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| When To Really Worry? How Long Kids' Coughs And Colds Tend To Last |  |
We love this article from the Common Health blog and encourage all our families to read it. Of course you are always, ALWAYS welcome (and encouraged) to call us to speak with Dr. McAllister or Nurse Practitioner Jen if you are worried. Over the phone one of our providers can help you determine if your child actually needs to be seen or if it's just a normal 15-day cold or 8-day earache. |
| NP Jen is Running Again! |  |
Stopped less than a mile from the finish line in last year's Boston Marathon, Certified Pediatric Nurse Practitioner Jen Simmons is running again this year to raise money Mass General Hospital for Children. If you can, join us in supporting Jen's run. To give and learn more visit her fundraising website. |
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Vaccination Corner
| The Resurgence Of Preventable Diseases
 Leading health agencies have been reporting a significant resurgence of preventable diseases due to the high number of parents choosing not to vaccinate. At Performance Pediatrics, we accept the data as true and recommend that all our patients be fully vaccinated. The vaccine campaign is truly a victim of its own success. Because of vaccines, many families have never seen a child with polio, tetanus, whooping cough, bacterial meningitis or even chickenpox, or know a friend or family member whose child died of one of these diseases. Such success can make us complacent about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results. While Dr. McAllister and NP Jen firmly believes in the safety and effectiveness of the CDC's recommended vaccine schedule, the American Academy of Pediatrics recommends pediatricians continue to treat non-immunized children in the medical home as it is important that they receive routine care and they have a safe place to continue to discuss vaccinations. If you have questions about vaccines, please read our vaccine policy, vaccine billing policy and refusal to vaccinate release form. At your child's appointment Dr. McAllister or Nurse Practitioner Jen will review the policies and form with you.
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| Attention Deficit Hyperactivity Disorder (ADHD) |  ADHD is a controversial topic.
The diagnosis of ADHD is difficult and the medications used to treat ADHD have potential serious side effects and can lead to drug abuse.
Because of the difficulty in diagnosing and risk in treating ADHD the American Academy of Pediatrics (AAP) has issued comprehensive guidelines to be used in treating it, and here at Performance Pediatrics we follow those guidelines closely.
AAP Guideline:- To make a diagnosis of ADHD, the primary care clinician should determine that diagnostic criteria have been met based on Diagnostic and Statistical Manual of Mental Disorders - Fifth edition (DSM-5). Making a diagnosis includes documenting that the child is impaired in more than 1 major setting.
- When evaluating a child for ADHD, the primary care clinician should assess whether other conditions are present that might coexist with ADHD, including emotional or behavioral (e.g., anxiety, depressive, oppositional defiant, and conduct disorders), developmental (e.g., learning and language disorders or other neurodevelopmental disorders), and physical (e.g., tics, sleep apnea) conditions.
- For preschool-aged children (4-5 years of age), the primary care clinician should prescribe behavior therapy as the first line of treatment and may prescribe methylphenidate if the behavior interventions do not provide significant improvement.
- For elementary school-aged children (6-11 years of age), the primary care clinician should prescribe medications for ADHD and/or behavior therapy as treatment for ADHD, preferably both.
The Performance Pediatric Protocol reflects these recommendations and recognizes the risk involved in using these medications:
- Children who present with attention or other behavioral concerns are first evaluated with Vanderbilt questionnaires given to both parents and teachers. The Vanderbilt questions reflect the criteria listed in the DSM-V; Dr. McAllister and NP Jen need input from teachers and parents to verify that the problems exist in multiple settings (school, home, after school programs, etc.).
- Children and parents are interviewed and examined in the office to further help identify exactly what the issues are and where they exist; we look for other underlying conditions that may be contributing to the issues.
- If the diagnosis is still not clear further evaluation may be needed including nueropsychiatric testing, academic evaluations, sleep studies, or psychiatric or nuerologic specialist consultations.
- When the diagnosis is confirmed and it is determined medications are needed Dr. McAllister and NP Jen prescribe a low dose of a long acting stimulant (Concerta or Adderall XR) and follow the child clinically for improvement in symptoms and watch for side effects.
- Dr. McAllister and NP Jen will only prescribe a one-month supply of stimulants at a time and need to see all children taking medications for ADHD at least every 3 months to evaluate their response to the medication, the appropriate use of the medication, and to watch for side effects.
ADHD is difficult to diagnosis, but properly trained medical professionals who take the time can make the diagnosis appropriately, and although ADHD medications have risk they also have great benefit when used correctly. |
| Contacting Us |  Scheduling Same-Day Appointments
One of the many benefits of a small practice like ours is that we can accommodate same-day appointment requests for acute issues as long as the patient calls us at least 2 hour before we close. We are proud of our track record!
Of course, one of the draw backs of being small is that we don't have a nurse to staff our phone line to answer questions in real time. Patients must speak with a provider to schedule a same-day sick appointment; sometimes this means getting a call back.
When you call with medical questions during regular practice hours, it is important to us that your questions are answered as soon as possible. Over 85% of calls to a provider (we track and calculate) are returned within one hour. It is our policy that a provider returns all calls by the end of the business day. Please note that administrative personnel may assist you with non-medical issues only. For liability reasons, all medical questions must be addressed by licensed medical staff.
Performance Pediatrics is open by appointment only and cannot accommodate walk-in patients. We leave an adequate number of appointment slots each day to accommodate urgent-care needs. When one of our providers speaks with patients it is determined through triage how soon a patient needs to be seen.
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Be well,
Medical Director
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Jennifer L. Simmons, CPNP
Medical Home Care Coordinator
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