Category Archives: checkups

Blood pressure checks for children and teens

Did you know that it’s possible for children to develop hypertension (high blood pressure)? Sometimes it is a genetic issue; sometimes it’s related to diet and lack of exercise. On rare occasions it can signal a serious underlying condition.

If your child’s blood pressure is too high, the pediatrician may want to do some tests to determine the cause, especially if the child is of normal weight. If obesity is the cause of hypertension, the doctor and nutritionist will help you develop a diet and exercise program to normalize weight and blood pressure. You will want to make sure that your child loses weight in a safe manor. Normal weight can also help prevent many other serious health issues, like diabetes.

Here’s a chart from emedicine and the American Academy of Pediatrics that gives normal ranges for heart rate (pulse), blood pressure, and respiration for children and teens.

Age	Heart Rate (beats/min)	Blood Pressure (mm Hg)	Respiratory Rate (breaths/min)
Premature	120-170 *	55-75/35-45†	40-70†
0-3 mo	100-150 *	65-85/45-55	35-55
3-6 mo	90-120	70-90/50-65	30-45
6-12 mo	80-120	80-100/55-65	25-40
1-3 yr	70-110	90-105/55-70	20-30
3-6 yr	65-110	95-110/60-75	20-25
6-12 yr	60-95	100-120/60-75	14-22
12 > yr	55-85	110-135/65-85	12-18

* From Dieckmann R, Brownstein D, Gausche-Hill M (eds): Pediatric Education for Prehospital Professionals. Sudbury, Mass, Jones & Bartlett, American Academy of Pediatrics, 2000, pp 43-45.

Also check out this article from the American Academy of Pediatrics about hypertension in children and teens. It gives lots of good information in how to prevent high blood pressure, signs and symptoms, and the importance of early detection.

At Georgetown Pediatrics, we typically start testing blood pressure in 3-year-olds. It’s something you should mention to your child because she might be frightened by it. Let her know it will squeeze tightly but won’t hurt. Some children even experience what health professionals call “white coat syndrome,” meaning a fear of medical offices and personnel. You can help your child get over this fear by not expressing any concerns in front of him, but speaking positively about doctors, nurses, and staff. Tell him that all those people like him and want him to stay healthy. Smile when you talk about them, be positive when you are in the office.

As your medical home, we always want your child to feel as comfortable as possible here.

Patient-centered Medical Home, Part 2: Your Part

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Remember that you will get the most from your PCMH, Georgetown Pediatrics, if you participate with the team.

What your PCMH team should do:

Learn about your child.
- Get to know your family, your child, your life situation, and preferences. Remember these details about you every time you seek care for your child and suggest treatments that work for YOUR CHILD.
- Treat you and your child as a full team member in your child’s care.
Communicate with you and your child.
- Give you time to ask questions and answer them in a way you understand.
- Make sure you know and understand all of your options for your child’s care.
- Help you decide what care is best for your child. Sometimes more care is not better care.
- Ask your feedback about your child’s experience getting care.
Support you in caring for your child.
- Make sure you leave the office with a clear idea of how to care for your child.
- Help you set goals for your child’s care and help your child meet those goals one step at a time.
- Give you information about classes, support groups, or other types of services to help you learn more about your child’s condition and keep them healthy.

What you can do.

Learn about caring for your child.
- Know that you are a full team member in your child’s care.
- Learn about your child’s condition and what you can do to help them stay as healthy as possible.
- As best you can, follow the plan that you, your child, and your PCMH team have agreed is important for your child’s health. If you have questions, ask!
Communicate with your child’s PCMH care team.
- Always bring a list of questions to each of your child’s appointments. Also, bring a list of any medicines, vitamins, or remedies your child uses.
- Always tell your child’s PCMH team when you don’t understand something they said. Ask them to explain it in a different way.
- Always tell your child’s PCMH team if your child gets care from other health care professionals, so they can help coordinate the best care possible.
- Always talk openly with your child’s PCMH team about you and your child’s experience and getting care from the medical home so they can make care better.

Together, you and we will make Georgetown Pediatrics the medical practice that works best for your family.

