Category Archives: family

Diabetes testing and prediabetes

Our last two blogs have been about diabetes, types 1 and 2. Now, let’s look at risk factors, testing, and what is called prediabetes.

Risk factors are slightly different for the two types of diabetes (see our previous two blogs to learn more about those types). We’ve gleaned these sets of factors from an article by the Mayo Clinic. Check out that article for more detailed explanation.

Type 1 risk factors

Family history
Environmental factors (such as exposure to certain illnesses)
The presence of damaging immune system cells (autoantibodies)
Dietary factors—though studies don’t show a direct cause and effect, there seems to be some relation to things like early consumption of cow’s milk and cereals, for example
Geography—people who live in some northern European countries have greater risks

Type 2 and prediabetes risk factors

Being overweight or obese
Inactivity
Family history
Race—it’s unclear why certain races (including blacks, Hispanics, American Indians and Asian-Americans) are at higher risk
Age—although type 2 diabetes is increasing at alarming rates among children and youth, risk increases with age
High blood pressure
Abnormal cholesterol and triglyceride levels

Other risk factors in the article pertain to adults.

Prediabetes is a condition that means your blood sugar levels are higher than normal but not yet in the “diabetic” range. It also means that you are at an increased risk of developing type 2 diabetes.

The American Diabetes Association has an online test you can take to determine possible risk. If you believe your child is at risk, talk to your pediatrician.

Please note that the top two risk factors for type 2 diabetes are things over which you likely have a great deal of control. A healthy diet and age-appropriate activity are your best tools for prevention, for your child and for you.

Younger children—don’t just focus on one sport

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Summertime is just around the corner, and it’s time for kids to be outside enjoying themselves. Organized sports are often a part of that. Whether you have big dreams for your child’s sports future (college scholarship, pro career) or she has dreams for herself, it’s important not to push too hard too soon. Doing so can cause injury and, perhaps more importantly, can decrease the all-important fun factor.

Most children love to play with a ball even before they can walk. As their bodies mature, they’ll enjoy learning to swim, running short distances, playing physical games like tag in the backyard. Activities like these are great for children’s physical health and for helping them grow into well-rounded people. Staying active prevents obesity, gives a boost to the immune system, improves mental outlook, and fosters the development of social skills (learning to play fair, settling disputes, taking turns, sharing).

Parents should be cautious by not encouraging a child to play one sport to the exclusion of others. Focusing on one sport, whether it’s swimming, soccer, baseball, gymnastics or something else, can lead to specific injuries. Swimmers may develop shoulder problems; gymnasts can damage joints; runners might get shin splints. Keeping a variety of physical activities in a young child’s life enables the whole body to develop, get stronger and more flexible, and decrease the risk for injury.

Eventually your child may decide to specialize in one sport, but doing so too early goes against the recommendations of the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness. There’s a great article on the subject here. It’s best for your child’s physical, mental and social development to generalize, try a lot of different sports and activities, and to simply have fun.

Are your children and teens getting enough vitamin D?

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Vitamin D: it helps build strong bones, may be protective of some diseases both now and in later life, and very few people get enough of it.

Generally, you hear about vitamin D in relation to milk (it often has vitamin D added to it) and time in the sunlight because UV rays trigger vitamin D production.

However, nearly everyone is short of the recommended dosages of vitamin D. This time of year, for example, there is precious little sunshine, and on sunny days we apply sunscreen to prevent the skin damage and sunburn those same UV rays cause. As much as we promote sunscreen for those very good reasons, it limits the production of vitamin D in our bodies.

The only way for most of us to get all the vitamin D we need is through supplements. They are inexpensive, easily available, and easy to administer.

An article by the AAP (American Academy of Pediatrics) announces their new recommendations that all ages should take vitamin D supplements to ensure bone and immune system health, both now and in the future.

