Pediatrics

Congratulations on becoming a parent! Whether it is your first or fourth, it is a time of wonder and excitement. We appreciate you choosing us to care for you and your child.  This visit is usually 2-3 days after discharge from the hospital, though sometimes we see the baby the day following discharge for issues like jaundice or poor feeding.

We assess your baby, check weight, length and head circumference. We discuss feeding plans and offer advice from evidence-based medicine. If you are having issues with breastfeeding, we may refer to lactation consultant. If formula feeding, we encourage iron-fortified formula and will discuss the many options available.

We will discuss safe sleeping for your baby. We recommend your baby sleeping on his/her back, with no pillow, blanket or toys, in order to help prevent dangerous situations, such as suffocation.

We also discuss rear-facing car seats and proper installation.

We also discuss what to expect from your baby between now and the 2 month well visit.  Allowing for input and questions from you, we prepare you for life with a newborn. Start reading to your baby now! Even though they are a newborn, this teaches them your voice and language, as well as stimulating the brain development.

Your baby is now 2 months old! Half of you will have a baby that sleeps all night without waking! The other half can get there soon, hopefully. You can help make this happen by not allowing baby to sleep more than 3 hours at a time during the day. Your baby may have 2-3 2 hour naps at this age. Choose a bedtime routine and time, sticking to it strictly. Put baby to bed in his/her own crib when they are awake but drowsy.

At 2 months baby should raise chest off bed, follow objects up to 180 degrees, coos, smile when smiled at and even begin to reach for objects. It is not unusual for them to roll over.

Vaccines Today

• Diphtheria, tetanus and acellular pertussis vaccine (DTaP)
• Inactivated Polio Vaccine
• Haemophilus Influenzae Type B Vaccine
• Pneumococcal conjugate vaccine (Prevnar)
• Hepatitis B Vaccine
• Rotavirus Vaccine (Rotateq) this is given orally

Hopefully, your little love bug is sleeping all night. If not, you are probably thinking it will never happen. You have to get busy if not! Be strict, firm and deliberate. Do not be frustrated, angry or upset. Naps are getting longer and fewer per day. Baby is now awake more hours a day than he/she sleeps. You may have 2, 2 hour naps and 11-12 hours of nighttime sleep.

At 4 months your baby will be able to pick their head and chest off the surface, rolls over at least one way. If he/she is not rolling yet, it should come before 6 months.

If your baby is able to hold his or her head up without lag, and makes mouth smacking motion when you eat, you may start with solid foods. Start with rice cereal made with formula to a thin consistency. If this is successful, you may advance to stage 1 foods after a week or so. There is no amount required, just let your baby guide amount to eat.

Vaccines Today

• Diphtheria, tetanus and acellular pertussis vaccine (DTaP)
• Inactivated Polio Vaccine
• Haemophilus Influenzae Type B Vaccine
• Pneumococcal conjugate vaccine (Prevnar)
• Rotavirus Vaccine (Rotateq) this is given orally

Coming Up

If your baby can hold his/her head up well, give them plenty of tummy time on the floor. It may not be enjoyable at first, but be consistent and place some objects like toys in front of baby’s eyes to engage with. This age is fun! Full of rapid development, new skills every few days. Your baby will be more interactive the coming months, cooing, making faces and laughing. Read to them and talk to them as if they were able to respond verbally. This promotes language. See you in 2 months!

For your own sanity, we hope you little one is sleeping all night. If not, let us know and we can give some feedback to help get you on track. Naps are getting shorter during the day, there may be 2-3 naps, but they likely last less than 2 hours each. Nighttime sleep should be 11-12 hours.

Your baby bean is likely starting to sit up with or without support, “tripoding” where they push up on both arms and raise their head and trunk off the surface. They are likely rolling all over the place and holding toys, passing them from hand to hand and putting things in mouth.

Babbling will be common and repeating sounds over and over. At this point, your baby may recognize people they are not accustomed to being around, as long as it has not been an extended period of time between visits.

If you have not started baby food yet, you may at this time. Starting with rice cereal and progressing to fruits and vegetables gradually over 3-4 weeks. Always give new food, alone for several feedings to see if there is a reaction. Meals may be 1-2 times a day by this point. Milk/Formula is still very important now and there is no need for your baby to drink water or juice yet.

