News

Head Injuries & Concussion

Acute head trauma in infants and children is a common cause of concern. These are some of the danger signs which should prompt an immediate call:

• Loss of consciousness
• Seizures
• Excessive lethargy
• test
• Loss of balance
• Dizziness
• Unequal movements
• Decreased use of extremities
• Unequal pupils
• Repetitive vomiting

A child suffering head trauma may be allowed to sleep, but should be awakened in order to assess level of consciousness every 2-3 hours. For several hours after head trauma, children should be allowed only small amounts of clear liquids. Consuming larger volumes may cause vomiting.

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Meridian Pediatrics 12065 Old Meridian St., Carmel, IN 46032 TEL: (317) 844-5351 - FAX: (317) 844-0310 For billing inquiries please contact Hannah Medical Consulting: (317) 324-8289

COVID-19 Testing Guidelines

State and Federal Guidelines for COVID Testing and Exposure

State of Indiana Back-to-School Resources (includes guidelines for returning to school)

CDC Testing and Exposure Guidelines for Children

CDC Testing and Exposure Guidelines for Adults

Note: If a person (of any age) has the following symptoms, they are assumed to have COVID until proven otherwise: At least two of the following: fever (measured or subjective), chills, rigors, myalgia, headache, sore throat, or new olfactory and taste disorder(s);

OR

At least one of the following symptoms: cough, shortness of breath, or difficulty breathing.

Testing: There is up to a 30% risk of false negative in any test. The validity of the test depends on the patient’s viral load, the quality of the swab, and the quality of the individual test. Tests are more accurate after approximately 2-5 days of symptoms. There is no role for testing to get a “negative test” to clear a child to return to child care.

Sick Appointment Arrival Protocol

If you have a sick appointment with one of our doctors, please come into the office’s main lobby and inform the front desk staff that you have arrived. We will ask you to socially distance in our waiting room, which has been arranged to offer our families adequate space while waiting for their appointments. We ask that only one parent and no siblings attend the appointment if possible, and that all parents and patients ages 3 and above wear a mask at all times while in our office.

We thank you for your understanding as we continue to adapt to the needs of these unprecedented times.

Telemedicine Appointments Now Available at Meridian Pediatrics

We are now offering telemedicine appointments to bring you face-to-face interaction with our doctors for a variety of medical needs. As this avenue of care is new to many of us, here is some helpful information to educate you on this care option.

What is Telemedicine?

Telemedicine is a method of providing clinical health care services through audio-visual telecommunication devices, such as your smartphone or computer. These “virtual” appointments give you a pediatrician’s undivided attention from the comfort of your home.

Who is Eligible for Telemedicine Appointments?

Your child must be an established patient at Meridian Pediatrics. Your child must be present at the time of the telemedicine appointment.

What Types of Telemedicine Appointments Are Available?

• Behavior concerns
• ADHD
• School concerns
• Sleep concerns
• Feeding concerns
• Academic concerns
• Follow-up appointments (at the pediatrician’s request)
• Rashes
• Insect bites
• Conjunctivitis
• Upper respiratory infections with cough and fever (only during the COVID-19 pandemic)
• Sick visit triage to determine if an office visit is needed
• Other visit types at the pediatrician’s discretion

What are the Benefits of Telemedicine Appointments?

Telemedicine appointments are a way of getting face-to-face interaction with one of our pediatricians in real time. These appointments allow your pediatrician to see those rashes, injuries, and crusty eyes without coming into our office. This type of appointment also cuts down on phone tag, a common source of frustration for both parents and doctors.

What Else Should I Know?

• Not all medical questions and conditions are appropriate for telemedicine visits. If we receive a request that is best suited for an in-office appointment, a staff member will contact you to schedule that appointment.
• Telemedicine appointments will be billed to your insurance company. Copays will apply and will be collected at the time of scheduling. Any coinsurance, deductible, or associated fees will be billed after your insurance company provides an explanation of benefits.
• A $25 convenience fee will be charged for all telemedicine appointments that are provided outside regular office hours (i.e. you have a telemedicine visit with the on call doctor.) This charge will not be billed to insurance and is your responsibility.

The COVID-19 pandemic has changed the way we practice medicine. While a telemedicine appointment doesn’t substitute for an office visit, we continue to provide the best care possible during these trying times.

Sick Visit Appointments

• Sick visits will be scheduled after all well visits unless otherwise scheduled by your doctor.
• All patients with fever or symptoms of respiratory illness (cough, congestion, sneezing, shortness of breath, etc.) will be triaged by our doctors and nurses by phone;
• Only one caregiver can accompany patients to sick visits.

We thank you for all of your patience and concern during this tumultuous period. We have received an overwhelming amount of support and encouragement from our patients and families and will remain steadfast in our commitment to providing you all with the absolute best care that we can.

How is COVID-19 spread?

