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Back to School Time!
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It may have come too soon, but the end of summer is upon us. With September comes a new school year, fall allergies, and increased asthma flares. Remember to start your child's asthma or allergy medications (make sure they have not expired) if needed, and to review your asthma plan to make sure you have scheduled an asthma re-check.
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| Nurse Practitioner MaryAnne Ouellette Co-Edits Textbook
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Congratulations to MaryAnne Ouellette, one of our nurse practitioners, for co-editing (with Dara Brodsky) a textbook titled Primary Care of the Premature Infant. MaryAnne splits her time between Westwood-Mansfield Pediatrics and the Cochran Newborn Service at the Beth Israel-Deaconess Medical Center and has always been a terrific resource for any newborn issue. Dr. Hyde and Dr. Fischer each contributed by writing a chapter of the book.
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| Back to School - Back to Good Eating Habits - Pack a Lunch!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Although summer is a great time to be outdoors and active, it may also be a season of barbecues, dining out, and ice cream. With the fall coming, this is a great time to re-dedicate ourselves to healthy eating!
Lunch is one meal which can make a big difference in the health of our children.
Many children buy lunch at school rather than bring it from home. School lunches consist mainly of fried and processed foods that are very high in bad fats, sodium, and carbohydrates (with very few fruits and vegetables offered). Even when healthy foods are on the menu, unfortunately, most children choose between pizza, pasta, hamburgers, fries and other fried foods.
Despite our busy schedules, try to have your children bring lunch as often as possible along with healthy snacks (see "The Healthy Lunchbox" below). The foods in the lunch should consists of good carbohydrates (wheat bread), good fats (lean meats), good protein (peanut or soy butter), as well as fruits and veggies for snacks. Remember to pack plenty of water to drink.
Making this small change of bringing a healthy lunch to school can make a huge difference in your child's health.
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| The Healthy Lunchbox
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September brings us cooler weather, new pencil boxes, fall foliage, and. . . lunchboxes! We hope that these suggestions (from the Rudd Center for Food Policy and Obesity at Yale University) will help you to make healthy lunchtime choices for your child.
Consider controlling portions of the most caloric part of the lunch by increasing the proportion of the lunchbox that is filled by fruits, vegetables, and whole grains. Try following the 3/4 Rule: as an example, 1/4 of the meal may be dedicated to the main food (sandwich, etc.), and the other 3/4 for a salad packed in a bag (see below), fruit sides, and whole grain snacks.
Try using fruits and vegetables as snacks. Dried fruits can include raisins, cranberries, apricots, bananas and apple chips. To "dress up" carrots, broccoli, cauliflower, celery, tomatoes or sliced peppers, think about using a small amount of dressing (just like you would a leafy green salad), hummus, or a little melted cheese.
Salad-in-a-bag: To increase fruit and vegetable consumption at lunch while minimizing consumption of more caloric alternatives, consider incorporating easy servings of plant foods. The Salad-in-a-bag idea is great for lunch. Stuff 1-1 and 1/2 cups greens in a Ziploc sandwich bag. Add 1/2 cup carrots and/or cherry tomatoes. Finally, throw in 1/4 cup dried cranberries and 2 tbsp. sunflower seeds. (this provides around 3-4 servings of fruits and vegetables combined, plus good fats to help absorb nutrients). The bulk provided by this salad can help satiate your child and help reduce consumption of the more caloric main parts of a meal (perhaps eating half of a sandwich versus a whole sandwich).
Look for whole grain options for all grains and breads. A huge selection of breads, cereals, and snacks that are whole grains-based is now available. Make sure the label says "whole grain" somewhere, and that the product contains a fair amount of fiver per serving (at least 3 grams/serving).
Try offering more healthy alternatives. There is nothing wrong with the standard fare of hot dogs or pizza in moderation, but try packing more chicken sandwiches, pitas with hummus, or peanut butter (or soy butter) and jelly sandwiches on whole grain bread, natural peanut butter, and low-sugar jelly. You may offer baked chips or pita chips rather than standard chips, and add a healthy dip. You can also offer salsa or hummus in a small container as a dip.
For more suggestions and an award-winning recipe for "Peanut Butter and Raspberry Sandwich Flowers", visit the Rudd Center website.
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| 0-1 Year Olds: Teething Time!
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Teething is a universal condition during the first year of life. While most babies have their first tooth break through at some point between 6 and 12 months of age (rarely this occurs later), the signs and symptoms of teething, however, often begin around 4 months of age (and may begin as early as 3 months). Signs that your baby may be teething include an increase in drooling, chomping on hands or toys, or fussiness. Fever is not a common finding.
We recommend using teething rings or a wet, frozen facecloth. If your infant seems extremely uncomfortable, we recommend giving him/her Tylenol (or Motrin if older than 6 months of age). It is ok to give Tylenol and/or Motrin for several days in a row. However, if after, 4-5 days, the symptoms don't go away, you may want to let us know.
We discourage the use of baby Oragel or Anbesol as it may numb the gag reflex or have more serious side effects.
Once your child does ave teeth, it is important to start cleaning them. Use a finger brush or a face cloth and water only (no toothpaste) and clean off the surface of the teeth daily.
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| 1-4 Year Olds: Lead Paint on Toys
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As most of you know by now, Mattel and Fisher-Price have recalled numerous toys due to having lead paint in them. Lead can be dangerous because it can slowly accumulate in your child's body and, at high enough levels, affect language development, attention, and even IQ. Lead can only enter the body if ingested (it cannot be inhaled or absorbed through the skin). The good news is that eating one flake of lead-containing paint is not harmful, rather your child must swallow a lot of lead over time. Your child may be at risk if he/she repeatedly chews on a toy being recalled (for lead paint) and paint is missing on that toy.