Vaccines Today

• Diphtheria, tetanus and acellular pertussis vaccine (DTaP)
• Inactivated Polio Vaccine
• Haemophilus Influenzae Type B Vaccine
• Pneumococcal conjugate vaccine (Prevnar)
• Hepatitis B Vaccine Rotavirus Vaccine (Rotateq) this is given orally
• Flu vaccines are possible at 6 months and recommended yearly

Coming Up

Next visit is at 9 months, no vaccines for that one! Until then, advance feeding gradually as guided by your little one. They will begin to “army crawl” all over the place. Make sure you have your home baby-proofed. If you do not, your baby will find out! Continue to read and talk to your baby as you progress.

Your baby is growing so fast! Where has the time gone? I am sure they are already very mobile, and into everything! Baby may be pulling to stand while holding onto objects and “cruising”.  They will become very mobile this way.  Most babies will crawl first then begin to cruise.  If your baby is just now trying to crawl, fret not, for it is common for some babies to progress slower than others without concern for delay.

Your baby may be making some repetitive sounds like “ma-ma-ma-ma” or “da-da-da”, “ba-ba-ba”. EVERYTHING goes from their hands to the mouth. Make sure there are no swallowing hazards. Avoid walkers, as these actually delay independent walking.

Feeding regular table food is allowed at this time. Make sure there is nothing the baby can choke on (they do not chew well) so avoid crunchy foods like raw veggies and fruit.  All foods should be small and bite size so he or she can pick it up and feed themselves.  An adult should be present as well, should choking occur.

Discipline can start now! If Baby is doing something he or she shouldn’t, give them a stern “No” and maybe shake a finger, or clap your hands. Try to refrain from laughing when the little angel laughs at you and continues to touch the precious Japanese vase (That’s VAHZE, not VACE)

No Vaccines Today

Coming Up

First birthday is coming soon! Your little tyke is almost a toddler. He or she may be taking a few steps in the next 3 months. You can help them walk by holding onto their hands and walking them. Advance the diet to more foods. You can give them almost anything except fish, eggs and shellfish. Peanut butter in small amounts is acceptable at this age, as new research shows earlier introduction of peanuts and legumes reduces risk of allergy. Pacifiers should be a thing of the past, or weaning at least. Their suck reflex is going away and it will soon become nothing more than a bad habit.

Happy Birthday young one Hopefully, there has been a grandiose celebration of this major milestone. Your infant has now transitioned into a toddler, more than likely. Taking steps with or without assistance. Now you get to see how fast a young one is on their feet. At this point your child may be dropping objects into a container or the floor, handing you objects and cooperating with dressing and diapering. There may be some words. Usually 3-5 simple words. Transitioning from bottle to sippie cup should have been started at 9-10 months and hopefully the bottle is falling by the wayside. If you are breastfeeding, continue as long as YOU want. There is no rule as to how long one must continue or cease breastfeeding. Formula-fed babies should be transitioning to whole cow’s milk at this time. If there is a milk intolerance, you may transition to soy or almond milk. There are new transitional formulas for babies 12-18 months. They give more well-rounded vitamins and nutrients, as well as calories. They are optional and by no means essential for your baby’s health.

Vaccines Today

• Hepatitis A Vaccine #1
• Varicella (chicken pox) Vaccine
• Measles, Mumps, Rubella Vaccine (MMR)
• Prevnar

Coming Up

Walking should develop as well as speech. By 15 months, your child should know 10-15 words. Be starting to show more fine motor skills like drinking from cup without spilling, starting to use utensils.

What have we here? A strong willed child? They are just getting you ready for teen years. There will be tantrums, crying, defiance, you  name it. They will test you until you scream or lose your mind. Hint, that is what they want, the reaction.  Whether a negative or positive reaction. So, try to remain calm and ignore their fits. As long as they stay safe, let it go, like Elsa. It will get better. One day.

By now, there should be a vocabulary of 10-15 words. No sentences as of yet. The padawan should be walking, stacking things, combining toys. Throwing balls. Sleep may get disrupted at this time as well, but do not fall into the trap of getting them up and out of their bed. Reassure them that all is well and calm them back to sleep.