Georgetown Pediatrics: Your Patient-Centered Medical Home

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Georgetown Pediatrics is proud to be your Patient-Centered Medical Home (PCMH). Just what is that, you may wonder? As defined by the National Committee for Quality Assurance, PCMH is a way of organizing primary care that emphasizes care coordination and communication to transform primary care into “what patients want it to be.”

Medical homes can lead to higher quality and lower costs, and can improve your child’s and your physician’s experience of care.

Essentially, with input from your family, a PCMH offers a patient-centered approach with our team of medical professionals and technology to provide the best possible care for your child.

In a PCMH like ours, your care team:

Is available 24/7 if you need them. You can communicate with your team by phone or email, and you can get an appointment quickly, even on the same day if needed.
Knows your child and remembers your health history. They know enough about your child’s personal or family history to suggest treatment options that make sense for your child.
Makes sure you understand your child’s condition(s) and how to take care of them. They help you sort through your options and make decisions about your child’s care.
Helps you coordinate your child’s healthcare—even if they are not giving the care themselves. They will help you find specialists, get appointments, and make sure those specialists have all the information they need. Your PCMH team will also be sure you know what the specialists say and what it means for your child.

Who is part of the PCMH team? The PCMH team will work like many athletic sports teams. There is the primary doctor (Head Coach), nurse (Assistant Coach), as well as other health care professionals who may assist in your child’s care, such as: pharmacists (Defensive Coordinators) and physical therapists (Offensive Coordinators). Your family caregivers are also included in your child’s team (fans). With a team approach and the input from your child’s “coaches” and “fans,” your child will feel like a “Star Player” of the team—with a championship level of care!

Back in School, Part 1: Staying Healthy

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Now that your child is back in school, the sometimes easy-breezy days of summer have turned hectic with schedules, deadlines, homework, complex relationships. For the next few weeks we’ll be running a series about things to keep in mind during the school year ahead.

Today we start with how best to insure a healthy year at school.

You already know the best way to stay healthy, but it bears repeating: prevention is always the best medicine. Here are some pointers.

Checkups. Has your child had her annual well child checkup? If not, now is the time to schedule it. The doctor will look at health history, height and weight, and will discuss age-appropriate health topics with you and your child. If you have a specific concern (social behaviors, learning difficulties, chronic ear infections, etc.) to discuss, you’ll want to let the office know when you call for the appointment to make sure they schedule a longer visit for you.
Immunizations. Yes, we harp on this a lot, but it’s for good reason. Immunizations protect children, families, and even whole communities from dangerous diseases. The state requires that you keep certain ones up to date; we have others we recommend. Check with our office (or on the patient portal) for your records.
Exercise. Sitting all day at school, then coming home and sitting in front of the TV or at the computer and homework desk is not good for your kid. He needs to get moving. Don’t expect physical education classes to provide all the exercise he needs. Unstructured play is good for all children, and organized sports are a great way to learn things like discipline, teamwork and a sense of accomplishment.
Germs. Let’s be honest. There’s no way to avoid germs at school. Uncovered coughs and sneezes, shared desks and close quarters give viruses all sorts of opportunities to infect students. Some exposure is good to develop immunity, but keeping hands clean is a great way to stave off colds and flu. Send hand sanitizer to school in your children’s backpack, and remind them to clean their hands before eating and after they use the restroom. Every time. Don’t share drinks or eating utensils. And, while we’re at it, remind them not to share combs, brushes or hats, which is the most common way to spread head lice.
Sleep. A good night’s sleep is an essential ingredient in the learning process. Sleep also helps mood and strengthens the immune system. Set a regular bedtime and stick with it, making sure your child or teen has an age-appropriate amount of sleep.
Balanced diet. Eating right feeds both body and brain. This webpage at the American Academy of Pediatrics site lists several of their articles regarding diet. Don’t forget we have a dietician on staff who can help you come up with an action plan for your young athlete, picky eater, diabetic, or can help you plan easy lunches and snacks to pack for school.

Keep these things in mind throughout the school year and they will help your child have a successful and healthy school year.

Measles

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You’ve been hearing about measles outbreaks in the news lately. Also called rubeola, measles is a respiratory disease caused by a virus. It causes a rash over the entire body, a fever and runny nose. According to the Centers for Disease Control and Prevention, “About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia.” Measles can also, rarely, be fatal. Between one and two children in 1000 who get the disease will die from it. The disease can also strike adults.

