Category Archives: All ages

Why narcotics are prescribed carefully

You may have noticed that narcotic prescriptions are increasingly difficult to get for patients of any age these days. That includes children and teens.

Because of the common problems of prescription drug overuse and even abuse, narcotics are more tightly controlled than ever. Before anyone (even a child) can be prescribed narcotics in Kentucky, the physician’s office must run a KASPER report on that person’s prescription drug history. KASPER (Kentucky All Schedule Prescription Electronic Reporting) “tracks controlled substance prescriptions dispensed within the state. A KASPER report shows all scheduled prescriptions for an individual over a specified time period, the prescriber and the dispenser,” according the official website. The intent is not to prevent you from getting the medications you need, but to prevent overuse and provide a source of information for medical practitioners.

For this reason, refills and usage of narcotics are scrutinized closely within our office and narcotic cough suppressants (such as codeine) are rarely prescribed or suggested.

This is a good time to remind adults to store medications out of reach and out of sight. A young child is curious, and differently colored and shaped pills can look like candy. Older children and teens may want to experiment with drugs, and the ones in your medicine cabinet are free and accessible. Serious consequences of overdose, addiction and even death can occur, so lock your medicines away so that your children and teens don’t have access to them. Remind grandparents and other homes where you child visits of these important safety guidelines.

Narcotics are sometimes important, even essential, tools in your family’s health. But they are to be used carefully and cautiously.

Back to school ALREADY???

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It seems as though summer just started, and we’re already talking about going back to school. That’s because now is the right time to be thinking about getting your child’s medical exams and immunizations covered.

Exams and physicals. Most sports (both school and community) will require that your child or teen have an annual physical. You’ll see ads for retail clinics in stores and also physicals being held at the schools, but keep these things in mind:

Those places don’t have your child’s medical records. Medical and immunization histories aren’t available to the person doing the physical or administering the immunizations.
They haven’t developed a relationship with you to know what is normal and appropriate for your family.
Follow up is minimal or altogether unavailable.
No nutritional counseling is available, which we believe to be extremely important.

For all those reasons and more, we highly recommend that you see your own pediatrician for back-to-school exams and immunizations. (Check out our 2013 blog on store-based clinics here.)

Immunizations. Many immunizations are required by the state, and there are some additional ones recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC). For example, Kentucky requires the meningitis vaccine for the 6^th grade; we also are doing a booster at the age of 16 which isn’t state required but is recommended by both the CDC and AAP. A printable immunization schedule for parents is available here from the CDC.

Concerned about immunizations? Read the article, “Why Immunize?” at the CDC website. Also, find here a series of articles from the AAP about a variety of immunizations.

Plan to arrange your pediatric appointments soon, so your teens and children will have everything they need before school starts.

In between your summer travel plans, pool days and sporting events, don’t forget to make room for health.

Sunburned!

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As the summer gets going into full swing with Independence Day weekend, days by the pool and in the backyard, and lots of sports, sun exposure is always a concern.

How do you keep your kids healthy, happy and sunburn-free while still giving them lots of time outdoors? And when sunburn does occur, how should you treat it?

Prevention. Check out our blog from last summer about sunscreens here. Bottom line: use sunscreen liberally and limit sun exposure. You don’t have to get a sunburn to cause long-term skin damage.

Babies and toddlers. See this detailed article from the American Academy of Pediatrics (AAP). Very young children are especially vulnerable to sunburn and heat stroke. Under 6 months they should be kept out of direct sunlight and in the shade as much as possible. Use the sun cover on the stroller. Take a canopy to the older kids’ soccer games—it’s not only a good place to put the infant, but the rest of the family can get out of the sun, too. Be aware that reflective surfaces, like sand or the concrete around pools, can still allow for sunburn even when you’re under an umbrella or other cover, no matter what your age.