Diet should be opening up. Toddlers are notorious for wanting to fill up on fluids and not eat.  Milk can give them all the calories they need, but not all of the nutrition necessary.

Vaccines Today

• DTaP
• HIB

Coming Up

The next few months will show leaps in development. Your youngling is becoming a little person, with imagination, excitement and control issues. They want to be the center of the world and will do their best to make it so.  Discipline now is critical to develop.  If you set the stage for proper discipline, you will make them a good child and better adult. They will understand that you are in charge and they are not. Be steadfast and enjoy the time. You can give them grief about it when they are grown.

We are now rolling along. Your toddler is probably agile, mobile and possibly hostile. Climbing, running and being uber active is a part of your daily life. There are probably many times a spontaneous tantrum occurs, which is normal. Your little person is now starting play alongside, but not necessarily with, other children. They may occasionally play with another child and likely act aggressively toward other children from time to time. Biting or hair pulling is common at this stage. It is not because your child is a delinquent. It is merely a form of communication through action, as their vocabulary is not sophisticated at this point of their lives.

Physically, they should be running, stooping, building things (and knocking them down) and using a spoon to eat. Communication is improving and developing.

Diet should continue to advance, with smaller shaped foods, as not to choke. Avoid allowing them to constantly have oral liquids, as that decreases appetite.

Vaccines Today

• DTaP
• HIB

Coming Up

We are now starting to stretch our visits out! The next time we see you for a well-child visit, your child, who was a newborn just a few minutes ago, is now 2 years old! My, how time flies. As your child gains more and more teeth, make sure that you establish a good oral care routine.  Brushing daily should begin as soon as there are teeth.  As much as your tyke wants to brush his/her teeth on their own, make sure you do it first, then allow them some time to “brush”. Also make sure you use a toothpaste approved for children, which is safe to swallow.

2 years old! You have made it out of the infant stage and now you have an older toddler. He or she should be walking up stairs and kicking a ball, using a fork and spoon and doing more intricate activities such as taking clothes off, shoes too. Making larger stacks of blocks and starting to play more with children. Vocabulary should include around 50 words and sentences are being developed. Naps are still present, usually, and longer sleep time at night.

No Vaccines until age 4!!!! YAY

Coming Up

We do not meet again until our little one is 3 years old! There will be many changes in that time. Development will continue at a dizzying pace. Speech will improve, activities will become more sophisticated. Your little one will become interested in drawing, writing, making things. Large puzzles and preschool Lego-type blocks are great at this age. Tricycles and balance bikes are fun at this age as well. Encourage your child to be physically active. Avoid junk food and sweetened beverages as much as possible. You are building lifelong habits now, so be intentional with your role and your activities. Your child will thank you later. See you next year!

WOW! Long time, no see. How is life treating you all? Hopefully you have an active, inquisitive and imaginative preschooler on your hands. By now throwing and catching a ball is developed, copying simple designs, like a cross are present. Speech should be intelligible now. Hand washing is a task most children are capable of at this time.

Diet should be varied and well balanced. They can be quite picky at this age! Do not cave to their pickiness. Food jags are also common. This is when a child LOVES one food for a bit, wanting it daily sometimes. Then, all of a sudden, they push it away and turn their nose up at it. Stay the course, continue to provide proper nutritionally balanced meals. He or she will give in. You have to be more stubborn than they are. You are the bus driver, not the preschooler.

Coming Up

As your child prepares for school, make sure you are interacting and promoting learning activities, by drawing, coloring, creating things. Building puzzles, playing organized games. If they watch TV, make sure it is “educational and informative” labeled. Enjoy this year. They will be in school before you know and it is very life-changing. See you next year!

This is the one before school starts! Your baby is now about to start school or K-4. They should be drawing stick figures, copying more complex drawings. Recognize objects and remember where things are if covered. (Remember playing MEMORY as a child). They should show signs of imaginative play. It is not unusual to have imaginary friends or very complex play scenarios. Learning is at the pinnacle, their brains are like sponges and absorb everything presented to them. It is not out of the question for them to learn other languages, musical instruments, dance, or other complex activities. We will make sure your child is prepared for school and provide booster vaccines for the entry to school.