If you thought measles was a disease left in the past, think again. An outbreak this year in Ohio (374 cases in 4 months) has health departments all over the country concerned, because such an event can happen anywhere. The Ohio outbreak began when unvaccinated people traveled abroad to places where measles is more common because a larger percentage of the population is unvaccinated.

It’s no coincidence that we used the word “unvaccinated” twice in that last sentence. The reason measles is spreading again in the United States is because of a drop in MMR (Measles, Mumps and Rubella) vaccinations. Those who decide not to be vaccinated (or to have their children vaccinated) put themselves, their families and their communities at risk for dangerous diseases. As with most diseases, those at highest risk are the very young, the very old, and those with compromised immune systems.

The MMR vaccination is required for students in Scott County Schools, and HIGHLY recommended for all other children. The State of Kentucky requires two doses of the MMR vaccine before your child can enter school. If you have concerns about vaccinations, talk to your pediatrician.

Remember that the extremely rare risk of a reaction to a vaccination is much smaller than the risk of being unvaccinated against a dangerous illness.

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.

Flu vaccinations are working

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Having encouraged all of you to be vaccinated against the flu, we think this is a good time to give you a local update.

Here are some very interesting statistics:

So far this season, Georgetown Pediatrics has administered 4200 doses of flu vaccine, including both shots and nasal mist.
We have had 76 positive flu tests in our office. Of those 76, one was influenza type B, one was both influenza A and B, and 74 were influenza type A (H1N1).
Only 22 patients who received flu vaccine in our office also tested positive in our office for the flu. Of course, some patients may have been diagnosed with the flu elsewhere or had the flu and weren’t diagnosed at all, or some may have received the vaccine elsewhere. Even so, we are happy to note that only 1 in 190 patients who received our vaccines tested positive for flu here.

The bottom line is that flu vaccine works.

Something else you should know: it isn’t too late to get the vaccine. Even if you’ve already had the flu, it was likely type A, and you can still contract type B. Both types are covered by the vaccines. Once kids are back in school after these snow days the virus is bound to be spread more.
We often see cases of influenza B all the way until spring break, so don’t hesitate to come in. Just remember that if you receive the nasal mist you will test positive for the flu for about two weeks, because it’s a live vaccine and the test is a nasal swab.

As winter drags on, you may not be able to stop the snow and ice, but you can certainly lower the risk of your family getting the flu.

Whooping cough–don’t take it lightly

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Whooping cough. It sounds like one of those old-fashioned diseases that shouldn’t be around anymore. In reality, it’s as modern as today’s news, and more common than you might think.

The good news is that it’s mostly preventable and treatable; the bad news is that it’s still a dangerous disease, especially for the very young.

A few confirmed cases of whooping cough (pertussis) in the Scott County Schools have spurred us to remind you of the dangers of this disease.

Whooping cough is a bacterial infection whose most striking symptom is described in its name—a loud, persistent cough that doesn’t easily go away. In an older child, there is a “whooping” sound made as the child tries to catch her breath between coughs. Infants may not “whoop,” but you should call the pediatrician if your infant has a persistent cough that seems to exhaust him, and his appetite has decreased.

This disease affects the lining of the bronchial tubes , and is very contagious because the vigorous coughing disperses the bacteria into the air. Anyone of any age can get it, but it’s most dangerous among the very young.

Infants and young children, in particular, can develop life-threatening illnesses from whooping cough, including pneumonia. Hospitalization is often required. This means that they, and the people around them, should be immunized.

We cannot stress enough the importance of getting the appropriate immunizations at the right ages. The pertussis vaccine doesn’t last forever, and must be taken at intervals to be effective.

Children should have a total of 5 pertussis (whooping cough) vaccines before they start school.
The youngest children are at highest risk and the most vulnerable to this disease, and should have vaccines at 2 months, 4 months, and 6 months of age.
Booster shots are given at 12-18 months, and
again at 4-5 years of age.
The College of Gynecology and Obstetrics recommends that pregnant women receive a pertussis vaccine with each pregnancy to reduce the chances of whooping cough in their newborn.
Caregivers and other adults who live or work with infants should also be re-immunized, because they’ve lost immunity from their childhood vaccines. They may not even realize they have whooping cough, because symptoms are not as severe. It may simply feel like a lingering cough from a cold, but they can transmit it to the children in their care.