COVID-19 is mainly passed from person to person in close contact (within about 6 feet) through respiratory droplets in coughs and sneezes. It possibly can be spread by touching a surface that has the virus on it and then touching your mouth, nose, or eyes, but this is not considered to be the main way the virus spreads.

People are thought to be most contagious when they are the sickest (most symptomatic). While it might be possible for people to spread the virus before showing symptoms (also known as viral shedding), this is not thought to be the main way the virus spreads.

Who is at risk? Are children and pregnant women at greater risk?

Like seasonal influenza and other viral illnesses, anyone can become infected with COVID-19 if directly exposed to the virus. However, reports suggest that older people and people with underlying health conditions (heart disease, lung disease, diabetes, compromised immune systems, etc.) are at greater risk of serious illness.

Based on the information coming from countries and areas with higher infection rates of COVID-19, children are not currently considered to be at a higher risk of contracting COVID-19. In fact, most cases of COVID-19 in China have occurred in adults. Additionally, based on the current information available, pregnant women are not at a higher risk of contracting COVID-19.

What are the symptoms of COVID-19?

Symptoms may appear 2-14 days after exposure. Patients with COVID-19 have mild to severe respiratory illness with fever, cough, and shortness of breath. Complications from this virus can include pneumonia, organ failure, and death.

The severity of illness when it comes to COVID-19 is still being investigated, but most available information suggests that the majority of cases are mild, with serious illness occurring in about 16% of cases. Furthermore, since patients with mild or no symptoms in impacted areas may not be tested and reported, the overall mortality rate of COVID-19 patients is currently believed to be less than 1%.

Is there a vaccine? How about treatment?

There is currently a vaccine for COVID-19. Current antiviral treatment is reserved for hospitalized patients ONLY.

How do we protect ourselves?

People of all ages can help protect themselves from COVID-19, as well as seasonal influenza and other infections, by taking everyday preventative actions.

These include:

• wearing masks whenever you are around others;
• avoiding close contact with people who are sick;
• avoiding touching your eyes, nose, and mouth with unwashed hands;
• cleaning and disinfecting commonly touched surfaces (door handles, countertops, etc);
• and washing your hands often with soap and water for at least 20 seconds. Easy ways to measure 20 seconds include singing the ABCs song or counting “1-Mississippi, 2-Mississippi, etc.”

What do we do if we have symptoms?

At this time of year, there are still many common viruses infecting our communities. To help prevent the spread of any respiratory illness (including COVID-19), take the following preventative steps:

• cover your cough or sneeze with your elbow or into a tissue, then throw the tissue into the trash; and wash your hands;
• stay home when you are sick, except to get medical care;
• avoid using public or shared transportation;
• separate yourself from other people;
• and call your doctor’s office before visiting.

If your child has respiratory illness symptoms (fever, cough, congestion, and shortness of breath) or a higher risk of COVID-19 (respiratory illness within 14 days of international travel or exposure to people infected with COVID-19), please call our office so that our clinical staff may help determine your best course of care. Please do not bring your child into the office without an appointment, as we take special precautions to minimize the spread of COVID-19.

Should I travel? What if I have traveled recently?

We suggest checking the CDC’s Travelers’ Health page for up-to-date travel restrictions and recommendations.

If you have recently returned from international travel (within the last 14 days) and you develop symptoms of COVID-19, call your doctor’s office for instructions for care while minimizing the number people exposed to your illness.

How is Meridian Pediatrics handling the COVID-19 outbreak?

Our clinical and administrative staffs are committed to staying informed of the latest news, guidelines, and advisories regarding COVID-19. Additionally, we continue to practice preventative steps to limit the spread of any respiratory illnesses in our office. This includes:

• regular cleaning and disinfecting of common areas, frequently touched surfaces (door handles, pens, desks, seating areas), and exam rooms;
• frequent handwashing and hand sanitizing protocol;
• triaging sick patients by phone and in our office to limit potential exposure and spread of respiratory illness in our clinic;
• providing patients with potential cases of respiratory illness with masks to lower their chance of spreading illness to others;
• structuring our physicians’ schedule to minimize the amount of time that healthy patients and sick patients are in our office together;
• and following CDC guidelines among our clinical and administrative staffs, including staying home if we exhibit symptoms of COVID-19.

Immunization Records Now Online!

You may now access your child’s immunization record by visiting the following website:  www.myvaxindiana.in.gov.  Before going to the website, please contact our office for your child’s PIN #.  You will need this before you can access their record.  The only information stored on this website is your child’s name, DOB, home address and a contact person.  You can access this website at any time.  Hopefully, this will help our parents getting a copy of their child’s immunization record without having to make a trip into the office.