Vaccines Today

• DTaP
• IPV
• MMR #2
• Varicella #2

Coming Up

We now see your child once a year for well child care, all the way to 18 years of age! We will be there for you along the way to ensure your child has the best care and you have the best information for any medical or health issue you may incur.

There will be vaccines given at age 10, 11 and 16.

No Vaccines Today

Vaccines Today

• TDaP (Tetanus, Diphtheria, and Pertussis)
• Menactra (Pneumococcal vaccine)
• Gardasi (Human Papilloma Virus Vaccine) is optional. Depending on age, it is a 2 or 3 dose vaccine.

Vaccines Today

• Menactra booster

Every ten years, for the rest of your life, you will need a TD, or tetanus vaccine.

References

https://www.cdc.gov/ncbddd/actearly/milestones/index.html

https://brightfutures.aap.org/Pages/default.aspx

https://www.ncbi.nlm.nih.gov/pubmed/22604661

At Preferred Medical Group, we closely follow the guidelines of the American Academy of Pediatrics in regards to immunizations. Immunizations that are commonly given in the childhood years protect against crippling diseases such as diphtheria, measles, mumps and rubella. For your convenience, we administer all immunizations right here in our offices.

We often give immunizations simultaneously with your child’s well child check. We follow the schedule as set by the CDC and followed by the AAP.

American Academy of Pediatrics’ Vaccine Preventable Diseases and Policy
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

Centers for Disease Control and Prevention’s Vaccine Schedule for 0-18 years old
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

If you are considering not vaccinating your child, please read this blog, by Dr. Chandra regarding the importance of vaccinations.

Childhood vaccinations are a must…..says the pediatrician

By: Ritu Chandra, M.D.

I think it’s easy for those of us who live in the U.S. to lose sight of the very serious risk that diseases like polio and tetanus pose for kids. Most of these diseases have been eradicated in our country. Few of us have never ever seen a case of polio. Vaccines in the U.S. can seem like an arcane practice for an intangible danger, and fears about harmful side-effects about vaccines drive some parents to avoid them for their own children. I get that.

The reason we get to “not believe in vaccines” today is because we have eradicated many of these crippling and life-threatening diseases in our country. Here’s the kicker: we have vaccines to thank for that. What an incredible privilege to raise our children in a time and place where not many people have seen any of these deadly diseases.

Parents don’t need to go very far to find opposition to vaccination, whether in play groups or online. The Internet is teeming with information on every conceivable choice a parent may encounter. Though suspicion about vaccines is not new, a now widely discredited study published in 1998 linking the measles, mumps and rubella (MMR) vaccine to autism kicked the panic over vaccines into overdrive.

During my training 30 years ago I myself saw numerous kids who were afflicted with the crippling Polio. During my internship in 1998, I saw a child with Diphtheria who ended up dying …I will never forget that sweet one-year-old baby and I cannot ever erase the memory of telling his parents that we could not save him. Today, we routinely administer the Polio, Diphtheria and other vaccines to all babies at the 2, 4, and 6-month visits, and boosters after that.

Prevnar, the vaccine against the pneumococcus bacterium, is one of the greatest pharmaceutical innovations of the past two decades. In children who are vaccinated, it has eliminated most of the pneumonia and meningitis that bacteria cause. It proved so effective, in fact, that fewer pneumococcal infections occur in people over 65 who have never gotten the vaccine, because the germs are no longer circulating. It has, quite simply, changed the world for the better.

In Columbus and Phenix City, pediatricians do not accept “non-vaccinators” or, those parents who refuse to vaccinate their children into their practices. As a pediatrician, I feel bad for the child whose parents choose to not vaccinate…I feel that as a pediatrician I should not abandon the child. However, from a practical standpoint, the non-vaccinators are putting at risk everyone else that they come in contact with. If a pediatrician knowingly allows an unimmunized child into the office, the pediatrician might be liable for that child potentially bringing in a communicable disease and exposing other kids in our office to the disease. A real-life example: Two years ago we had two siblings come to the Fort Mitchell Clinic with Pertussis that was confirmed by lab testing. These unimmunized siblings exposed our staff and doctor to Pertussis, and our staff had to take antibiotics because of the exposure!