Infants. Since breast milk doesn’t usually contain enough vitamin D, a supplement of 400 IU (international units) is recommended daily for breastfed babies. The recommendation is the same for formula-fed babies, unless they are receiving 32 ounces of formula per day (formulas contain vitamin D). Liquid supplements are best for infants.
Children. By the age of three, when children can chew hard foods, a chewable multivitamin that contains 400 IU of vitamin D is the daily recommendation. If your child is drinking 32 ounces of vitamin-fortified milk each day, she should be getting enough vitamin D without a supplement.
Teens. The recommendation holds for teens: 400 IU of vitamin D daily, whether through diet (though few get enough through food alone) or supplement.

Remember to keep all supplements and medications out of reach for a child.

Build a stronger skeletal and immune system now, and let your child reap the benefits both now and later.

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!

Halloween Safety Tips

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Today’s entire blog below is quoted from the AAP, here. Have a great Halloween!

Halloween is an exciting time of year for kids. Here are some tips from the American Academy of Pediatrics (AAP) to help ensure they have a safe holiday.

All Dressed Up:

Plan costumes that are bright and reflective. Make sure that shoes fit well and that costumes are short enough to prevent tripping, entanglement or contact with flame.
Consider adding reflective tape or striping to costumes and Trick-or-Treat bags for greater visibility.
Because masks can limit or block eyesight, consider non-toxic makeup and decorative hats as safer alternatives. Hats should fit properly to prevent them from sliding over eyes.
When shopping for costumes, wigs and accessories look for and purchase those with a label clearly indicating they are flame resistant.
If a sword, cane, or stick is a part of your child’s costume, make sure it is not sharp or too long. A child may be easily hurt by these accessories if he stumbles or trips.
Obtain flashlights with fresh batteries for all children and their escorts.
Do not use decorative contact lenses without an eye examination and a prescription from an eye care professional. While the packaging on decorative lenses will often make claims such as “one size fits all,” or “no need to see an eye specialist,” obtaining decorative contact lenses without a prescription is both dangerous and illegal. This can cause pain, inflammation, and serious eye disorders and infections, which may lead to permanent vision loss.
Teach children how to call 9-1-1 (or their local emergency number) if they have an emergency or become lost.

Carving a Niche:

Small children should never carve pumpkins. Children can draw a face with markers. Then parents can do the cutting.
Consider using a flashlight or glow stick instead of a candle to light your pumpkin. If you do use a candle, a votive candle is safest.
Candlelit pumpkins should be placed on a sturdy table, away from curtains and other flammable objects, and should never be left unattended.

Home Safe Home:

To keep homes safe for visiting trick-or-treaters, parents should remove from the porch and front yard anything a child could trip over such as garden hoses, toys, bikes and lawn decorations.
Parents should check outdoor lights and replace burned-out bulbs.
Wet leaves should be swept from sidewalks and steps.
Restrain pets so they do not inadvertently jump on or bite a trick-or-treater.

On the Trick-or-Treat Trail:

A parent or responsible adult should always accompany young children on their neighborhood rounds.
If your older children are going alone, plan and review the route that is acceptable to you. Agree on a specific time when they should return home.
Only go to homes with a porch light on and never enter a home or car for a treat.
Because pedestrian injuries are the most common injuries to children on Halloween, remind trick-or-treaters:
- Stay in a group and communicate where they will be going.
- Remember reflective tape for costumes and trick-or-treat bags.
- Carry a cell phone for quick communication.
- Remain on well-lit streets and always use the sidewalk.
- If no sidewalk is available, walk at the far edge of the roadway facing traffic.
- Never cut across yards or use alleys.
- Only cross the street as a group in established crosswalks (as recognized by local custom). Never cross between parked cars or out driveways.
- Don’t assume the right of way. Motorists may have trouble seeing trick-or-treaters. Just because one car stops, doesn’t mean others will!
Law enforcement authorities should be notified immediately of any suspicious or unlawful activity.

Healthy Halloween:

A good meal prior to parties and trick-or-treating will discourage youngsters from filling up on Halloween treats.
Consider purchasing non-food treats for those who visit your home, such as coloring books or pens and pencils.
Wait until children are home to sort and check treats. Though tampering is rare, a responsible adult should closely examine all treats and throw away any spoiled, unwrapped or suspicious items.
Try to ration treats for the days following Halloween.