32 Phrases To Stop Tantrums in 3 and 4-Year-Olds

Most parents can use more ideas to help big and little kids with their frustrations! The trick to communicating successfully with three and four year-olds is to be clever, funny, clear, rested, and to have a method to calming yourself down as fast as possible. Children this age are often more aggressive and frustrated than they were as toddlers, so being aware of this and meeting their challenging behavior with strategies and patience are very helpful for all involved. More here: http://www.andreanair.com/1328-2/

Car Seat Safety Tips Video

For Child Passenger Safety Week, pediatrician and certified car seat technician Benjamin D. Hoffman, MD, FAAP, offers tips for parents on how to keep children safe in the car, including information on when to transition from rear-facing to forward-facing seats, and from forward-facing seats to booster seats and seat belts. Video here: https://www.youtube.com/watch?v=njlJ5h8PSeg&feature=youtu.be For more car seat installation tips and videos, visit http://healthychildren.org.

The Bedtime Pass Helps Parents And Kids Skip The Sleep Struggles

Dr. Hill may have mentioned this in the past. A great technique for better bedtimes. It’s called “the bedtime pass,” and it works like this: Every night, parents give their child a five-by-seven card that is the bedtime pass. They explain to their child that the pass is good for one excused departure from the bedroom per night, whether that’s to use the bathroom, get one more hug, report a scary dream, whatever. After the pass is used, the child may not leave the bedroom again, and the parents are not to answer if they call out. Learn more here: http://www.npr.org/sections/health-shots/2015/09/18/441492810/the-bedtime-pass-helps-parents-and-kids-skip-the-sleep-struggles

Good Summary on Car Seats

This is not a brand endorsement. But it is a good summary of car seat recs. I would add:
-Backwards facing until age 2. Even when their legs are bent/touching the back seat
-Car seat as long as it fits….then booster
– Pay special attention to the quide as to when it’s ok not to use a booster
– Back seat if 12 or under!

https://www.facebook.com/TheBabyGuyNYC/photos/a.385956342086.166343.324403437086/10153231030392087/?type=3&theater

Need 3 across car seats?

As always fit and proper use is the most important safety feature. One of the most common car seat questions I’m asked is, “Is there any way to get three car seats into one row in my backseat?” People are often surprised to find out that the answer is, “Yes, you probably can!” Three-across is like a puzzle. The smaller the car, the trickier the puzzle becomes. In some cars, it may truly not be possible to safely seat three children in the back. In most cases, though, it’s just a matter of finding the right seats. See more here. http://www.autobytel.com/car-ownership/family/21-car-seats-that-fit-3-across-in-most-cars-129813/

Another Approach to Raising Healthy Eaters

A recent book provides three tips to introducing children to foods that are good for them. The book has a telling subtitle — “Three Habits to Teach Your Kids for a Lifetime of Healthy Eating.” The author has used her training as a sociologist and parent educator to develop a systematic approach to introducing children, even the pickiest among them, to foods that are good for them. At the same time, the tactics she suggests allow children to respond to their internal signals of hunger and fullness, rather than trying to “earn” dessert or please parents by taking a few more bites or cleaning their plates after they say they are full. Though the author calls her three critical habits “proportion, variety and moderation,” they are really about understanding and adapting to children’s natural aversion to strangeness and how tastes develop for foods initially disliked.

Full article available here: http://well.blogs.nytimes.com/2015/08/17/another-approach-to-raising-healthy-eaters/?mwrsm=Facebook&_r=0z

Bedtime Stories for Young Brains

A little more than a year ago, the American Academy of Pediatrics issued a policy statement saying that all pediatric primary care should include literacy promotion, starting at birth. Reading to your children is a great way to bond and help them develop. In fact, children whose parents reported more reading at home and more books in the home showed significantly greater activation of brain areas associated with multisensory integration, integrating sound and  visual stimulation. Reading picture books with young children may mean that they hear more words, while at the same time, their brains practice creating the images associated with those words — and with the more complex sentences and rhymes that make up even simple stories.

Full article here: http://well.blogs.nytimes.com/2015/08/17/bedtime-stories-for-young-brains/?mwrsm=Facebook

Interior Temperatures of Vehicles

The interior of vehicles used to transport children should be maintained at a temperature comfortable to children. When the vehicle’s interior temperature exceeds 82°F and providing fresh air through open windows cannot reduce the temperature, the vehicle should be air-conditioned. When the interior temperature drops below 65°F and when children are feeling uncomfortably cold, the interior should be heated. To prevent hyperthermia, all vehicles should be locked when not in use, head counts of children should be taken after transporting to prevent a child from being left unintentionally in a vehicle, and children should never be intentionally left in a vehicle unattended.

In addition to the standard’s recommendation for head counts of children after transportation, it would also be a good idea to keep attendance while transporting.  Each child should be logged by name.  If a child is added during the transport and manages to hide in the vehicle, a simple head count may not detect his absence.  If staff only count heads at the beginning and end of travel, they could easily forget about any children added during the transport.  Some programs keep a checklist; when a vehicle is emptied, the designated staff must go back through and check the whole vehicle and then sign the checklist when that inspection is completed.

