When is a fever something to be concerned about?

That’s a great question, because we probably get more calls about fevers than about anything else.

The American Academy of Pediatrics published a brief article about fever and treating it, reminding parents that fever is the body’s way of fighting an illness, and the reason to treat it is to make the child more comfortable. They emphasize:

watching for signs of serious illness;
being careful of dosage amount based on the child’s weight;
keeping the child well-hydrated;
storing the medication in a safe place;
not waking the child up to administer the medication.

So, what should you be watching for, and when do you call the pediatrician? Here we’ve quoted a list from the same article that we think is quite helpful:

“Call your child’s doctor right away if your child has a fever and

Looks very ill, is unusually drowsy, or is very fussy.
Has been in a very hot place, such as an overheated car.
Has other symptoms, such as a stiff neck, severe headache, severe sore throat, severe ear pain, an unexplained rash, or repeated vomiting or diarrhea.
Has immune system problems, such as sickle cell disease or cancer, or is taking steroids.
Has had a seizure.
Is younger than 3 months (12 weeks) and has a temperature of 100.4°F (38.0°C) or higher.
Fever rises above 104°F (40°C) repeatedly for a child of any age.

“Also call your child’s doctor if

Your child still “acts sick” once his fever is brought down.
Your child seems to be getting worse.
The fever persists for more than 24 hours in a child younger than 2 years.
The fever persists for more than 3 days (72 hours) in a child 2 years of age or older.”

Don’t forget: since a fever is a sign of an illness, do NOT send your child back to school/daycare until his temperature has been under 101 for 24 hours.

Together, we’ll work at keeping your child healthy.

Artwork by Tori

Preparing for (owie!) shots

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No one likes to get a shot, but we all know they are necessary. Whether getting an annual flu vaccine or immunizations for school, your child will sometimes be coming to our office to receive a shot. How you prepare your child is important and may make the event go better for all concerned.

While every child is different, some basics are helpful.

Tell the truth. If you tell your child she’s not getting a shot, or that it won’t hurt, she may not want to go to the doctor’s office again, even when she won’t be getting a shot.
Tell the truth–again. Explain that though the shot will hurt a little, it won’t last long and it will keep him healthy for a very long time.
Don’t blame the doctor or nurse. They often hear some version of: “If you don’t behave, the nurse will give you a shot.” Vaccinations are not punishment; they are insurance against future illness. Words spoken against the nurse or doctor, even in jest, can harm your child’s view of medical personnel—the people who are there to help. Your child should feel positively about our staff; it will make it easier for you to bring him the next time he’s sick.
Have a conversation and plan a reward. Some children can’t keep from crying, but you can help them refrain from dramatic overreaction. Let them know what is going to happen, and that you expect them to be kind and behave appropriately for their age. A promised reward can help—a bike ride with you, a favorite dessert, a play date with a friend.

Getting a shot isn’t fun, but with some assistance from you, we’ll make the experience as painless as possible for all concerned!

This week’s artwork

Moving on…

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It is with both joy and sadness that we announce the upcoming retirement of Suetta Williamson, the “Voice of Georgetown Pediatrics” for the past 21 years. As our receptionist, Suetta was likely the first person you spoke to in our office. Her warm and cheerful attitude and her ability to make people feel welcome have been the essence of her work. Suetta’s calm voice is just what a parent needs to hear when a child is sick. These wonderful personal qualities make her leaving particularly hard for us.

Our joy is in knowing that Suetta is now beginning the next portion of her life’s journey. She’ll have more time for family, especially her grandchildren; she can spend more time in the garden and pursue all those things she has put off for the last two decades.

Suetta’s official retirement date will be October 21, exactly 21 years from the day she was hired! She has been a huge part of the success of Georgetown Pediatrics. We know you will join with us in wishing her well even as we recognize how much she will be missed. In the words of Dr. Hambrick: “Go well, stay well, come back well.”

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

We welcome Dr. Lacey Sweigart to our practice!

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For the second time this summer, Georgetown Pediatrics is expanding our staff so that we may better serve our patients.

Dr. Lacey Sweigart comes to us from the University of Colorado Department of Pediatrics, where she completed her three-year residency, culminating in a fourth year as Chief Resident of the program. Her references were filled with superlatives like “superstar” and “excelled in every aspect,” and her résumé includes a long list of awards and publications, as well as public service. For our part, we were taken with her well-rounded background that is both deep and broad—necessary qualities in a practice like ours. Her Spanish-speaking ability will also be a tremendous asset.

Wanting to live closer to family, Dr. Sweigart , her husband Joe (who recently took a position as a physician with the University of Kentucky), and their three-month-old son Nathan will be moving here soon. They’ll fit right in to Kentucky with their love of hiking, camping, and travel, and are even bringing their horse! Dr. Sweigart says, “Georgetown specifically attracted us with its small town feel and the fact that everyone we spoke with felt that it was a great place to live and raise a family.”

She also was drawn to Georgetown Pediatrics because “the group has amazing physicians who are very dedicated to their patients and provide a supportive environment both to bring your children to and to work in.”

Dr. Sweigart begins her work with us on September 9. You may call the office anytime to schedule a checkup with her.

Dr. Lacey Sweigart

To use or not to use antibiotics

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So your child has been coughing and sneezing for a week, has a bit of fever, a little green mucous coming from the nose, and has missed school or childcare, which causes you to miss work. You see the pediatrician to get a prescription for an antibiotic, but you walk out disappointed. Why didn’t they prescribe what you wanted?

Since penicillin was first manufactured in the 1940s, antibiotics have been quite successful in treating bacterial infections, reducing the spread of disease, and saving many lives. In the last few years, though, it’s been determined that overuse of antibiotics has led to the growth and spread of antibiotic-resistant bacterial infections.