Whether dressing up in costumes, trick-or-treating, or having parties with their friends, most kids love Halloween. But did you know that Halloween is also a time when more children than usual end up in the emergency room due to falls, traffic collisions and other injuries? All the sweets in the house (and at school) can also wreak havoc on a child’s teeth and healthy diet.

To help ensure your child’s Halloween is both safe and healthy, pediatrician Corinn Cross, MD, FAAP joins the Healthy Children show on RadioMD with some tips from the American Academy of Pediatrics. Listen here.

Stomach virus season

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Yes, we’re starting to see some fall/winter viruses that cause gastrointestinal (GI) problems. By the end of winter, Rotavirus will have been our most common offender, but now that kids are back in school, lots of viruses are happy. Families who get the viruses… not so much.

GI viruses like school, daycare and home settings because these places have children who haven’t always learned good hygiene practices. Prevention is always the best action against these diseases, so don’t forget to CLEAN door handles, toilet seats, other bathroom surfaces, television remotes. Also be sure to wash hands before cooking, serving and eating food.

Another way to hinder a virus is to keep your child home when she’s sick, preventing the spread to other children and adults. That may have been where she came into contact with the virus. Let’s not spread the “love.”

When can you send him back to school or daycare? Make sure he has been fever free for 24 hours (without a fever reducer), is able to tolerate small amounts of bland foods, has gone at least 12 hours since his last episode of vomiting and has had no more than 3 episodes of diarrhea in 8 hours.

Contact our office if diarrhea and vomiting don’t subside within three days or if diarrhea is bloody, if there’s been no urine output for 10 hours, or if the fever is high or doesn’t subside. We have a nurse available for advice on the phone, and we often can call in prescriptions for nausea for older children, unless we think they need to be seen in the office first.

More information? See our blog from last spring which includes a link to the American Academy of Pediatrics article on Rotavirus. Also, our blog regarding when to be concerned about a fever.

Stay healthy this winter!

Back in School, Part 4: Friends

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While you are worrying about your child’s academic year, he is probably more concerned about friends. Honestly, he has a point. While academic skills are an important part to future success and happiness, so are the social skills that help us make and keep friends.

Children at a very young age are usually too self-centered to have friends. This isn’t their fault; it is just a normal developmental stage. If you watch a couple of toddlers on a play date, they will usually engage in what is called “parallel play,” meaning they play side-by-side, but not really together. Even so, you can start to teach them to share, not to grab toys away, etc.

By school age, most children want friends, whether it is just one or many. Good social skills are learned from parents, teachers and peers. Here are some behaviors you can teach your kids that will serve them in school and throughout their lives.

Kindness. Use kind words and tones around the house. Don’t allow your children to be unkind to their siblings, to pets or to adults. Everyone responds positively to kindness, and no one likes a bully.
Politeness. (See our post on manners.)
Assertiveness. You don’t want your child to be aggressive toward others, but you want her to be able to assert her opinions and express her feelings without being overbearing. This takes practice, and it can be something you encourage through conversation, questions, and even role playing. For example, “What will you say if your friend wants to play kickball and you’d rather swing?” They can learn from you the give-and-take of good relationships.
Meeting and greeting. Teach your youngster to introduce himself and to ask questions about another person. They can learn to shake hands, make eye contact, smile.
Listening. Hearing what another person has to say is as important as expressing your opinion.

Here’s a really nice FREE online resource entitled 101 Ways to Teach Social Skills to Children. While the games and activities are designed for groups, many of them can be adapted for use within the family—a fun way to learn appropriate ways of behaving in different settings.

Every school in Scott County has a counselor who can observe behavioral issues both in and out of the classroom, and who can meet with your child and/or other students if needed.

A final word: pay attention to the friendships your child/teen is forming. Get to know his friends and their parents. Make sure their behavior isn’t out of line with what you expect from your own kids.

The friendships we form in childhood and adolescence may or may not last a lifetime. But they teach us skills and behaviors that are timeless.