Insect Bites and Stings

It is important to distinguish typical, local reactions versus life-threatening symptoms when dealing with insect bites and stings.  In general, insect BITES (from mosquitoes, ticks, fleas, chiggers, bed bugs) usually do not pose a serious problem; however, in some cases STINGS (from bees, hornets, wasps) can be more concerning.  Your child’s reaction to a bite or sting depends mainly on his/her sensitivity to the particular insect’s venom.  While most children have only mild reactions, those who are allergic to certain insect venoms can have severe symptoms that require emergency treatment.

Although insect bites may be irritating, the itchy, red bumps usually start to regress within 4-5 days and do not require treatment by a physician.  You may try a cool compress and/or calamine lotion to most parts of your child’s body (avoiding the eye and genital areas). NOTE: We do NOT recommend using lotions that have diphenhydramine in them, since the anti-histamine applied to the skin is absorbed and may cause an over-dose of diphenhydramine. If your child needs an anti-histamine to help with the itching, we recommend oral diphenhydramine (to be taken by mouth). If your child is stung by a bee or a wasp, you should remove the stinger and use a cool compress to sooth the area. The skin may be more swollen by the second or third day after the bite or sting;however, there should not be any red streaks or yellowish fluid near the bite or sting.  If you find these signs, please call our office, as the site maybe becoming infected.

Call for medical help immediately if your child has any of these others symptoms after being bitten or stung:

• Sudden difficulty in breathing
• Weakness, collapse or unconsciousness
• Hives or entire body itching
• Extreme swelling near the eyes, lips or penis that makes it difficult for the child to see, eat, or urinate

Insect repellents prevent bites from biting insects but not from stinging insects.  The American Academy of Pediatricians recommends that repellents be used once daily for children OLDER THAN 6 months. DEET is a chemical used in insect repellents with a wide range of concentration (from 10-30%);therefore, it is important to read the label of any product you use.  Studies show that products with higher amounts of DEET protect people longer.  For example, products with 10% repel insects for 2 hours;whereas, a product with 24% DEET will protect for 5 hours.  Studies also show that products with >30% DEET do NOT offer additional protection.  An alternative to DEET is a insect repellent called picaridin (available in concentrations from 5-10%).

HPV vaccine reducing infection rates in teen girls, study shows

Fox News reported June 19^th 2013 that public officials appear to be gaining significant ground in their battle against Human Papillomavirus, the most common sexually transmitted disease in the U.S.

Vaccine-type HPV infections among female teenagers (age14-19) decreased by 56% since the vaccine was introduced in 2006, according The Journal of Infectious Medicine.

This represents significant progress in preventing an infection blamed for causing cancer in 27,000 Americans each year.

According to the Centers for Disease Control and Prevention, two-thirds of girls, age 13-17, in the US have not been vaccinated against HPV.

An estimated 79 million Americans, most in their late teens and early 20s, are infected with the virus, according to the CDC.  HPV causes 14 million new infections each year!!

While most people infected with the virus do not develop symptoms or health problems, some types of HPV can cause genital warts in males and females which are unsightly and hard to treat.  Other strains of HPV cause cancer in both sexes.

The CDC estimates that HPV causes 19,000 cancers in U.S. women each year, with cervical cancer being the most common.

Vaccinations are recommended for teenage men and women.  According to CDC estimates, the virus causes about 8,000 cancers each year among males, with throat cancer as the most common.

Actor, Michael Douglas, has freely come forward saying HPV was responsible for his bout of throat cancer in 2010.

The CDC recommends routine HPV vaccination for both boys and girls ages 11 and 12, as well as for older teens and young adults who have not previously received the vaccine (up to age 21 for males and 26 for females).

Early vaccination is necessary BEFORE sexual activity ever begins in order to develop a strong immune response against HPV.  According to public health officials, studies have found NO evidence that vaccinating young people against HPV makes them more likely to engage in sexual activity.

Any other questions should be addressed to your pediatrician.

Organic Foods and Children

In 2012, an American Academy of Pediatrics clinical report was published on the topic of organic foods. It was entitled “Organic Foods: Health and Environmental Advantages and Disadvantages”. Earlier, there was a similar report in The Annals of Internal Medicine entitled “Are Organic Foods Safer or Healthier Than Conventional Alternatives?” These reports found that organic and conventionally produced foods were nutritionally similar, but the internal medicine report did not account for the special needs of the pediatric population, especially related to the issue of pesticide residual in conventionally produced foods.

There are definitely higher levels of pesticide in conventional food as compared to organic, and there are data which show there are adverse effects in children, pregnant women, and farm laborers from these pesticide residues. While the pesticides in regular foods don’t exceed government maximums, these maximums are regulatory and not health based.

Some conventionally grown foods contain more pesticide residue than others—examples are apples, celery, sweet bell peppers, grapes, and lettuce. There are other foods that are typically lower in pesticide levels. More information can be found in the “Shopper’s Guide to Pesticides in Produce” at www.foodnews.org.