Check out this article at USA Today.

Even so, your child’s pediatrician will not shy from using antibiotics when they are warranted. Here’s the thing: antibiotics are completely ineffective against colds or other viruses. Your child may sometimes feel better after taking antibiotics, simply because the virus began to subside on its own as the body fights back.

Research continues to create new antiviral drugs that will work against viruses (with much success in the area of influenza). In the meantime, don’t forget that antibiotics work only in the fight against bacterial infections, and also with some funguses and parasites. And if you do take an antibiotic, MAKE SURE YOU TAKE ALL THAT ARE PRESCRIBED. Stopping the course just because you feel better can lead to drug-resistant infections later on.

Corinne, age 5

Teaching your children and teens financial responsibility

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Shhhh. Don’t tell your kids, but it’s almost time for school! Just starting school is costly, with all the supplies and book fees, sports, extracurricular activities, field trips, etc. The school year requires planning, budgeting, and financial decisions. Those are skills you’ve acquired over a lifetime.

But what about your child? Does she need to start learning those skills, too? Do you want him to grow up able to manage money and work? Where to start?

The good news is that it’s never too late to begin teaching the importance of financial responsibility.

Start with chores. These should be age-appropriate and reasonable. Even a toddler can help put toys away, and they love to “help” by pretending with their toy vacuum cleaner or child-sized leaf rake. Elementary aged children can set the table for meals and put their dirty dishes in the sink, make their beds and collect trash. Teens can contribute with yard work and house cleaning.
Build a sense of accomplishment. Lavish praise for a job well done. Post of checklist of chores in a prominent place, and check them off when done. Allow your child some choices: “Would you rather set the table or clear it after we eat?”
Tie chores to allowance. Make expectations clear up front. Keep the allowance reasonable as it relates to family finances.
Set some rules about handling money. Determine percentages for saving, giving to charity, and spending. Discuss the benefits of long-term saving.
When your teen nears driving age, talk together about the privilege (and cost) of using the family car, and decide well in advance what costs the teen will assume. Be clear about how one earns—and loses—the privilege of driving.
Teach your teens the value of work by encouraging them to get a job, but make sure that job doesn’t interfere with school.
Help your child open a bank account. When in elementary school children can start savings accounts, and when teens start a job they can open a checking account.

With your help, your children can grow up financially healthy, with good attitudes about spending and saving.

Artwork by Molly

The truth about poison ivy

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There’s that little bumpy rash, trying to keep from scratching, pink lotions… Just reading the description makes you start to itch.

More time out of doors in the summer leads to more exposure to lots of things, including poison ivy. But there are lots of myths about how it’s spread and how to treat it.

True: The rash results from exposure to a poison ivy plant. All poison ivy is three-leaved, but it doesn’t all look the same. Sometimes the leaves have a reddish tint; sometimes the plant is all green. It can grow low to the ground or vining up a tree. Leaves can be quite small or 8 to 10 inches across. The rule often quoted is: “Leaves of three, let it be.” Good advice.

True: It’s the oil of the plant that causes the rash. So, it’s possible to get a rash even if you were wearing long pants through a poison ivy patch, by touching the clothing later. Some people have contracted poison ivy when burning brush, as they inhaled the smoke.

False: You can get a poison ivy rash by touching someone else’s rash, especially if it is oozing fluid. This is only true if there is still oil from the plant remaining on the rash—an unlikely scenario. You can, however, get the oil from the fur of a pet that has been out of doors. And if you have the oil on your hands, any skin that you touch can develop a rash.

False: Some people are immune to poison ivy. While it’s true that everyone’s susceptibility level is different, exposure to enough of the plant oil can cause anyone to break out in a rash.

According to an article by the American Academy of Pediatrics (AAP), if you believe your child has been exposed to poison ivy, wash the affected area as soon as possible with soap and water for several minutes, and wash the clothing immediately. Use calamine lotion 3 or 4 times per day to reduce itching, and/or 1% hydrocortisone cream to decrease swelling. Call your pediatrician if the rash covers a very large area or doesn’t respond to treatments, if there’s a severe rash on the face, a fever or any other indication of infection, or a new outbreak.

The best treatment of all is to avoid contact with the plant in the first place, so teach your child what it looks like.

Shelby, age 5

HPV vaccine: the who, what, when, and why

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You’ve heard of HPV (Human Papillomavirus), but you may not be sure what it is or what (if anything) you should do about preventing it in your children and teens.

[Most of the information that follows is adapted from the websites of the Centers for Disease Control and Prevention (see here at CDC).]

THE WHAT: HPV is the most common sexually transmitted infection (STI), and there are more than 40 types of HPV. It’s unrelated to HIV, herpes, or any other STI. HPV can cause genital warts, cervical and other types of cancer.

There are two types of vaccine. Cervarix is for females only, and protects against cervical cancers. The other, Gardasil, is for both males and females, and protects against genital warts as well as cancers of the cervix, anus, and vulva. As of 2012, over 46 million doses had been distributed in the US (most of them Gardasil). The vaccine is considered to be very safe and highly effective.

THE WHO AND THE WHEN: Both males and females can contract HPV, from genital contact or from oral or genital sex. It’s recommended that preteens (ages 11-12) of both sexes receive the series of three doses so that they can develop an immune response before they become sexually active. Gardasil is considered effective in teenagers and young adults through the age of 26.

THE WHY: Since a person can contract HPV even if he/she only has one sex partner, and since someone can have HPV for years without symptoms and therefore not even know that she or he has the virus, parents should consider whether this vaccine is right for their preteen or teen. The very good news is this: studies indicate that the vaccine is highly effective: the HPV rate of transmission in adolescents is declining faster than expected.

Ask your pediatrician about this. That’s why we’re here.

artwork by Camille