As a mom myself, I can certainly understand the desire to protect one’s child from any potential harm. When parents bring up concerns regarding vaccines or the AAP schedule, I encourage them to discuss their anti-vaccination ‘research’ with me. In my role as a pediatrician, I try to empower parents to make informed decisions regarding their children’s health. I want parents to have reliable, complete, and science-based information, so that they can make the best decision for their child about vaccination. Pediatricians most often rely upon the American Academy of Pediatrics for providing reliable information.

Additionally, here are a few of the most popular vaccine myths “debunked,” as per the Centers for Disease Control and Prevention.

MYTH #1: Vaccines aren’t safe.

FACT: Vaccines are held to the highest standard of safety. Extensive testing is required by law before a vaccine can be licensed. Once in use, vaccines are continually monitored for safety and effectiveness. The United States currently has the safest, most effective vaccine supply in history.

MYTH #2: Vaccines cause autism.

FACT: Research shows autism rates are the same in vaccinated and unvaccinated children. Twenty-three studies have tested hundreds of thousands of children and found no link between autism and vaccines. The American Medical Association, American Academy of Pediatrics, the Institute of Medicine, and World Health Organization have all maintained that there is no connection between vaccines and autism.

MYTH #3: There is a lot of mercury (thimerosal) in vaccines, which is dangerous.

FACT: Extensive research has failed to show any consistent link between thimerosal in vaccines and any health condition including autism. Thimerosal was removed from all routine child vaccines in 2001. Despite the removal of thimerosal from childhood vaccines, autism rates have continued to rise. This is the opposite of what would be expected if thimerosal caused autism.

MYTH #4: Combination vaccines or multiple vaccines given at the same time are dangerous.

FACT: Before combination vaccines are licensed for use, extensive studies are done to ensure safety and effectiveness. Similar studies are done before multiple vaccines are recommended to be given at the same time.

MYTH #5: We don’t need to vaccinate kids anymore for the same diseases we had as children.

FACT: Recent history continues to demonstrate that when vaccination rates dip in the population, these diseases rebound. Small pox is the only disease that has been eliminated world wide and against which we no longer need to be vaccinated. An example would be the recent measles outbreaks in New York and California. The news article can be found here, detailing how the choice not to vaccinate can lead infectious diseases to bounce back in our country.

MYTH #6: A “holistic” lifestyle will bolster our immune systems and protect us from disease.

FACT: Certainly, there are steps we can take to reduce our risk of contracting or getting seriously ill from vaccine preventable diseases, such as washing our hands and maintaining a healthy lifestyle. However, research has shown over and over that vaccination is by far the safest and most effective way to avoid infection with these diseases.

MYTH #7 Only young children need vaccinations.

FACT: Vaccine-preventable diseases continue to be a threat throughout our lives. Adolescents need boosters for many childhood diseases, some college age students need protection from meningitis, adults need vaccines for shingles and pneumonia, and everyone needs the flu vaccine and, especially for those around infants, the pertussis vaccine.

MYTH #8: Too many vaccines can overwhelm the immune system.

FACT: Before a vaccine is licensed, extensive studies are done to ensure that the vaccine produces an effective immune response and does not overwhelm the immune system when given alone, in combination with other vaccines, or, if necessary, in multiple doses over time. The current schedule of recommended vaccinations for all ages is perfectly safe for the vast majority of the population.

We are happy to address any concerns regarding vaccinations with parents. But, in an effort to protect all of our patients, their families, and our staff, from vaccine-preventable diseases, we cannot accept families who choose not to vaccinate their children in accordance with the AAP schedule into our practice. Additionally, we may have to recommend alternative healthcare arrangements for current patients who choose not to follow this schedule. This includes required vaccinations, as needed for public school entrance, and does not include flu or other OPTIONAL vaccines, which PMG may still highly recommend.

Concentration for both INFANTS SUSPENSION and CHILDREN’S SUSPENSION LIQUID is 160mg/5ml. The dosage is based on average weight of the child at listed ages. If you have any questions or need assistance, please call the office 334-664-0463.

