Child laughing while seated on a table with an open bible on his thigh
Behavior, Blog, Immunization, Infection, Infections, Promotion

What Every Parent Needs To Know About Ear Infections In Children

What Every Parent Needs To Know About Ear Infections In Children

Common Ear Infection – (Also called Otitis media) in children that usually presents with ear pain, fever, excessive crying or a variation of those.

According to the AAP, otitis media is diagnosed when there is bulging of the tympanic membrane (ear drum) or there is a new onset of drainage of fluid from the ear in a child that has not been diagnosed with otitis externa (inflammation and pain of the hole leading into the ear). Onset of ear pain has to have been recent in the last 48 hours or less. If there is no solid evidence of increased fluid in the middle ear, otitis media should not be the diagnosis.

 

With regards to other factors that help us diagnose otitis media, they include fever. If the temperature has been above 39 degrees celsius (102.2 F), and the pain is significant, the child is more likely to have otitis media that requires treatment.

 

Sometimes the symptoms are not as severe but both ears are affected. In such cases I would diagnose otitis media. In milder cases with children between 6 months and 2 years if both ears are involved even if pain is not significant, we would want to treat such children.

 

During your visit to our clinic with your child, I will ask you several questions relating to how the child is normally. One of the commonly observed patterns in toddlers as well as preschoolers is increased pain (and distress, usually crying) at night. Many parents have tylenol and/or ibuprofen at home and would have given that before they present to the clinic. That is okay. In fact the guidelines recommend giving mild analgesics for pain.

 

There are some cases where the child has nonsevere pain in one ear. I generally would discuss with the family about observing the child’s symptoms for a few days in these children who are more than 2 years old. However I do discuss this with the parents and it is usually a joint decision. Sometimes there is justification for giving antibiotics as that is the mainstay of treatment apart from pain relief.

 

In the children that we do decide to observe, the parent(s) or caregivers have to have a reliable means of obtaining the child’s temperature periodically and also ready access to a pharmacy of their choice in the event that we decide to treat with antibiotics.

 

The antibiotic of choice which is very well tolerated and recommended by the AAP is amoxicillin. This is used if there are no complications, there is no concurrent purulent conjunctivitis and the child has no penicillin allergy. We give high dose for 10 days. It is an oral medication.

 

With this treatment, we would expect positive improvement in the whole spectrum of symptoms and if we are not seeing improvements within the first 48 to 72 hours despite appropriate compliance, we often re-evaluate the child for either a change of antibiotics or a change of diagnosis (occasionally both the diagnosis and the treatment do change).

I have had parents ask about tympanostomy tubes. These are tubes (super tiny) that are inserted surgically into the ear drums in children that have had recurrent ear infections. Usually up to three separate episodes in a 6 month period or 4 episodes within the preceding year with at least 1 in the preceding 6 month period.

 

We are always in touch with the appropriate Pediatric ENT surgeons who would evaluate every case we do send to them. The procedures, though, simple could have complications so I would not send any of my patients for tubes unless they actually meet the criteria outlined above.

 

With that, I turn it over to you. What has been your experience with ear infections in your child? Did they need tubes? Did they get tubes? Comment below.

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Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

 

Blog, Infection, Infections, Promotion

In The Beginning It Was A Simple Diaper Rash

 When Is Diaper Rash not Just A Rash?

Diaper dermatitis is common and is usually easily treated. However, just like many other things in life, it can also get complicated. There are several scenarios that every parent, as well as providers, should be aware of in which a rash IS not a simple diaper rash. As we stated in a previous post, diaper rash as a clinical entity accounts for between ten and twenty percent of the in-office complaints that we see in children under 2 years of age. Even though it is called diaper rash and is found mainly in the diaper-covered areas of the infant, there are situations in which the rash goes beyond these areas. In such instances as well as in others with more severe clinical features, medical intervention is both necessary and urgently needed.

Below are four variants of complicated diaper rash that need medical intervention.

Candida Diaper Dermatitis:. The hallmark of candida diaper dermatitis is the red beefy raised areas of skin (the medical term is plaques). Other clinical characteristics are the presence of some superficial pustules that look as if they have pus in them. Also to aid in clinical diagnosis, one looks for satellite lesions. Essentially, with candida, it is a phenomenon whereby there will be some spots that are located away from the main area where the rash is present. It looks as if they are satellites thrown far away from the main bulk of the lesions. of the constant contact, that ensues when a child sits in a wet or stool-soiled diaper for a prolonged period. Chemicals from urine and feces irritate the wet skin, thus putting the top layer of the skin under chemical pressure. Eventually, the skin breaks out and the rash develops. As one may expect, candida diaper rash usually is preceded by a chemical diaper dermatitis often times due to urine irritation of the area. The disease process transitions into candida as soon as the skin folds start getting involved. Normal chemical irritants do not affect the skin folds. Although we diagnose this infection clinically without any lab tests, a laboratory scraping usually stained with KOH in the lab shows the candida components. Treatment is with topical (skin-applied) antifungal cream. On rare occasions, the infant’s candida infection persists.That gets your provider thinking and trying to expose or eliminate conditions like Type 1 diabetes and chronic mucocutaneous candidiasis.