Back in School, Part 3: Teachers

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Every morning when you send your child to school, you are putting her into the educational, social, emotional and physical care of other adults. This can be intimidating at times, but it doesn’t have to be.

The vast majority of teachers are in classrooms because they want to be, because they care about the students and love the material they teach, and because they want to make a difference. They spend time in the classroom trying to instill in youngsters the love of learning. And they spend time outside the classroom preparing lessons, grading work, and keeping the mountains of records and paperwork required by the school system.

Most of all, they want every child—your child—to be successful. That success is far less likely without your support.

Speak positively about your child’s teachers. If you hear complaints from your young student, listen with an objective mind.
Establish a relationship with a teacher. If you can volunteer at the school, wonderful. Your schedule may not allow that, so find other ways to be in touch.
- Stay connected. Most teachers and classrooms have a website. Send the teacher an e-mail when you appreciate something he’s done for your child or if you have a question. If there’s ever a problem, you will have built a positive base for your relationship, and the problem will be easier to deal with.
- Attend parent-teacher conferences. These are important for everyone concerned: student, teacher, family. You will learn things about the classroom and how your child interacts with adults and classmates, and will come away with a much more rounded picture of the education process in that particular class.
- Make appointments. Don’t wait for a conference if you have questions or concerns. Face-to-face meetings are helpful and teachers want to be available to you. They will want to hear from you sooner rather than later.
- Reinforce at home what’s happening in the classroom. From spelling tests to chemistry homework, from learning how to talk out problems with fellow students to deciding what to eat for lunch, the teacher and you are on the same team.
- Of course, if there is ever concern about inappropriate or illegal activity by a teacher or any other adult, notify the authorities immediately.

Teachers are on the front lines of helping your child develop in age-appropriate ways. Support them, connect with them, and thank them.

Back in School, Part 2: Homework

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If it seems that with the new school year your kids’ amount of homework has increased, that’s likely true. Each year a new grade brings with it increasing amounts of responsibility, including homework. Some homework can be started during the school day, but often it needs to be finished after hours.

Homework can sometimes seem overwhelming, both for your child and for the whole family. Here are a few helpful tips.

Attitude. If you treat homework as positively as possible, that will help your young student. Doing schoolwork at home has many up sides, including letting you in on how things are going at school. You’ll learn what your child is studying and how easy or difficult a particular subject is for him.
Assistance. You shouldn’t do your child’s homework, but there are many things you can help her with. Memorization is one of the biggest. Make practicing for spelling and arithmetic tests fun. Make flash cards together out of scrap paper cut into squares. Use free online websites to get ideas or even create games around specific words or subjects. Prepping for a social studies test about Mexico? Make sure you understand what topics are being covered, and look at some web videos that show art, culture and travel.
Time. This is the biggie, isn’t it? You’ve been thrown from sleeping in and days by the pool, to waiting for the bus and trying to decide what to have for supper and how you’ll get everyone where they need to be when they need to be there. Every day is crunch time. How to schedule in homework?
- These first few weeks are important in figuring out which subjects and days of the week will require more time.
- Negotiate with the students in your house. They may need a little down time to play a game and have a snack when they first get home, or they may prefer to get homework out of the way.
- Do a back-off timetable from bedtime. Figure out when they need to be in bed, about how much time homework will take, and work out with the students when and how they’ll get the work done.
- If the time is overwhelming and your child is spending far too much time with homework, talk to the teacher. This is important information for any teacher to know.
Space. Find the right space where you can keep an eye on computer screens while also limiting distractions.
Support. The Scott County Library has online help from 2 p.m. until midnight, a great local resource. Many teachers and classrooms have their own website where homework assignments may be posted. For middle and high school, get familiar with the Infinite Campus site, where you can follow grades and attendance. There’s even an app in the Apple Store.
Involvement. If you see problems developing, don’t wait. Talk to your child’s teacher right away. Usually they’ll have good ideas for helping your youngster’s academic progress at home. If you worry that there may be a medical problem or learning disability, contact our office for an appointment.

Homework is an essential tool in learning, both now and in developing the right skills for a lifetime. With your help and encouragement, the students in your family can do well.