Category Archives: physicals

New information about preventing peanut allergies

An extensive study of children and peanut allergies has recently been released, and it encourages pediatricians to re-assess the recommendations that have been in place for some time. The study, called LEAP (Learning Early About Peanut Allergy), looked at children who have a severe or mild risk of developing peanut allergy and those who don’t.

Peanut allergies have been on the rise in recent years. Conventional wisdom has been that infants and toddlers should not be given peanuts or peanut products until they were older. That wisdom is now changing as a result of the LEAP study, conducted by the National Institute of Allergy and Infectious Diseases (NIAID).

The director of NIAID said in a recent press release: “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”

So, what are the new guidelines, and what should parents do about introducing peanuts to the diets of their young children?

For babies who are considered to be at NO risk for developing a peanut allergy, parents can begin introducing peanut butter with solid foods at about six months of age. The LEAP study concludes that once peanut butter is introduced and tolerated with no allergic reaction, it should remain in the baby’s diet with some regularity.

There are different guidelines for babies and young children who are determined to be at moderate or severe risk of developing peanut allergy. How do you know whether or not your child is at risk? There are several factors that contribute to that risk, and it’s a conversation you should have with your child’s pediatrician in the office before introducing peanut butter into the diet.

Your concerns are our concerns, and we look forward to answering any questions you may have at your child’s next checkup.

The consequences of lead poisoning in children

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The tragic, preventable events in Flint, Michigan, have brought to the nation’s attention the results of lead poisoning, especially in children. It’s a good time to remember that lead poisoning can be a risk, no matter where you live.

How are children exposed to lead? Lead can be inhaled in polluted air (which is why lead was removed from gasoline decades ago). Children can be exposed through paint containing lead, either by eating paint chips or when lead paint is removed and is introduced into the air. They can also ingest lead through tainted drinking water, which is what has happened in Flint.

Children are at greater risk than adults because their bodies absorb higher percentages of lead. In addition, their developing bodies are more easily and irreversibly damaged.

Some of the worst and most obvious problems that result from lead poisoning occur in the central nervous system. Brain development can be greatly affected, especially in those under the age of two. Such problems are permanent.

Other severe effects can include anemia, kidney problems, endocrine issues (including the inhibiting of normal growth), and gastrointestinal concerns (like vomiting and constipation). Both small motor and large motor skills suffer from lead poisoning.

Because lead so severely affects the central nervous system, children often exhibit serious behavioral problems like aggression, impulsive behavior, and difficulty with attention—problems that don’t end with childhood. Later in life, these individuals experience a much higher than normal incidence of substance abuse.

The growing understanding of the severity of the consequences of lead poisoning has caused the Centers for Disease Control and prevention to modify its definition of toxic lead levels over the past several decades to one twelfth of its former measurement (from 60 micrograms/deciliter in 1970 to 5 mcg/dL in the current definition).

So, what can we and you do to prevent lead poisoning? First, make sure you limit your child’s exposure to lead. If you’re concerned because you live in an older home, you can have your water tested to be certain that no lead is leeching into the system from pipes. Make sure that any lead paint has been removed.

In our office, we assess lead levels at the one year checkup. In addition, we have increased our frequency of using a verbal questionnaire to screen for risks, starting at six months of age.

Together, we can reduce or eliminate your child’s risk of toxic lead exposure.

***Much of the information in today’s blog was gleaned from “Pediatric News,” Vol. 50, number 3, March 2016.

Sports physicals – it’s time

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Your kids are on the move – literally, and all the time! If they are involved in a fall sport at school, then it’s time for their sports physical. Don’t forget that there is tremendous benefit to getting these physicals at your child’s pediatric office, rather than at a clinic or a school-sponsored physical day. The pediatrician has all your records including vaccinations, allergies, and your individualized and family medical history. He or she can discuss important sports information with you, including nutrition. And, of course, follow-up is always readily available, whether one week or six months from now. We are delighted to be working, with you as our partner, to make a medical home for your family here with us. If your child has a physical at a clinic or the school, that physical is not a part of our records, and we end up with an incomplete picture of his or her development and needs. Read our previous blog post for more reasons on why it’s wise to bring your child to the pediatrician when it’s time for a physical.

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!

Why narcotics are prescribed carefully

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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.