Impetigo is Secondary Infection from Staphylococcus aureus (or S. pyogenes): This is a bacteria found literally everywhere. It has a subspecies that lives on the human skin and it also has some multi-drug resistant subspecies called MRSA. Impetigo is a common, itchy and fast-spreading (read contagious) skin infection. I have treated many children in the past with impetigo on other parts of their body. These are usually teens. Unfortunately, infants can have impetigo as a complication of a diaper rash. They have raised 2mm lesions that are fragile, may have some pus and do look like honey crusts when eroded. Some children have more serious infections called bullous impetigo where the lesions are much larger and rupture easily. The diagnosis is usually confirmed with laboratory testing of the pus. Treatment is with antibiotics. If the infant is under two months, we may decide to treat her as an inpatient because they are very delicate at this age and may be at a high risk for developing septicemia (bacteria multiplying in their blood). Furthermore, if the infant looks ill, has symptoms of being tired, not acting herself, or crying excessively or if she has a fever, further testing needs to be done along with immediate treatment. 

Perianal excoriation due to streptococcus:. Infections in the area covered by diapers can indeed get complex. This infection in the area around the anal opening is caused by group A streptococcus infection. The area looks red and inflamed. There is a sharply demarcated area of redness and other parts of the diaper area may also be red. When this has been around for a while, the child may develop perirectal fissures and blood-streaked stools. Fissures are notorious for causing pain on stooling so this may be an indication if your child has distress doing ” number 2″. Treatment is with antibiotics after a thorough examination by the provider.

Herpes Simplex Virus Infection. Some infants develop vesicles, papules or pustules caused by HSV virus. HSV is known to be sexually transmitted so is an infant develops herpetic lesions, this is a red flag for potential child abuse. Such cases are not common but do occur. If it is suspected, we initiate an investigation of child sex abuse and this includes both the law enforcement agents and child protective services. Herpes is treated with antiviral agents, but more pertinent is the safety of the child from a potential abuser. As we have seen, there can be serious complications of diaper rash that require more detailed management and treatment. It is important that parents understand the need to seek medical attention whenever they notice things unusual with their child. Second guessing and “watching it for a while” may not always be the best decision though reasonable at times.

Here at Omega Pediatrics we ensure that parents have access at all times so that they can reach us for decisions about their child’s health. Read other blog posts here.

What have you experienced with diaper rash? Please comment below and feel free to share this blog post.

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Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

 

toddler in diaper
Blog, Infection, Infections, Promotion, What is

My Baby Has A Diaper Rash. What’s That?

 What Is Diaper Rash?

Diaper rash is one of the first things new mothers experience with their newborns that requires intervention from a healthcare professional after going home with their bundle of joy. The old school providers call it nappy rash and the medical terminology is napkin or diaper dermatitis. It is very common for infants and toddlers and accounts for between ten and twenty percent of the complaints that we see in children under 2 years of age. As the name suggests, it occurs around the areas that the diaper covers – the diaper area.

The appearance of diaper rashes varies widely and so does the range of causes. There is also a healthy overlap of how these rashes look and so some expertise is often needed to make the diagnosis. The skin changes could range from mild inflammatory reactions of the skin in the diaper area to extensive erosion of the perianal skin. The rash color may be pink, red or same color as the infant’s skin. In very severe forms, there could be crater-like ulcers exposing a raw area of flesh. Of course, the more severe forms are more of a rarity. More often one would encounter small spots or blotches localized to a small area.  Affected babies are well-appearing and not ill-looking, especially in mild cases. Because it is usually a mild condition, treatment can be done at home, but it remains a concern for most parents and that is why we are discussing it here.

Causes of Diaper Rash – the perfect storm

The leading cause of diaper rash is irritation and dampness to the skin. The dampness is understandable, as a result of the constant contact that ensues when a child sits in a wet or stool-soiled diaper for a prolonged period. Chemicals from urine and feces irritate the wet skin, thus putting the top layer of the skin under chemical pressure. Eventually, the skin breaks out and the rash develops. This happens when the baby’s diaper is not changed frequently (as can happen with an exhausted mother, an inexperienced caregiver or a very busy daycare center where diapers are changed on the clock instead of as needed with periodic checks). Diaper manufacturers do a good job of marketing their products but it only takes one diaper change to know that the diaper can not absorb and keep unlimited amounts of urine away from the skin. Also with stool, there is no absorption and it has to be changed as it happens. Failure to do this results in some of the more nasty rashes that we see. The child’s delicate skin when exposed to urine and feces suffers! The urine and feces once outside the body generate a chemical known as ammonia leading to irritation of the skin (Morris, 2012).