It is also recommended that organic poultry and pork be considered, as conventionally raised animals are given antibiotics that increase the risk that their meat products will have antibiotic-resistant bacteria on them. Risk from these bacteria can be reduced or eliminated by cooking carefully.

Finally, many have asked us about the dangers of hormones in milk. There is concern that bovine growth hormone, which is given to dairy cattle to increase milk production, may adversely affect maturation in children, especially in females. However, this hormone is biologically inactive in humans and therefore doesn’t pose a risk. It should be noted that we recommend that children drink only pasteurized milk and avoid raw milk.

The cost of organic foods is, unfortunately, significantly higher than conventionally produced foods, but these costs have gradually been dropping. Generally, conventional foods are safe and nutritious, but if one wishes to eat in a more “holistic” way, in may be reasonable to find which foods have the highest pesticide residuals, and substitute organic foods, at least for infants, children and adolescents.

Spring Allergy Season is Here

The spring allergy season is upon us!  Sadly this brings on lots of coughing, congestion, runny and itchy noses and watery and itchy eyes!  There are many treatment options that can help control your child’s allergy symptoms.

For nasal symptoms and post nasal drip which can cause coughing, a non-sedating over the counter medication may be your first choice.  These medications include Claritin, Zyrtec, Allegra or any of their generic preparations.  Usually these are given once or twice a day and also are dose dependent on the age of the child.  Always be sure to check the package insert for proper dosing or consult your Pediatrician.  Sedating antihistamines, including Benadryl, may make your child tired and need to be given more often thus this is not a first line choice for seasonal allergies.

For itchy, watery eyes an eye antihistamine may help to control these symptoms.  Zaditor is an eye drop that can be used safely down to age 3 and can be given every 12 hours.  Wearing sunglasses can also protect the eyes from allergens blowing in the air.  Other medications such as Visine are not helpful for allergies as they only constrict the eye blood vessels and do not provide any allergy treatment.

If these OTC medications do not improve the quality of the allergy symptoms then it may be time to discuss further options of treatment with your doctor.  These include nasal steroid sprays which decrease the swelling of the nasal membranes and thus decrease mucous production.  There is also a prescription medication called Singulair that also treats allergies and asthma symptoms.

Update on Ear Infection Treatments

Hoping to reduce unnecessary antibiotics use, the American Academy of Pediatrics on Monday issued new guidelines for how doctors should diagnose and treat ear infections. Every year, millions of parents take their children to the pediatrician for ear infections, and most of them end up going home with antibiotics. In fact, ear infections are one of the most common reasons kids see doctors and the leading reason kids get antibiotics.

“Parents, if their child is up all night screaming and tugging the ear, they want something to make the child feel better,” says Dr. Richard Rosenfeld of the State University of New York Downstate Medical Center, who helped write the new guidelines. But about 70 percent of children get better on their own within two or three days, and about 80 percent are better within a week to 10 days, he says.

And he says there are some real downsides to using antibiotics when they’re not necessary: They can cause upset stomachs, allergic reactions and other problems. And they can contribute to the development of superbugs — infections that are getting harder and harder to cure. “The bacteria that do survive the antibiotic get tough, and next time you get an ear infection or any other type of infection, they’re harder to manage,” Rosenfeld says.

The first thing the new guidelines say is: Make sure the child really has an ear infection.

“There are dozens of reasons an ear can hurt,” Rosenfeld says. “In this guideline we say, ‘Listen, if you’re not sure of the diagnosis, don’t even think about giving an antibiotic. Please, don’t even think about it.’ ” The only way to know for sure is to take a close look at the eardrum and see if it is clearly bulging. “If it’s pushed outward — looks like it wants to pop — that is a very, very accurate sign of an ear infection,” Rosenfeld says.

But even kids who really do have ear infections don’t necessarily need antibiotics. The guidelines say doctors have the option of just watching kids who don’t have intense pain, a high fever or other symptoms of a severe infection. “You don’t have to freak out as a parent. [Ear infections] tend to go away on their own quite often with just some pain medicine,” Rosenfeld says.

But there are some kids who definitely should get antibiotics, such as those ages 6 months to 2 years who have infections in both ears or any child who has severe symptoms, such as severe pain for several days and a fever of at least 102.2 degrees. Any child who has a ruptured eardrum should also get antibiotics, according to the guidelines. “If you have a severe infection, no point discussing it further. Those children are going to get antibiotics. And the reason is they’ll get the most benefit,” Rosenfeld says.

Other experts praised the guidelines. But some worry they might make some doctors a little too hesitant to use antibiotics. “When the diagnosis is correct, then antibiotic treatment is never wrong,” says Dr. Ellen Wald of the University of Wisconsin School of Medicine and Public Health in Madison. “Kids tend to recover more often and they recover more quickly if they’re treated appropriately with antibiotics.” That’s especially important for working parents, Wald notes.