In addition to limiting time outside in the hot part of the day, here are other considerations for the very young:

Dress them in lightweight, light colored clothing that covers arms, legs and the head.
Use sunscreen on any exposed skin. There are several types that are appropriate for tender baby skin. Don’t ever spray directly onto the face, but into your hand first.
Put a brimmed hat on babies and toddlers, or spray their scalps with sunscreen. A fully-brimmed hat can protect scalp, ears, and partially protect face and neck.

Possible skin damage. Don’t forget that everyone, even those with darker skin, are at risk of skin damage from the sun. Exposure over time can lead to skin cancers later.

Treatment. Sooner or later, most everyone will have a sunburn no matter how hard you try to prevent it. What to do? It depends on the severity.

Minor burns (red, warm to the touch) can be treated with cool compresses, acetaminophen and rest.
More serious burns can cause blisters, fever and chills, headache or other feelings of malaise, even infection. If the burn is very serious, call your pediatrician.

So, by all means enjoy the summer sun, just be careful of getting too much exposure!

Reading is fun, but what if your child has dyslexia?

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Many people delight in reading a good book over the summer and families often take trips to the library or virtual trips to Amazon. But for some, reading is a chore or nearly impossible.

Dyslexia, also known as Developmental Reading Disorder (DRD), is a learning disability that starts with the brain, though it doesn’t at all mean that the affected person has lower intelligence. It’s simply the inability to process words properly and can involve auditory and oral issues as well as reading. A person with DRD might have trouble distinguishing letter and word sounds when someone is speaking, as well difficulty recognizing written words. DRD may sometimes be clustered with learning disabilities that inhibit writing and/or arithmetic skills.

If you’re concerned that your child may have dyslexia or another learning disability, speak with your pediatrician. She’ll ask questions about family history and the particular difficulties your child is having, and may schedule (or refer for) a neurological exam or other testing.

Treatment involves specific types of tutoring and coping skills, depending on the type and severity of the learning disability. The pediatrician or an educational psychologist can help you find the right program for your specific situation.

Learning disabilities often lead to boredom, behavior problems, and low self-esteem. The frustrations of not being able to read at grade level or perform schoolwork correctly and in a timely manner can be very stressful. For that reason you may want to arrange some counseling for your child as well. Psychological coping skills are just as important as educational coping skills.

For more information, this National Institutes of Health article is very helpful, and the source of much of the information in today’s blog.

When testicle pain can be a surgical emergency

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Sudden, severe testicular pain should always be taken seriously. It can be a sign of testicular torsion, a dangerous condition that requires immediate surgery.

Testicular torsion occurs when the spermatic cord inside one testicle becomes twisted, which cuts off blood supply to the testicle. If surgery isn’t performed within 6 to 12 hours, then the testicle might have to be removed. There is even the danger of permanent infertility.

While testicular torsion can occur at any age, it is most common between the ages of 12 and 20. Rapid growth of the testicles during puberty can cause torsion, as can exercise or an injury. However, torsion can occur during inactivity, even while asleep.

If your son complains of extreme testicular pain, even if it goes away, report this to your pediatrician. According to the American Academy of Pediatrics (AAP), up to 50 percent of patients with testicular torsion have had scrotum pain before.

Other symptoms: the scrotum can become enlarged, red, and very painful; abdominal pain may accompany torsion, along with nausea and vomiting.

The AAP article also tells how the condition is diagnosed:

“Physical examination by a urologist;
Urinalysis, to detect presence of white blood cells;
A radionuclide scan or scrotal doppler ultrasound, to assess blood flow to the testicles;
Some urologists will take a patient with typical symptoms of torsion directly to the operating room.”

The bottom line: take testicular pain very seriously. It could be an emergency.

Manners? Yes, please.

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Summertime is easy—so they say. It can also be an easier time to remind children and teens about good manners. Hopefully, you will have more times of relaxed conversation when you aren’t trying to juggle homework, school and extracurricular schedules all at once.

Manners are important because they remind us of the value of every human being. Saying please and thank you is respectful, whether those words are spoken to someone in the family, a teacher or coach, or a complete stranger. Being helpful ingrains kindness in the helper and encourages it in the recipient and observer.

What are age appropriate manners?