A fungal infection can also cause diaper rash. If your child’s skin is warm and wet it becomes very favorable for the growth of a fungus known as Candida. Just like ammonia, Candida can also irritate your child’s delicate skin. A diaper rash may start up being caused by ammonia irritation and then it is further complicated by a fungal infection. 

The third cause of diaper rash can be linked to changing food and diarrhea. Some infants develop loose stools when a new food is introduced to their diet. With diarrhea, which is frequent loose stools, the wetness becomes even more frequent and this can also lead to the development of a diaper rash.

There are some studies that have linked diaper rash to antibiotics in breastfeeding mothers. Some breastfed babies can develop diaper rash in response to what the mother ate especially if the mother is on antibiotics that result in diarrhea in the child. The suggested mechanism is that the child may have ingested some of the antibiotics from the maternal secretion of her antibiotics in breast milk and then the child suffers antibiotic-associated diarrhea and this leads to diaper rash.

It has also been reported that some breastfed babies may develop diaper rash when they are weaned from breast milk to infant formula ( Gozen et al., 2014).

toddler in diaperSymptoms – check the name, duh!

I say this tongue-in-cheek, but yes, diaper rash symptoms appear to be rash in the diaper area. A facial rash is not a diaper rash and a diaper rash is not a facial rash. So yes there is a rash. However, all rashes are not created equal. Other symptoms will depend on how severe the rash is but in most cases, the symptoms are mild. In the early stages, your baby’s diaper area will start looking more reddened or pink and within a space of another diaper change, you may notice some spots or blotches around the area. Apart from the rash, the baby should appear healthy with no systemic symptoms like a fever. It is not uncommon for an infant to go to daycare with a perfectly normal diaper area and come home with a very nasty diaper rash after 10 hours. In severe cases, the infant is usually very distressed due to advanced and painful symptoms that include increased redness, cracked or broken skin, blisters and ulcers. The rash will spread and cover the entire diaper area, thighs and sometimes up to the abdomen.

 Treatment of Diaper Rash

As I have mentioned above, most are mild and do not require admission to the hospital or an emergency room visit. Your baby’s Provider will focus on the healing of the ulcerated skin, and prevention of reoccurrence.  Sometimes we prescribe a barrier cream be applied on the infant’s skin after each diaper change. The diaper should be changed frequently to prevent reoccurrence. If the infant is in daycare, a discussion with the more senior members of the care team there would help. That way they can ensure prompt checks and diaper changes. The diaper brand may need to be changed to control the source of exposure because though no diaper brand is perfect, not all diapers are created equal.

Other strategies include leaving the diaper off for as long as possible, using only water or alcohol-free baby wipes, avoiding soap, bubble baths, and lotions and avoiding the use tight-fitting plastic pants. Occasionally, the provider may be of the opinion that there is a fungal superinfection or that the rash is due to candida. In such a case, the child will be prescribed a topical antifungal agent and this usually clears up the rash quickly.         

When To Seek the provider

Take the baby to the clinic if the rash is not healing or appears different even after treating it at home. Also if the rash is draining fluid, or you notice white patches that itch or seem to have fluid in it or if your baby is running a fever or cries during urination. These may be indicators that there is a secondary problem that the provider needs to address. 

 

What has been your experience with diaper rash? What did you do?

 

Reference

Gozen, D., Caglar, S., Bayraktar, S., & Atici, F. (2014). Diaper dermatitis care of newborns human breast milk or barrier cream. Journal Of Clinical Nursing, 23(3/4), 515-523. doi:10.1111/jocn.12047

Morris, H.,R.G.N.S.C.M. (2012). Getting to the bottom of nappy rash. Community Practitioner, 85(11), 37-8. Retrieved from http://search.proquest.com.ezp.waldenulibrary.org/docview/1150212146?accountid=14872

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Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

 

Behavior, Blog, Immunization, Infection, Infections, Promotion

Parents, before you refuse your child’s next vaccine read this

Your Child’s Pediatrician Is on Your Side

Contrary to what may are told by proponents of vaccine refusal, your child’s pediatrician is your child’s advocate. The pediatrician earns his or her livelihood by seeing your child do well in health and being on the same page with the parents. The pediatrician has no ulterior motive and no direct benefit when he ensures your child’s best health. Likewise, stands to lose rather than gain if he or she fails to keep your child in the best state of health. Also in contrast to other service delivery models like restaurant services or car wash, there are very serious and far-reaching consequences for both the pediatrician as well as the pediatrician’s employer if things go south in the primary care they provide to any one child or family.

Because of these consequences which could also be grave for affected children, every pediatrician who is trained and board-certified by the American Board of Medicall Specialties would do everything within their power to provide your child with the best possible care available to us. This includes recommendations that have been scientifically vetted by both the Centers For Disease Control and Prevention and the American Academy of Pediatrics. These include vaccines, their recommended administration schedule and the necessary information to be shared with the parents in relation to vaccines.