“We live in a society where there is so much pressure for both parents to be working outside the home and it’s just complicated when our child is sick. Besides which, there’s always parental anxiety and concern when their child is sick,” she says.  Rosenfeld stresses that doctors are free to figure out the best way to treat each child. In many cases, they can give parents a “safety net” or “wait and see” prescription and say: “Hold on to this antibiotic. Give some pain medicine the first day or two. And if they’re not better after two days, then we do want you to let us know and start the antibiotic,” Rosenfeld says. “But if they are better, just throw it out and they’ll do fine.”

The new guidelines also recommend ways parents can protect their kids from ear infections in the first place, such as by breast-feeding and keeping kids away from cigarette smoke.

Concussions

Concussions have become increasingly more concerning to parents and pediatricians over the last several years.  A concussion is any injury to the brain (typically caused by a blow or a jolt to the head) that disrupts the normal brain function on a temporary or permanent basis.  Young athletes are particularly susceptible to the effects of a concussion because their brains are still developing. Concussions most commonly occur in collision sports (football, hockey, rugby) but also can happen in contact sports that don’t require a helmet (soccer, basketball, wrestling, lacrosse).  Some concussions may even occur outside organized sports, when children are just doing things that children do!

Symptoms of a concussion usually happen immediately after the event but may take hours to days to show up.  The child usually is NOT knocked out or unconscious.  The most common symptoms of a concussion are: headache, nausea or vomiting, dizziness or balance problems, double or blurry vision, sensitivity to light or noise, feeling dazed, stunned, “foggy” or confused, trouble concentrating or remembering, slow to answer questions, changes in mood, drowsiness, and sleep problems.  Physical and cognitive exertion (homework, playing video games, using a computer or watching TV) may worsen symptoms. Symptoms usually resolve within 7-10 days, but it may take weeks or months to fully recover.

The American Academy of Pediatrics recommends the following:

• Children or adolescents who sustain a concussion should always be evaluated by a physician and receive medical clearance before returning to play.
• After a concussion, all athletes should be restricted from physical activity until there are no symptoms at rest AND with exertion (both physical and cognitive).
• Neuropsychological testing may provide objective data to athletes and their families, but testing is just one step in the complete management of a concussion.
• There is no evidence proving the safety or efficacy of any medication in the treatment of a concussion.
• Retirement from contact sports should be considered for an athlete who has sustained multiple concussions, or who has suffered post-concussive symptoms for more than three months.

All concussions should be taken seriously.  Never ignore a heady injury, no matter how minor!

Jill Mazurek, M.D.

About The Flu

What is Flu?

Influenza, commonly shortened to “flu” is an extremely contagious respiratory illness caused by influenza A or B viruses.  Flu appears most frequently in the winter and spring months.  It attacks the body by spreading through the upper and/or lower respiratory tracts.

What is the difference between a cold and the flu?

Both are contagious viral infections of the lungs.  Although the symptoms can be similar, flu is MUCH worse.  A cold may drag you down a bit, but the flu can prevent you from getting out of bed!

Congestion, sore throat, and sneezing are common with colds.  Both cold and flu bring coughing, headache, and chest discomfort.  With the flu, though, you are likely to run a high fever for several days and have a headache, body aches, fatigue and weakness.  Usually, complications of colds are minor, but a severe case of the flu can lead to serious infections, including pneumonia, or even death.

More than 100 types of cold viruses are known, and new strains of flu evolve every few years.  Since both diseases are viral, antibiotics CANNOT conquer cold or flu.  REMEMBER:  ANTIBIOTICS ONLY TREAT BACTERIAL INFECTIONS.

What is the difference between stomach flu and Influenza?

“Stomach flu” is not due to influenza despite the word “flu”.  Stomach flu, or gastroenteritis, is an inflammation of the gastrointestinal tract (stomach and intestines).With gastroenteritis, stomach flu, you may have symptoms of abdominal cramping, nausea, vomiting and diarrhea.

How is flu spread?

The flu virus is spread from person to person through respiratory secretions and seems to infect large groups of people who are in close contact, such as daycare facilities, school classrooms, college dormitories, offices and nursing homes.

Flu is spread when you inhale droplets in the air that contain the flu virus, make direct contact with respiratory secretions through sharing drinks or utensils, or touching things contaminated by a person infected with flu.  In the latter case, the flu virus can infect you if you touch an infected surface and then touch your eyes, mouth or nose.  That’s why frequent and thorough hand washing is a key way to limit the spread of influenza.  Flu symptoms start to develop from 1-4 days after infection with the virus.

Who is at greatest risk for flu complications?

While anyone can get flu, infants, the elderly, and people with chronic illnesses are at highest risk for complications from the flu.  Despite advances in flu prevention and treatment, the CDC estimates that deaths related to influenza range from 3,000 to 49,000 each year.