We have screened almost 20 kids in our office so far and none of them have had a toxic level of lead. We are not routinely screening for lead unless your child chronically chews on toys and they have missing paint.
We urge you to go onto the government web site and see if any of your child's toys have been recalled and to follow the manufacturer's protocol for returning the toys.
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| 4-9 Year Olds: Constipation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The first month or two of the school year is often a time of stress for children. If your child suffers from intermittent or chronic constipation, the start of school often brings on a relapse. Constipation may present with intermittent mild-to-moderate stomach aches. In severe cases, diarrhea and even soiling may occur.
Be extra vigilant this season. Pay attention to your child's stooling habits so he/she doesn't get backed up. Have your child sit on the toilet for 5-10 minutes after meals to encourage stooling (and discourage withholding behavior). Miralax is a safe and effective medication (now available over the counter!) that should be considered. Don't hesitate to contact us if you need help managing your child's symptoms.
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| 9-13 Year Olds: School Transitions
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The transitions from 3rd to 4th grade and from 5th to 6th grade are times when learning style issues are often noted.
In 4th grade, children stop "learning to read" and begin working on comprehension and "reading to learn". Some kids may need extra help with this transition. This may also be a period when organizational demands increase. Children (who may later be diagnosed with ADHD) can start to show significant coping deficits.
In addition, the transition from 5th to 6th grade (elementary to middle school) involves a new school, multiple teachers, numerous different daily schedules, and more homework. Organizational and learning issues may become apparent.
Teachers or school guidance counselors may refer your child to our office to talk about these issues. All of our doctors and nurse practitioners are experienced and available to help in these evaluations, and to work with you to explore your options to maximize your child's learning experience.
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| 13-18 Year Olds: Athletic Pre-Participation Exam - Screening For Potential Life-Threatening Conditions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sudden death is a fortunately rare, albeit universally tragic, occurence in high school athletes. Estimates of the rate of sudden death fall between 1 in 280,000 and 1 in 735,000 adolescents. Approximately 80% of non-traumatic sudden death is related to congenital heart disease.
HCM is present in approximately 1 in 500 people and is marked by thickened cardiac tissue, especially the left ventricle (the part that pumps the blood out of the heart). In most cases HCM is mild and not life-threatening.
Marfan's Syndrome is an inherited connective tissue disorder that affects approximately 1 in 10,000-20,000 people. Maran's Syndrome is marked by near sightedness, long-slender fingers ( arachnodactyly), tall height (over six feet for boys and five feet, ten inches for girls), scoliosis or kyphosis (hunchback), a caved-in "funnel" chest ( pectus excavatum), and an arm span that is longer than the patient's height. Sudden death occurs in Marfan's syndrome as a complication of aortic dissection, a tearing of the aortoa due to weakened tissue.
If your child is a high school athelete and there is a family history of HCM (or other cardimyopathy), Marfan's Syndrome, prolonged-QT sydrome, or sudden death, you should let us know. In addition, if your child-athelete experiences chest pain, shortness of breath, dizziness, or passes out on exertion, he or she may be at risk.
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| 18-20 Year Olds: Sending Your Adolescent Off to College
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Your children are heading off to college! You previously could assist them with their activities of daily living, including ensuring meeting their basic healthcare needs. Now, for many of those activities, they must go it alone.
Most college students are over 18 years old and hence are entitled to complete confidentiality in receipt of healthcare as well as being able to independently consent for all their healthcare. This may be hard for parents who are often still the ones paying the bills and are used to keeping track of their child's medical issues. Encourage your child to share all his/her healthcare issues and concern with you while at the same time, realize he/she is becoming an independent adult.
It's hard letting go, but there are things you can do to send him/her away prepared to meet his/her healthcare needs. The Society for Adolescent Medicine's The Healthy Student: A Parent's Guide to Preparing Teens for the College Years provides some suggestions to aid in this process. First, ensure your child has had a precollege physical exam and that all his/her immunizations are up to date. Immunizations that may be required or recommended by your child's college include Hepatitis A, Hepatitis B, HPV, Influenza, Meningoccocal Meningitis, MMR, Tetanus-diphtheria-acellular pertussis, and Varicella (chicken pox).
Next, check with your health insurance carrier to ensure that your child can use the policy while away at school. Depending on the region to which he/she is headed, the policy may not cover out of state/network visits. However, many colleges have a student health center which will see all students regardless of insurance status or will allow students to enroll in a student health insurance program.
Make sure your child knows where and how to access the student health center, including most importantly at night or on weekends. If your child takes any medications, make sure he/she has an up to date list of all of his/her medications and dosages, as well as a list of all allergies. If your child has a chronic medical condition, make sure a copy of recent visits or summary of his/her condition is sent/delivered to the health center.
Finally, assist your child with putting together a "First Aid Kit" to include band-aids, acetaminophen, ibuprofen, antihistamines, thermometer, cold packs, hydrocortisone cream, a list of their medical conditions/medications/allergies and emergency numbers. Then, sit back and enjoy the peace and quiet! |
| Reaching Beyond Ourselves
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We at Westwood-Mansfield Pediatrics are concerned about the environment. We continue to take steps to decrease our energy use. We have also begun to increase our recycling efforts. When we transition to electronic medical records we anticipate our paper usage decreasing even more. We support all your efforts to do the same!
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