Our approach to Vaccine Hesitancy (or refusal) is one of dialogue and transparency. This is best practice and has worked to help children globally stay healthier when there are barriers to adopting recommended healthcare interventions.

We Maintain A Positive Dialogue

Despite being pro-vaccination and our best desires for the children under our care, parents may not be on the same page with their child’s pediatrician and we understand that. It is thus our aim to maintain a positive, and nonconfrontational dialogue which ultimately benefits the child and the entire family. With this approach, we often are able to identify parental concerns at its core. While it may seem that the vaccine-refusing parent is hell-bent on ensuring that their child does not get adequate care, keeping the channels of communication and maintaining a mutually acceptable positive dialogue is one approach that has proven to be of great benefit in the relationship between the families and our clinical staff. This is consistent with the recommendations of the AAPCommittee on infectious diseases.

It is our opinion that irrespective of a parent’s attitude towards vaccines, having a medical home has other benefits beyond vaccines and thus we choose not to severe a relationship because of noncompliance of a family with one aspect (a very big one) of the care we offer. We still offer other anticipatory guidance and acute illness care to families and help see the child grow into a healthy adult.

We make sure we:

Acknowledging a shared goal (ie, what is best for the child)

Acknowledging the large volume of complex, conflicting information about vaccine benefits and safety

Offer to help parents to gather and interpret the best information to make an informed decision

We Identify Parental Concerns

Parents have a wide spectrum of reasons for being hesitant about vaccinating their child. During our open dialogue, we help our team identify the source of concerns. The  concerns may be from family, religious background, previous experiences or the media. It may also be due to parents feeling they do not have enough information to make the decision about vaccines. We make it a point of duty never to make assumptions, but rather to understand where each parent is coming from. We seek to first UNDERSTAND before deciding on what the needs are in the child’s case.

As we identify the areas that have driven the parental decision, we can then work with the parents to review what has informed our own (medical community’s) decisions. Many parents see reason if there is a reason to be seen and if we, the providers are indeed reasonable. That has been our experience and thus we are yet to “fire” any child from our care because the parents refused for the child to be vaccinated.

We ensure that we listen respectfully, though this may sometimes take excessive time. We owe it to these children and their families and that is what we do.

We provide targeted education

Our clinic provides several authentic sources of information to support the use of vaccines in children and adults. As the parents get the truth, they make the best decision for their children. Mainstream media stories are designed to gain attention and as such may end up evoking anxiety in young parents and sometimes parents are so anxious about harming their children that they connect it with permiting harm through vaccinations.

We provide information about

  • safety which is often lost to some parent
  • vaccine benefits
  • the seriousness of what is being prevented
  • the real risks of natural infections
  • injection pain
  • correcting misconceptions

Vaccines have worked very well in the United States

According to a 2014 publication from the CDC “…Modeling estimated that, among children born during 1994- 2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths over the course of their lifetimes, at a net savings of $295 billion in direct costs and $1.38 trillion in total societal costs. With support from the VFC program, immunization has been a highly effective tool for improving the health of U.S. children…”

The benefits of vaccines in when compared with the potential risks associated with contracting the diseases they prevent often puts the issues in perspectives that parents have not had time to consider. Thus, just like almost any other medical intervention (or any good or service for that matter), there are risks associated with its use however the benefits outweigh the risks. That is why people still fly, use their automobiles and use gas and electricity.

If you doubt it, please read this http://www.voicesforvaccines.org/growing-up-unvaccinated/well written post by someone who was not vaccinated but has decided to vaccinate her children. It indeed says it better than any doctor could ever because she experienced it herself; the life of being unvaccinated child.

Vaccines are extensively tested and use is monitored for adverse events

The vaccines that are used on children in the United States are fully tested in large numbers before they are licensed by the Food and Drug Administration (FDA). Also, there is a robust Vaccine Adverse Event Reporting System as well as the Vaccine Safety Datalink. Because this is a public health intervention that affects millions of families, any identified concerns are made known immediately and if it is serious enough the vaccine may be temporarily or permanently pulled from the market. This system is much more robust than any drug adverse events registry or monitoring system.

Adverse events are also usually minor and self-limited. This is in contrast to the devastating effect contracting any of those vaccine-preventable diseases can have.

The Risk of Natural Infection Is Real

It is fact that the United States has a very effective public health system and many countries have modeled their public health efforts after the United States model. Unfortunately, the world has become much more mobile that 100 years ago. There is also a huge health disparity globally: from developing countries to war-torn countries; from climate-ravaged lands to natural disaster-affected places. This inequity festers a potential source of unimmunized children and this has led to some isolated epidemics including measles. In such cases, unimmunized children are up to 35 times more likely to get infected than immunized children. These natural infections like measles can kill a child by causing a severe form of viral pneumonia with a serious depression of the child’s natural immunity and making the child prone to bacterial pneumonia and other infections.