Treatment

• Rest
• Fluids
• Acetaminophen (such as Tylenol or other brands) to relieve fever, headache, and muscle aches.
• Cough medicines may not be helpful and should not be used under the age of 6 years.
• Antiviral treatments- These can be used to treat and prevent influenza.  When used as a treatment the medicine does NOT eliminate flu symptoms, although is may reduce severity and duration of symptoms by about 1 day.  Not every person with influenza needs an antiviral and this should be discussed with your doctor.  Also, in order to achieve benefit, antiviral medication must be given in the first 48 hours of treatment.  Some antiviral medications cause vomiting and diarrhea as a side effect.
• Antibiotics-  Antibiotics are NOT helpful for treating viral illnesses such as influenza or the common cold.  Antibiotics should ONLY be used if there is a bacterial complication of the flu such as bacterial pneumonia, sinusitis  or a bacterial ear infection.

Remember, we at Meridian Pediatrics are here to help you manage through any illness your child may encounter. Call us to make an appointment if you have concerns.

Technology Use and Children

Although technology affords opportunities for young children to develop early computer skills, the independent use of this technology may be harmful in excess. There are concerns that too much technology use may replace valuable time spent in outdoor play and socialization that the traditional playground has offered. This can directly lead to obesity as the child eats during “screen time” and lacks exercise.

Negative effects of television viewing include increased aggressive behavior and greater acceptance of violence as well as trivializing sexual activity. Television viewing can also blur the distinction between fantasy and reality. Increased screen time also results in less time spent in healthier activities, including unstructured play. Results of numerous studies have also suggested that television has significant effects on child behavior, however, poverty, ethnicity, parental education and parental health habilts have also been found to play a role in a child’s development/behavior.

Parents should be made aware of the recommendations to limit screen time to 2 hours per day or less for all children. Absolutely, under no circumstance should a child have a televion in their room. Research has shown that children who have televisions in their room have increased rates of obesity, sleep disturbance and lower academic performance.

The best thing of all is that the recommendation of less than 2 hours of total screen time per day still allows for sharing of family-oriented activities thus building stronger family relationships!

The Use of Honey as a Cough Suppressant

Some years ago, the FDA issued a warning against the use of many OTC cough suppressants. Adverse side effects include excessive sedation, cardiac rhythm abnormalities, and high blood pressure. Even worse, most of the products had limited or no effectiveness. What is a parent to do when faced with another sleepless night for both child and parent?

The World Health Organization has previously recommended the use of honey as an effective treatment for nocturnal cough. In order to test the validity of this recommendation, a recent study involving more than 6,000 children from ages one through six was conducted. The study did indeed confirm the value of honey as a cough suppressant in the age group represented (honey should not be given to children less than one year because of the risk of botulism).

The authors suggest that honey may work for different reasons—it is very high in anti-oxidants, it has certain anti-microbial effects, and its sweetness may suppress areas of the central nervous system associated with coughing.

The type of honey used seems not to be important, and the amount should be between one and two teaspoons. It is given within one-half hour of bedtime. Your friendly dentist may ask that your child rinse his or her mouth after swallowing the honey.

Happy Flu Season

Our doctors recommend the annual trivalent seasonal influenza immunization for all individuals, including all children and adolescents, aged older than 6 months during the 2012-2013 influenza season.  Now is the time, through January or later.

The CDC, (check out their website www.cdc.gov, it is a great source of information) considers the following people at high risk for developing flu-related complication.  If you know of anyone in these groups consider adding to their protection by immunizing yourself and your whole family:

• Children aged 6months-4 years
• People 50 years and older
• People with chronic diseases
• People who are immunosuppressed
• Women who are or will be pregnant during the influenza season
• Health-care workers
• Residents of nursing homes and other chronic-care facilities
• American Indians/Alaska Natives

Some children aged 6 months to 8 years require 2 doses of influenza vaccine, such as those who are being vaccinated for the first time.  The child who has received 2 or more doses of seasonal influenza vaccine since July1, 2010 requires only 1 dose.  However some children who received influenza vaccine previously will need 2 doses during this flu season (those who received only 1 dose previously and those with unknown vaccination history.

Our goal is to provide vaccination for our patients scheduled for wellness appointments.  For the convenience of our families we will also be able to vaccinate accompanying siblings at that wellness appointment.   Since we recommend all family members be vaccinated as well, we would like to offer the Visiting Nurse Service clinics at our office, after hours.  Please see our website for times.  The Visiting Nurse Service is completely separate from us.  They require payment in full, their rates are published on our website.  They are able to supply you with the forms you need to file your insurance to get reimbursed.

There exist other sites to get vaccinated.  The Marion County Health Department is a fantastic resource, see www.mchd.com for details.  Pharmacies and medical clinics have some restrictions and stipulations, so please call ahead if you would like to use them.

Please remember that we are trying to cover as many people as we can during the busiest time of our office.  Because our staff needs to concentrate on their regular duties as well as many more ill children whose needs may be unpredictable, we are not able to administer flu vaccine during ill visits, during a scheduled extra shot time, or as an accompanying sibling to one who is ill.  Our office will not write a prescription for outside agencies that require one.

