have been so fortunate to live in a country and at a time when we rarely see death and complications from vaccine preventable diseases, that some of us do not know what are supposed to be afraid of. Vaccines save lives. Illnesses like measles cause suffering and death. That this outbreak of measles in Garden City is happening during the same week that at an anti-vaccine bill is proposed to our Kansas state legislature is beyond irony. House bill 2094 would allow parents to send their children to public daycares, preschools, and public schools without any vaccinations by simply declaring that it is against their "personal beliefs".
Parents, please don't fall prey to pseudo-science websites that engender fear about vaccines. For reliable information about vaccines, please refer back to my website. There is a list of excellent websites to inform and educate about immunizations. Feel good about protecting your dearest little ones from outbreaks like the one happening right now in Garden City.
Pediatricians spend a lot of time talking about pooping and peeing. So, it's only fitting to blog about it, too. . .
I have recently seen several little girls aged 3-6 years old in my practice with a common problem: they have to pee "all the time", every hour or so, and sometimes are having accidents. This is of course alarming to parents, who are worried about a urine infection. It is important to check the child's urine for an infection, but if finding there is none, what is the next step? Often, simply changing the way the little girl uses the bathroom will cure the problem, which I call "the busy little girl syndrome".
Typical 3-6 year old girls do not have good bathroom habits. They are busy little preschool and kindergarten students who often have to use adult sized toilets. They go to the bathroom in a rush. Pants are pushed down to just above the knees, and their hands grasped on the toilet seat so they won't fall in. Then, as soon as they pee enough to relieve some pressure on their bladder, they are "done!", and stop, rub dry, and pull up their undies and pants.
Going pee in this manner can cause lots of problems: 1.) Sitting with the thighs together means that the urine has to spray through the closed and sensitive labia and surrounding skin on it's way out and into the toilet. This can cause irritation and sometimes even a rash. 2.) Sitting upright and gripping the toilet seat so as not to fall in causes the back of the thighs and therefore all the the muscles that control the "private parts", to be tense-- making it difficult to relax the muscle that lets all the urine come out of the bladder. 3.) Going to the bathroom quickly often means that, while some pee did come out, the bladder did not have time to fully empty. 4.) Rubbing or "wiping" dry can be irritating to sensitive skin.
"Proper Pottying" can be taught to your little girl:
1. push your undies and pants down all the way to the ankles before sitting on the toilet.
2. Sit on the toilet and spread the knees apart (at least shoulder's width or a little wider). This allows the labia to open up so the pee can go straight out and down into the toilet, without spraying much.
3. Lean the body forward, with elbows or forearms relaxing on the thighs. This makes the bladder (in the lower belly) smash up against the upper thighs which helps it to empty better.
4. Sing a little song (the ABC's works well)-- this makes the child stay on the toilet long enough for the bladder to empty fully. (It also allows time for them to realize "gosh, maybe I have to poop, too!".)
5. Drying off: "PAT, PAT, PAT" . no wiping after going pee, just patting.
**** Bonus points for giving a nightly bath (no bubbles) instead of a shower and swishing water gently around/at the vaginal area to clean out any stray bits of toilet paper, poo, or whatever else is stuck there causing irritation to the sensitive vaginal skin.
Yesterday my website went live! I am so thankful to our good friend and neighbor,DJ LaChapelle, for all of his web design work. I will be adding to the website in the upcoming months to include a link for parents and patients to search and access information about specific medical problems, and a secure patient portal. Patient portals are becoming a new standard for medical offices. They allow for approved users to access their medical records online. The Redbud Pediatrics patient portal will allow parents to review and print immunization records and physical exams in daycare or school-friendly format, as well as check on lab work and other account information. If you have comments about the website, please post them on my blog! Thanks!
Our clinic opened today! The clinic looks beautiful thanks to the design work by my cousins Sandra and Eric Denneler. See Sandra's blog at Project Denneler for some great photos of the office! My first patients of the morning were twins - double the fun! My staff, "Team Redbud" was fantastic. Thank you to all our friends, family, neighbors and colleagues for the well wishes, cards, flowers, plants, food(!) and good vibes you sent today! It worked!
I am a Wichitan with a classic Kansas upbringing. I was raised in a large family, in a small farming community. My family and upbringing have instilled in me the “small town” values and attitudes that continue to define me today: get along with others (you’ll have them in your classroom until you graduate from high school), take responsibility for your actions (before someone sees your parents and tells on you), look out for one another (because they are looking out for you), and participate in your community (you can’t sit on the bench if there are only five girls on the team).
I became a pediatrician because I was drawn to the incredible resiliency, openness, and innocence of children in the face of illness or even chronic diseases. A pediatrician is trained not only to diagnose and treat the illnesses of childhood, but also to respect and recognize the vulnerabilities and strengths of children. A good pediatrician will work with families to improve their child’s health and behaviors in a way that will impact them into their adult lives. A good pediatrician can help parents enjoy their children more and worry about them less. This is the kind of physician that all children deserve and that I strive to be.
I have a lot of things that I feel strongly about as a pediatrician: fruit is good for kids, fruit juice is not. Breast milk is best, but formula is not toxic! Immunizations save lives, and your child should get all the recommended ones on time. Not all infections need antibiotics. Routines are very important for all children, especially bedtimes. You should read or share books with your child every day. Most nosebleeds are caused by fingers in noses. Seat-belts save lives. Brush your teeth twice a day. . .
I hope you enjoy this blog as I hope to inform, educate and empower my patients/parents. Your comments will stimulate discussion and help me select new topics to discuss. As any physician, I am always learning from my patients. If you would like your child to become a patient with me, please call 316-201-1202. I would love the opportunity to get to know your family and care for your child at Redbud Pediatrics!
Disclaimer: Please note that my entries are for general informational purposes only and are not intended as professional medical advice, diagnosis or treatment. I advise readers to always seek the advice of their physician with any questions regarding personal health or medical conditions.