With measles, survivors can suffer a long-term brain damage from encephalitis which is debilitating and leaves the child permanently disabled most times.

I have managed measles in children and I have seen many suffer from the illness and then die. It is not worth risking a child’s life especially since it has not been eradicated. It is a viral infection and most viruses are difficult to treat because you need antiviral agents, not your regular antibiotics. Also, the viruses can change form and the antivirus if it exists will immediately become ineffective.

Multiple Vaccines DO NOT overwhelm the immune system

The number of antigens in the vaccine series that we offer children in the United States today are way less than were in vaccines barely 35 years ago. In 1980, the vaccines contained more than 3000 antigens. Today they contain less than 125 antigens. There have been huge strides in the science of vaccines and we have tapped into it to provide the best options for our children and future generations. The human body constantly interacts with thousands of antigens daily. Infants’ immune system can respond to thousands of antigens simultaneously even while they are battling an illness. Thus it is incorrect to assume the children’s immune systems are being overwhelmed by vaccines.

It is also critical to note that both immunized and nonimmunized children respond the same to an infection which they were not immunized for. Thus there is no evidence for the misconception of  “overwhelmed immune system” .

Antigens In Vaccines Through The Recent Years

Vaccines Are Still Necessary

The absence of devastating epidemics of these vaccine-preventable diseases does not render vaccines unnecessary because these infectious agents still abound and do resurface once there is a slight dip in immunization coverage in the community. There have been epidemics of measles in several communities where the immunization rates dropped.

The AAP says your family could be FIRED!

Believe it or not the most recent (2016) report from the AAP about this subject gives physician practices the option to fire families from their practices if:

The clinician has exhausted all means of education

The family has been made aware of the policy regarding dismissal of non-vaccinators

The geographic area is not in short supply of pediatric providers

The practice provides sufficient information to help the family find another provider and continues to provide health care until the family does so (usually 30 days)

Here at Omega Pediatrics we have not fired any child yet, and we sure do not hope to start firing families. It is, however, important for parents to know that the degree of evidence continues to increase and so is the intolerance of vaccine refusal especially among communities and parents that have suffered dearly for a vaccine-preventable illness.

Feel free to call us to talk to a provider about vaccines or text VACCINE to 470-485 7337 for more information.

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What are your thoughts about pediatric problems and the challenges they face?

Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

 

Behavior, Blog, Promotion

Is My Child’s Head Normal?

Are you worried about you child’s head?

Uncertainty about your child’s head can be an uneasy feeling. On your first visit, the provider will perform a thorough head to toe physical examination.

The Top Is Soft

At the top and the back of your child’s head is a soft spot, called the fontanelle. There is an anterior and a posterior soft spot and it can be seen to move up and down with your baby’s heartbeat.  It is okay to touch the spots. It is a natural adjustment that gives the babies brain space as it grows. It is also an important window for the provider during the physical examination process as clinicians can detect illness through it.

Children delivered vaginally may have molding which is just a temporary elongation of the head due to passage through the birth canal. This eventually resolves over the first 24 to 36 hours and is barely noticeable by discharge.

The Eyes

A newborn’s vision continues to develop even after birth. They have dysconjugate gaze which is normal in the first two to three months of life. Your baby may have some redness in their eyes. This may be just because of  some pressure during birth in the birth canal or chemical irritation due to the antibiotic ointment (erythromycin) that is applied when they are born for eye infection prophylaxis. Irrespective of the cause, the eyes are usually clear within the first two weeks. In the clinic, your child’s provider will check your baby’s eyes with an ophthalmoscope and at subsequent visits, clinicians use a bright light to get the baby’s attention as eye reflexes and gazing patterns are assessed. Any visible abnormalities are easily identified.

The Ears

Your child’s hearing will be checked in the hospital before discharge. The shape of the ears may be of concern to a parent, however, if there is a poor development or absence of a part of the ear such as the auditory canal, it is usually identified at birth in the hospital with the initial physical examination. Factors assessed on the ears include symmetry, shape, and size, any skin tags on the baby’s ears. The auditory canal is also looked into to make sure it runs all the way into the eardrum. They use an otoscope for that part of the examination. The baby’s earlobes can bend easily but become stronger with time. Despite the bending it still springs back to its normal shape except in very premature babies and these babies are not let out until they are more mature.

The Nose

Newborns breathe from their nose normally. Sometimes the baby may breathe loudly if the nose is stuffed or if she has mucus, after birth the babies nose may be flattened, which is a normal finding and will resolve in a few days. Sometimes we give parents a bulb syringe to help with clearing the nostrils.

The Mouth

Your baby’s upper and lower jaw should fit appropriately, and when the baby’s mouth is open it should be symmetrical.  The baby should swallow easily during feeding. Also there should be no swelling or lumps in the mouth, the palate (the roof of the mouth) should be easily seen, intact and without any injury.