NEW:  BUSINESS OFFICE VOICEMAIL NUMBER

We are happy to introduce our new business office voicemail number: 317-844-4340.  This line is available 24 hours a day, 7 days a week.  Calls will be returned between 9 a.m. and 5 p.m., Monday-Friday, eastern standard time.

October is National Bullying Prevention Month

Whether you are an educator, student, family or individual who cares about students, PACER offers the tools you need to address bullying in your school, recreational program or community organization. During National Bullying Prevention Month—and throughout the year—the community is encouraged to use these creative resources to engage, educate and inspire others to join the movement.  PACER also offers one to one assistance by phone and email to students, parents and professionals to address bullying related situations. For more information, click the below links:

Parents and Professionals: http://www.pacer.org/bullying/
Middle and High school students: http://www.pacerteensagainstbullying.org/
Elementary school students:  http://www.pacerkidsagainstbullying.org/

Forms, Forms, Forms

Our office promises to complete forms for your child that requires a physician’s signature.  We also can give you up to date shot records.  All we need is your commitment to follow our wellness appointment guidelines highlighted in our book.

For older children, an annual physical will be sufficient.

We are able to complete forms with short notice.  Please call us before you head off to a med check or group physical for form completion-we may be able to save you a needless trip.

Teething Pain Relief

(FDA update 4/7/2011) “The FDA is warning the public that the use of benzocaine, the main ingredient in the over-the-counter gels and liquids applied to the gums or mouth to reduce pain, is associated with a rare, but serious condition. The condition is called methemoglobinemia and results in the amount of oxygen carried through the blood stream being greatly reduced. Benzocaine gels and liquids are sold as a OTC under different brand names such as Ambesol, Hurricaine, Orajel, Baby Orajel, Orabase and store brands. These products are used to relieve pain from a variety of conditions such as teething, canker sore and irritation of the mouth and gums.”

We typically recommend the following for pain relief from teething: Tylenol, frozen mini bagels, frozen teething rings, a frozen washcloth tip, teething toys.

Dr. Cory Martinson

Parents of Teens: Hookah Smoking

I just wanted to update our families and patients with some interesting news and research from my recent Pediatrics journal and American Academy of Pediatrics magazine.

Parents of Teens: Hookah smoking is becoming popular amongst teenagers and Hookah bars and restaurants are popping up everywhere. I think I just saw one in Broadripple. Here are a couple of myths to review with your teenagers and young adult children…

“Myth: Smoking tobacco through a hookah is safer than smoking cigarettes. Fact: Hookah smoking sessions, usually lasting 20-60 minutes, generate 10 liters or more of smoke, which is far greater than cigarettes.

Myth: The water used in Hookah is an effective filter against carcinogens. Fact: False, there may actually be higher levels of carcinogens in Hookah smoke.” AAP news August 2011

Hookah smoking is a tobacco product and like all tobacco products, hookah use can lead to various cancers, as well as heart and lung disease.

CDC update: US measles cases at highest level since 1996.  Measles continues to be on the rise in the U.S. this year, due mostly to unvaccinated US travelers to countries where measles is common. This increase underscores the ongoing risk of measles importation to the US and the need for high measles vaccine coverage. Be sure to let us know if you are traveling to an area outside of the US that is measles endemic. A great resource for families traveling outside of the US is www.cdc.gov. Also remember that we recently had an outbreak in northern Indiana. We are not immune here in Indiana (no pun intended :)).

Acetaminophen (Tylenol) Update: All infants’ and children’s liquid acetaminophen products soon will be sold in a single, uniform concentration to help reduce dosing errors.  If you still have infants tylenol or acetaminophen at home be SURE to note the concentration. Infant drops are 80/0.8 ml of medicine and children’s suspension is 160 mg/5 ml.  The dosing is DIFFERENT for the infants’ and children’s suspensions. If you have any questions our handbook has a dosing chart on page 9.

Be safe!

Dr. Cory Martinson

What is a Medical Home?

A medical home is an approach to providing comprehensive primary care that facilitates partnership between patients, physicians, and families. A family-centered medical home is not a building, house, hospital, or home healthcare service, but rather an approach to providing comprehensive primary care.

In a family-centered medical home the pediatric care team works in partnership with a child and a child’s family to assure that all of the medical and non-medical needs of the patient are met.

Through this partnership the pediatric care team can help the family/patient access, coordinate, and understand specialty care, educational services, out-of-home care, family support, and other public and private community services that are important for the overall health of the child and family.

The American Academy of Pediatrics believes that every child deserves a medical home, where care is accessible, continuous, comprehensive, patient- and family-centered, coordinated, compassionate, and culturally effective. Over the past year the AAP has been at the forefront of numerous initiatives to promote the adoption and spread of the patient- and family-centered medical home. For more information, please visit http://www.medicalhomeinfo.org