DO NOT USE IN CHILD UNDER 12 WEEKS WITHOUT PHYSICIAN GUIDANCE

Each dose lasts 4 hours

Asthma in Children (and Adults)

Asthma is one of the most commonly encountered pediatric conditions. However, it can be a life-threatening condition, so symptoms should not be taken lightly. The physicians at Preferred Medical Group have significant training and expertise with managing asthma in children. We are here to help you and your child!

What is asthma?

Asthma is an inflammatory condition of the lung, accompanied by bronchoconstriction (narrowing of the airways ).This leads to difficulty in getting the air out of the lungs and when air passes through the narrow airways, a wheezing sound can be heard.

What are the commonly encountered symptoms of asthma?

Wheezing, Coughing, difficulty breathing, chest tightness.

At what ages is it common?

Asthma is generally diagnosed by age 5 years of age. Asthma in children can be diagnosed earlier based on symptoms and risk factors such as positive family history of asthma, personal history of allergies and eczema, prematurity, chronic lung disease, and RSV bronchiolitis.

What causes asthma?

Asthma is commonly seen in patients with an underlying airway hyper reactivity. Common triggers could be an upper respiratory infection, allergies, active/passive smoking, food allergens, dust mites, molds, cockroaches. Any trigger can bring about an asthma exacerbation. Symptoms can be triggered by exercise for asthma in children.

How to treat asthma?

At Preferred Medical Group, we are able to help your child manage his/her asthma so that symptoms do not detract from sports, academic performance or daily activities. Asthma management depends upon its onset and severity. Acute asthma exacerbation is treated with oral steroids and albuterol, either by nebulizer or metered-dose inhaler (MDI).  If your child is given the albuterol inhaler, it is important to ensure that he/she always keeps it close by in case of an asthma exacerbation episode. We will ensure that you and your child understand the proper use and technique in using the medications at each visit.

Chronic asthma in children is often treated with inhaled steroids and long acting bronchodilators along with  other agents as necessary. Education regarding avoidance of triggers whenever possible is also important.

We manage an acute asthma exacerbation and also prevent further asthma attacks by following the current American Academy of Pediatrics/ National Institute of Health guidelines for asthma management.

One of the ways to assess your child’s asthma control is the use of Spirometry. This is a test of the lung capacity and gauges whether there is inflammation or not present.

Allergic Rhinitis

Allergic rhinitis is a very common and chronic condition. Especially in our part of the world.  We offer multiple options and education regarding your allergic rhinitis, sometimes including referrals for testing. We use medications based on evidence and recommendations of the American Academy of Asthma, Allergy and Immunology (AAAAI).

Obesity and Pre-diabetes

Obesity and pre-diabetes are on a massive increase in the United States among pre and post-adolescents.  It is important to monitor values in their blood such as cholesterol, thyroid function, blood count, fluid balance, and Hgb A1C, which is a predictor or indicator of Type II Diabetes status.  Lab values are usually checked every six months. Weight is checked every 3 months. We do not prescribe weight loss medication, but rather provide education regarding dietary modifications and exercise routines. If standard therapy fails to improve the status of your child’s condition, a referral to an endocrinologist may be ordered.

Acne

Acne is a common problem among adolescents.  It is very stressful to their mental health and confidence.  We provide assessment, medications and management of acne with dermatology consults as needed. Many of the over the counter treatments can be successful, and we assist you in deciding which treatment is best for you.

Each Dose Lasts 6-8 hours

References

The Harriet Lane Handbook: A Manual For Pediatric House Officers. Philadelphia, PA : Mosby Elsevier, 2012. Print.
http://www.pediatric-healthcare.com/dosage0001.pdf

PMG believes in providing comprehensive medical services for families. We will never send you away if we can treat you in one of our offices, saving you a trip to the hospital or other medical facility. Therefore, we often perform small procedures in-house including:

• Suturing
• Spirometry
• Casting for fractures
• Incision and drainage for abscesses
• Excision of ingrown toenail
• Ankyloglossia (tongue tie) surgery
• Tympanometry (Ear Wax Removal)
• Circumcision
• Wart Removal