Judd, J. (1985). Assessing the newborn from head to toe. Nursing, 15(12), 34-41. 

 

What are your thoughts about infant head problems?

Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

Behavior, Blog, Obesity, Promotion

These Things Keep Your Pediatrician Awake At Night

What Is On A Pediatrician’s Mind?

Pediatricians have the task of pleasing or appeasing three or more separate persons at any given time of which only one is the patient and the others are parents and siblings (not forgetting the grandparents). Under such circumstances, the challenge, therefore, is to deliver care that society will deem fair to our most vulnerable.

That task also comes with the need to ensure that both the evolving culture of the society as well as psychological and social factors are taken into full consideration when delivering care to children. There is also a thin line between ethics and access to care which we must ensure even within the most constrained systems.

Below are some of the facts at the back of your pediatric practitioner’s mind when he or she asks you those questions in the clinic, on the phone or in a questionnaire. A shorter version of this article is on our Omega Promise blog on Medium. (www.promise.omegapediatrics.com).

Pediatrics is less profitable than other specialties

In being at the forefront of healthcare delivery for children it is interesting how one has to juggle a lot of interloping factors including the economics of health. In February 2016, a large healthcare organization unceremoniously let go of a group of 16 pediatricians. As reported in this article, Pediatrics is less profitable than other medical specialties. Many children are covered by the low-income Medicaid program, which reimburses doctors and hospitals considerably less than private insurers.

According to the CDC Faststats, 3.3% of children under 18 years still do not have adequate health insurance coverage. This number has been dropping from a high of 9.9% in 1997 to 6.6 in 2008 and now down to this 2015 number. However despite this apparently high percentage of coverage (more than 96%), the bulk of reimbursements from care given to children, 42.2% was from public healthcare coverage plans which we know pay much lower than the private insurance. This makes pediatrics as a specialty, a low revenue specialty since most of its revenue comes from government insurance.

Many mothers refuse to act responsibly and thus put their children in danger

Early pregnancy care, prenatal care and first-trimester supervision of pregnancies are still at 75 to 90%. Many pregnant mothers still smoke, take alcohol or use illicit drugs during pregnancy, thus putting the unborn baby at risk. The problems of the infant fall directly onto the pediatrician’s turf and the pediatrician usually is not in a position to influence the public health roots of the problems.

Improved neonatal and prematurity survival makes the job of the pediatric practitioner more challenging

In the United States, there are still a lot of preterm births, low birth weight infants, and prematurity. Though the peak was in 2006 at 12%, it has been falling steadily but the overall incidence of infants born under 2500 grams has remained steady. These are the more challenging infants to take care of especially when these infants need neonatal intensive care prior to discharge. Pediatricians manage these children once they are home with their families unless they have major issues or have to see a specialist in which case they are managed in collaboration with the specialists.

Pediatricians often have to take care of “babies” who have babies

Birth rates among adolescents have been dropping. The latest numbers show a decline of 9% down to 24.2% in 2014. However, it is still a major pediatrician hassle to provide primary care for infants of children, emancipated or not! According to the CDC, “…teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children”.  “In 2010, teen pregnancy and childbirth accounted for at least $9.4 billion in costs to U.S. taxpayers for increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers.”

Breastfeeding is best for the baby but uptake and sustenance remains a challenge

Initiation, as well as maintenance of breastfeeding, have remained a challenge despite supporting legislation and more trained professionals in the lactation medicine arena. The good news is that an increasing number of mothers initiate breastfeeding, the latest numbers put the national score of ever breastfed at 81.1% but that number falls off steeply at 6 months with only 52% still breastfeeding at that time. Despite the numerous advantages of breastfeeding exclusively and the personal health as well as public health advantages of breastfeeding, the numbers remain worse than health indices from resource-limited countries. This suggests that it is the abundance of resources that has been our biggest disadvantage in the breastfeeding space. Other factors include old family traditions and cosmetic misconceptions, especially among the young adults and teens.

Mental health issues fuel most of the pediatric admissions that are not trauma

Hospital admission of children is a rarity, occurring in 2.4% of children in 2010. Overall for children under 17, respiratory illnesses such as asthma and pneumonia were the leading diagnosis as well injuries. However of note is that in children between 13 and 17 years old, mental illness is a top diagnosis on admission.

Trauma kills a lot of children

The cause of death in the U.S. child aged 1 to 24 remains mainly preventable conditions: accidents, suicides, and homicides. Malignancies (cancers), and congenital malformations which children may have been born with also play a role to a large extent in the younger age groups.

Substance abuse is extremely high in adolescents

Substance abuse is very high among adolescents in high schools. In 2011 one report put it as high as 71% of students had had at least one drink. A different report showed that 46% had tried cigarettes. About 40% of high school students have tried marijuana. Other drugs that are a problem include cocaine, heroin, and methamphetamine.