When should you bring your child to the pediatrician for whooping cough? If he has cold symptoms, and you notice that the cough is worsening at about the time when it should be getting better, call our office for an immediate appointment.

There is a test we can do in the office, but it has to be sent to a lab, which takes several days. In the meantime, if the pediatrician suspects pertussis, your child will be started on a five-day course of antibiotics. The child is considered contagious and should not return to school or daycare until the five-day course has been completed.

To read more, check out this article from the American Academy of Pediatrics. Also, see our Facebook November 8 reposting of an article from two years ago by our own Dr. Hambrick. The experience of one of his own children having been made dangerously sick by this disease makes him particularly diligent in trying to keep your child healthy. artwork by Macy

: artwork by Macy

It’s time for flu vaccine!

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Georgetown Pediatrics has this year’s flu vaccine ready for your child. Here are a few answers to common questions about the vaccine.

Why get a flu vaccine? Influenza can be a very dangerous disease, and at the very least can make your child be sick for several days. With a vaccine, even if your child gets the flu, it is typically a milder case.
My child had the flu vaccine last year. Does she really need to have one this year, too? Yes. Each year the vaccine is specifically designed and manufactured to be effective against the expected flu outbreaks for that particular flu season. In addition, the vaccine is effective for a few months. For both of those reasons, the vaccine should be administered every year.
Should my infant or toddler get a flu vaccine? Yes, if he’s at least 6 months old. Children who are 6 months to 2 years old are especially susceptible to the flu and it can be very dangerous for them.
Should my child get the flu vaccine as an injection or as the nasal mist? That depends. The nasal mist is easier for most people to take, and is approved for those between the ages of 2 and 49. Since it is a live (though weakened) virus, the short-term side effects (cold-like symptoms) can be a little stronger as the body’s natural reactions take effect. Children who have a compromised immune system (or who have close contact with someone who has a compromised immune system) should get the flu shot instead of the nasal spray. Also, those with certain health conditions like asthma or wheezing, or conditions requiring long-term aspirin usage should take the shot rather than the mist. More information about the flu mist is found here.
Who should NOT get any flu vaccine? Check with your doctor if any of these conditions apply:
- NOTE: If your child has an allergy to eggs, she may still be able to take the vaccine. Check with your pediatrician.
- If your child or adolescent has had other vaccines within the past four weeks.

We have flu vaccine available now. Call for an appointment. And read more about influenza and the vaccines here.

artwork by Josh

Should you use a medical clinic in a store?

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The key to providing the best possible care for your child is to provide a medical home where there is a continuity of care. It seems that you can hardly open a newspaper or turn on your radio without hearing about retail-based clinics (RBCs), also called convenient care clinics. They are often found in supermarkets, pharmacies, and other retail locations. They pride themselves on getting patients in, making a quick diagnosis, and getting patients out the door with medications in hand. You should know that the American Academy of Pediatrics (AAP) has some concerns.

The AAP has taken a strong stand against RBCs, stating that it “opposes retail-based clinics as an appropriate source of medical care for infants, children and adolescents and strongly discourages their use.” *
The AAP supports a model of care called the medical home, which provides accessible, family-centered, comprehensive, continuous, coordinated, compassionate, and culturally effective care for which the pediatrician and family share responsibility.**
Retail-based clinics are staffed by nurse practitioners or physician assistants with no physician on site to help these providers.
No one reviews these clinics for compliance and quality issues the way that our office is reviewed.

There is no such thing as a “minor illness” when it comes to children. We use these “minor illness” visits to identify other, potentially more serious issues. We also use this time with you to stay current on the events in your family’s and your child’s life.

Getting routine care for your child should be done by your pediatrician who knows you and your family.

Our office is working to ensure that we meet your needs while also being the medical home. We are open 7 days a week and can accommodate same-day “illness” appointments in most situations. You can be sure you will get the highest quality care from us, in a way that works for you and your family.

REFERENCES

*American Academy of Pediatrics, Retail-Based Clinic Policy Work Group. AAP principles concerning retail-based clinics. Pediatrics, 2006;118:2561-2562
** American Academy of Pediatrics, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. The medical home. Pediatrics. 2002;110:184-186
Artwork by Molly