Ages 2—5. Teach children to say please and thank you at the right times. Children at this age usually love to help people, so encourage that tendency. At the playground, they can help a younger child, with supervision. At home, they can learn to pass the potatoes. When meeting someone, they can shake hands and learn to answer questions that are asked.
Ages 5—7. As the child develops physically and emotionally, so should their moral growth be progressing. Teach good phone manners by practicing in a game. Have a “manners night” once a week at the supper table, where everyone has to speak politely and initiate good conversation. Give a small reward at the end of the meal for the person who showed the best manners.
Older children. Learning to smile and maintain eye contact during a conversation is important as children grow. They can learn to ask people about themselves, and to distinguish between appropriate and inappropriate questions. Your suppertime conversations can engage their imaginations and teach them how to talk to other people.
Teens. When our children mature into teens, they often become less receptive to their parents’ helpful instructions on manners, but that doesn’t mean you can let them off the hook. By now they should know your standards, and you should be able to witness them using their manners at home and elsewhere. Teens who are mannerly, you may tell them, will likely advance at school and work because others respond positively to our good behavior.

Perhaps the main thing to remember about teaching manners to your children is this: be an example. Use please and thank you when you remind them about their chores. Treat your spouse and other adults and youngsters with respect.

If you are often cross with them, they will reflect that attitude back to you and to others. But if you treat them and others kindly, they will learn to mimic that behavior, both consciously and unconsciously.

Expect good manners from your children and that is likely what you will get.

Appendicitis

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Do you ever wonder whether abdominal pain warrants a call to the doctor, or even a visit to the emergency room? How can you tell?

One worry with children and teens is appendicitis. The appendix is a small, tubular-shaped organ in the lower right abdomen, that has no known function. Sometimes it can become inflamed and needs to be surgically removed. If left alone, an inflamed appendix can rupture and cause very serious illness.

Appendicitis can occur at any age, and is often difficult to diagnose.

The American Academy of Pediatrics has a great article here about appendicitis. The main symptom is pain, which begins as a “vague stomachache near the navel,” and then is described as a combination of a sense of fullness and pressure on the lower right side. Here is the complete list of symptoms they give, some of which are similar to stomach viruses, and some of which are different:

“Persistent abdominal pain that migrates from the midsection to the right lower abdomen
Nausea and vomiting
Constipation
Gas pain
Diarrhea
Low fever, beginning after other symptoms
Tenderness in the right lower abdomen
Abdominal swelling
Elevated white blood cell count
Appetite loss.”

Call your doctor immediately if your teen or child experiences these symptoms. Have him lie quietly and “don’t offer water, food, laxatives, aspirin or a heating pad.” Any movement can increase her pain. If appendicitis is suspected, a blood test (to determine white blood cell count) will likely be taken, possibly with other diagnostic tests.

E. coli and other nasty things: how to have good food safety for your cookout or picnic

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The holiday weekend approaches, with plans for picnics, cookouts, reunions, and fun! At the same time we’re hearing about a recall of nearly 2 million pounds of ground beef that is possibly contaminated with E. coli bacteria. How can you be sure about the safety of the food you’re serving your family?

You are right to be cautious. Foodborne illnesses can be very serious, even deadly. E. coli, in particular, can cause organ failure, and children may be especially vulnerable.

Here are some basic rules to keep in mind.

Cook ground meats ALL the way through. Pink interiors mean raw meat, and when that meat is ground, microbes that used to be on the surface of the meat can now be deep inside it. If the meat is fully cooked, any E. coli should be taken care of.
Cook poultry completely through. Chicken, in particular, can be contaminated with Salmonella.
Don’t reuse the plate that held raw meat or poultry. It must be washed before being used to hold cooked meat or other foods. The same goes with knives and other utensils.
Keep food separate. Fruits and vegetables shouldn’t be stored in the same container with uncooked meat and poultry, for example.
Chill leftovers soon. This is important when you’re at a picnic and far from your refrigerator. Take a cooler and ice packs.
Keep your hands clean. Wash them often. Take hand sanitizer on your picnic. Don’t change a baby’s diaper while preparing food.
Wash your fruits and vegetables. When you clean poultry in the sink, be sure to sanitize the sink afterwards so that you don’t contaminate food, dishes and utensils.