Obesity remains a big problem for us now and for our future

The obesity epidemic is not yet going away. It may never go away. There is much we can do as a planet, but not much can move the needle just from the pediatric office. Society as a whole has to start taking responsibility.

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What are your thoughts about pediatric problems and the challenges they face?

Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

 

Child laughing while seated on a table with an open bible on his thigh
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Fall prevention in children 0 to 4 years old.

Our clinic is one of the leading destinations for children’s health in Roswell and Alpharetta. Today’s post is about falls and injury prevention.

Falling is a normal part of a young child’s development as they learn to walk, climb, jump, run and play. Fortunately, most children who fall are not injured, other than a few bruises and scrapes. Falls are the leading cause of non-fatal injuries for all children ages 0 to 19 (CDC,2016). Look around your house and backyard using the ‘Kidsafe Home Safety Checklist.’ Injuries due to falls are the leading cause of nonfatal injury.

The following are the different types of falls in children 0 to 3 years old. Children can fall off play equipment, out of windows, down stairs, off a bike or tricycle, furniture, especially chairs, beds, and tables and off anything that can be climbed on. Be sure the surface under play equipment is soft enough to absorb a fall.

Tips to prevent dangerous falls

  1. Communicate with your young child, let them know what you are doing when you are keeping them safe, and why.
  2. Teach your child as they grow on how to protect themselves.
  3. Teach your child to safely get off a chair or bed by sliding down on their tummy, feet first.
  4. Use safety tested mats or loose-fill materials.
  5. Always remember to lock the doors to all dangerous areas (like the street – see image)
  6. Always remove furniture in front of windows, as these can act as props for climbing and add protective window guards.
  7. Make sure the yard has a fence to keep them from wandering to more dangerous territories (read streets).
  8. If your child has a serious fall or does not act normally after a fall, be sure to call your doctor. An injury from a fall can worsen with time, so prompt medical attention can prevent serious complications.
  9. Close supervision by caregivers and firm guidance to children are needed to reduce falls from chairs and beds as a substantial proportion of serious injuries are caused by children playing and standing on these items.
  10. Children should always be placed in a five-point harness when using a high chair. A good quality harness should be fitted to a high chair by the manufacturer or at the point of sale before you take it home.
  11. Close supervision and firm parental/carer guidance is needed to deter young children from standing when in a high chair.
  12. Cots are recommended for children aged three years and under if they have not already been observed close to successfully climbing out of the cot at a younger age.
  13. Toddler beds are recommended for children in transition from a cot to a bed
  14. Children aged less than nine years should not be sleeping in the upper bunk of a bunk bed and certainly not children aged less than six years (Australian Competition & Consumer Commission, 2012).
  15. The top bunk should have a protective railing on all sides at least 160mm above the mattress. Any gaps between mattress and guardrails and between individual guardrails should be small enough not present a head entrapment hazard.
  16. The ladder should be removed when upper bunk is not in use to prevent young children from accessing the top bunk.
  17. make sure your playground equipment is in good repair and is age-appropriate.
  18. Supervise your child closely when they are playing on slides, swings, and mini-trampolines (we are not endorsing trampolines here).
  19. Hold your baby’s hand while climbing or down stairs or riding escalators; teach your child to hold onto handrails to avoid falling (however do not forget hand hygiene after an afternoon at the mall).
  20. Never let your children ride a bicycle, tricycle or scooter without a properly fitted and secured helmet.
  21. If a child is riding a bicycle with an adult, the child should be in a rear-mounted seat and be wearing a helmet.
  22. If you have a tree that your child likes to climb, teach them how far to climb, how to get down safely and have a rule that an adult always has to be with them when they climb the tree.
  23. A child with a disability needs more attention and supervision to avoid falls.

These are some of my recommendations for keeping your child safe from falls. Do you have other ideas? What has worked for you in the past? Share those below as a comment and please share this piece if you enjoyed reading it.

Reference:

Center for disease control and prevention(CDC,2016) https://www.cdc.gov/HomeandRecreationalSafety/Falls/children.html

 

Comment below or on our Facebook Page. Please share this article.

Omega Pediatrics Difference: At Omega Pediatrics in Roswell, Georgia we understand the challenges that parents face when their children develop symptoms late in the day or after hours. Many pediatric offices are closed after 4 pm however we are open every weekday up to 9 pm for walk-ins and we have telemedicine via evisits for our known patients. Our clinic is one of the easily accessible pediatric primary care clinics in Roswell and Alpharetta. We provide pediatric primary care to families in the North Fulton area and we have families that live in Sandy Springs, Johns Creek, Duluth and Cumming.

Immunizations after-hours: One advantage of switching to Omega Pediatrics for your child’s primary care is that you can bring your child in for immunization after regular business hours. We provide this service because we have the passion for what we do and we want to be a comfortable and convenient service, not the ordinary pediatric doctor’s office.

Book an appointment online here.

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Children with asthma more likely to become obese: study

WASHINGTON – Children with asthma may be at higher obesity risk later in childhood or in adolescence, according to new research published online this week. Researchers from the University of Southern California found that young children with asthma were 51 percent more likely to become obese over the next 10 years than children who did not… Continue reading “Children with asthma more likely to become obese: study” »

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Health check-ups for the parents can keep children healthy: here is why?

The focus for any parent, aunt, uncle, friend or even nation has always been children: our kids, our future. If they are indeed that important then isn’t it ironic that I will be writing this? Anyway, as I am already writing I will let you in (one again) on the importance of keeping an eye or four on our health through routine check-ups with our primary physician.

Children have immature immune systems and as such are prone to all sorts of illnesses. It could be a cold that gets complicated and becomes pneumonia; or a minor cut that gets infected. Those things that we pass off as normal in an adult can become serious in a child. Hence, the need for regular health check-ups in kids. The interesting thing is that the adult needs to stay alive and healthy to be able to provide the best chances of a normal life for their children. Thus the adult parent needs check-ups too.

I can hear that mom asking, “Do routine health check-ups ever end?”. Well, No. They end when life ends. You would continue to put gas in your car and fix any problems while you have the car (if you want it to keep running well). Your health is equally as important for you as a parent. Engaged parents never miss their child’s dental appointment or routine physical yet many fail to schedule their own check-ups for their teeth and body.

Preventive health care does not end as a parent or at planning a healthy pregnancy. We need to be able to monitor our health throughout our lives. Despite passing on those great genes to your child, with fantastic immunity and a rock-star health profile, all the work is not yet done. Nature needs nurture and as products of nature, we have the moral responsibility both to ourselves and to society to ensure that we tap into the vast medical knowledge and get checked out periodically.

Your child needs you as healthy as you can be to be able to take care of them. Research shows that fewer people are dying of cancer today due to regular check-ups during which the screenings pick these killer diseases before they become untreatable. Every adult should have a medical exam from time to time or a physical exam at least once a year. Dental visits for routine checks and cleanings are also very important, usually 2 times a year as well as vision checks which are recommended every two years for individuals who do not have diabetes.

Many of us adults still dread going to the doctor and the dentist. I do understand. These are subconscious fears that have found their way into our psyche from very tender ages. However, to be a “responsible adult” means we have to take responsibility of our feelings and face our fears.

During these routine visits, one has the opportunity to ask the health care provider questions about one’s health and well-being. A common theme at many visits is the challenges of parenting while earning a living. This can be very stressful and unless the adult addresses it either with their provider or with the child’s provider, it may lead to some serious consequences for the family.

Day to day stress is very common and is on the increase especially with young families and a strangulating economic system. Managing the stress of a regular life with the added responsibility of a new child could be challenging for parents who do not have the right kind of support. According to Dr. Walton of biopsychology and behavioral neuroscience, there is very little but interesting evidence that suggests that a parent’s stress level can affect the child and increase his or her risk of mood disorders, addiction, and even disorders like ADHD and autism. Your healthcare provider can suggest ways to cope and manage your stress levels so it does not affect your child.

Little things like managing a blood pressure, dietary habits, preventing or catching a developing cataracts can be assessed during routine check-ups with the adult’s provider. People generally feel healthy until they do not. Waiting till there is a crises is not the best way to handle an irreplaceable asset, your body. Routine tests like serum cholesterol level or a random glucose check can expose vulnerabilities that would otherwise remain unnoticed. Immunization status check is also important as the primary immunization immunity has started to wane and the adult usually needs boosters for some vaccines like tetanus. It is advisable to set an appointment with your doctor to discuss any test results so that you will have a clearer view of your risks and focus on preventative care to maintain a good stress-free health.

Children learn a lot from their parents. They model their parents from a very young age. A lot of kids may believe that health check-ups or clinic visits are for kids alone. Now imagine the thought process of a child being told ‘daddy is going for a health check-up’? It is important that we get our kids involved in this as well so they know the importance and see it as a necessity when the are scheduled.

I will end this piece where I started. We need a healthy generation. The first of the four overarching goals of the Healthy people 2020 is to “…attain high-quality, longer lives free of preventable disease, disability, injury, and premature death” – this can be attained by keeping regular check up appointments and up to date immunizations so we can be healthy for our children.

 

If you enjoyed this read please share it with someone who might need a check-up because you care about them. Please look forward to other upcoming posts about the importance of an annual physical.

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Omega Pediatrics Video Ad

This video advertisement gives a summary of some of the Omega Pediatrics unique qualities. Many of you may have seen it before, but we decided to share it in this blog post so that those who have not seen the video can watch it. There are a few other Omega Pediatrics videos which we will share at some point later.

Please add your comments below.