More information is available here from the Centers for Disease Control and Prevention.

A fun holiday is a safe holiday. Enjoy the time together and have a great weekend!

I’m thirsty!

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School is almost out and warmer weather is on its way. Hydration is always important, but never more so than when you’re active in warm temperatures. What are the best things to give your kids to drink, and are there drinks they should avoid?

First, drinks to avoid completely:

Energy drinks. Make sure you know the difference between sports drinks and energy drinks. Energy drinks contain stimulants like caffeine and are not appropriate for children and teens. According to the American Academy of Pediatrics: “Caffeine… has been linked to a number of harmful health effects in children, including effects on the developing neurologic and cardiovascular systems.” Caffeine is a drug, and is addictive.
Caffeinated soft drinks. (See bullet point above about the ill effects of caffeine on children and teens.)

Drinks that are okay for occasional use:

Sports drinks. These replace electrolytes and calories lost from prolonged exercise.
Non-caffeinated soft drinks. They are okay on special occasions, but only for older children. Sodas are acidic and therefore are harmful for teeth. Add sugar to that equation and you could be creating some real dental health problems.
Sugary drinks, carbonated or not. These have been linked to childhood obesity in children as young as 4. As with soft drinks, all sugary drinks can cause tooth decay.
Fruit juices. Better options than carbonated drinks, and often a good source of vitamins, they are still calorie rich and shouldn’t be overused.

Drinks that are best:

Water. Always the best way to hydrate, water can be a great part of the healthy child’s diet throughout the day, even when they’re not thirsty. Your kid doesn’t like water? Check out the flavor packets and squirts that add flavors to water.
Low fat milk. If your child or teen can tolerate milk, it is an indispensable source of calcium. If she is unable to drink milk, talk to the pediatrician about alternate sources of calcium.

Finally, a note about very young children.

Nothing but breast milk or formula should go in a baby’s bottle. Even fruit juice is too sugary and can lead to tooth decay. Read here about beverages for the very young.
Children can start learning to use a cup at about 6 months. Still, limit juice to 4-6 ounces per day until the age of 2.
Wean completely from bottles at about 12-15 months of age.

What we drink becomes habit, and starting good drinking habits in childhood is an excellent way to build healthy bodies and teeth for a lifetime.

ADHD—diagnosis, treatment and your concerns

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You hear so much about ADHD these days. It’s in the news. You likely know children, teens or adults who’ve been diagnosed with it. Debates continue about under- and over-diagnosing, and about medicating.

First, just what is ADHD?

ADHD is Attention-Deficit Hyperactivity Disorder. Of course, nearly all children will sometimes be hyperactive and lack focus. How do you know when it’s a problem worth taking to your pediatrician?

The American Academy of Pediatrics has a great article covering the basics of ADHD in which they say, “Children with attention-deficit/hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.” We might add that family life is also greatly affected by a child with ADHD. This same article deals with concerns about medications and why more children are now being diagnosed with ADHD than, say, 10 or 20 years ago.

Another fascinating article about the trend is here, from MacClean’s.

The bottom line is this: yes, it’s a real problem. And yes, it may also be over-diagnosed.

Families of children and teens who have ADHD find that the right medication in the right amount can profoundly help. Specific testing is needed up front, then some time is often required to pinpoint and adjust the proper medication. In addition, coping mechanisms for studying, chores and social skills can assist parents in dealing with ADHD.

At Georgetown Pediatrics, we are conscientious in making the right diagnosis for your child. Four of our physicians (Dr. Hambrick, Dr. Hoddy, Dr. Sweigart and Dr. Forster) are specially trained to diagnose and design a treatment plan specific to your child. With compassion we can help you find your way to a less stressful future with your family.

If you have concerns that your child may have ADHD, contact our office for an appointment.