Batter up!

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Baseball is here for the summer, for kids of all ages. Grownups, too, for that matter. If you’ve ever had a pitcher in the family, you know that shoulder injuries are common, and if you’ve ever watched a slow motion video of a pitcher’s action, you can see why. It’s not an entirely natural motion, and done repetitively, it can cause injury. Pain and swelling may occur and sometimes even surgery is required if the damage is severe.

Little League Baseball has guidelines in place, designed to prevent injury. These rules govern both the number of pitches allowed per day, and the number of days rest required after pitching. You can read their entire list of pitching rules here.

Both the number of pitches and the number of rest days are regulated by age. Here is their list of pitching limits per day:

17-18 105 pitches per day

13-16 95 pitches per day

11-12 85 pitches per day

9-10 75 pitches per day

7-8 50 pitches per day

And the rest day requirements, again quoting from their website:

Pitchers league age 14 and under

• If a player pitches 66 or more pitches in a day, four calendar days of rest must be observed.

• If a player pitches 51-65 pitches in a day, three calendar days of rest must be observed.

• If a player pitches 36-50 pitches in a day, two calendar days of rest must be observed.

• If a player pitches 21-35 pitches in a day, one calendar day of rest must be observed.

• If a player pitches 1-20 pitches in a day, no calendar day of rest is required.

Pitchers league age 15-18

• If a player pitches 76 or more pitches in a day, four calendar days of rest must be observed.

• If a player pitches 61-75 pitches in a day, three calendar days of rest must be observed.

• If a player pitches 46-60 pitches in a day, two calendar days of rest must be observed.

• If a player pitches 31-45 pitches in a day, one calendar day of rest must be observed.

• If a player pitches 1-30 pitches in a day, no calendar day of rest is required.

A game official is required to keep the pitch counts for every pitcher in the game and to let the head umpire know when a pitcher has reached his/her limit.

For other notes on safety and required equipment for ALL baseball players at different positions, please read Little League’s equipment checklist here.

Fun and safety are the twins of any sport. Insuring your child’s safety and health increases the fun quotient!

Fifth disease: What is it? When to call the doctor.

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Fifth disease was given its name because it’s the fifth in a list of viruses that can cause rashes in children (the other four are chicken pox, rubella, measles and roseola). Its other name is Parvovirus B19. This might sound a little scary to you, since you may have heard of a canine parvovirus that is very serious for dogs. While in the same family as the canine virus, Parvovirus B19 is only a human virus and cannot be transmitted either from dogs to people or from people to dogs. In children, Parvovirus B19—fifth disease—is relatively common and generally quite benign.

Fifth disease in children is not usually dangerous, unless the child has anemia or an autoimmune disease. It’s contagious through the droplets of coughing and sneezing or through saliva (or from a pregnant mother to her fetus), and can show up 4 to14 days after exposure. Frequent hand washing is the best way to reduce the spread of viruses.

The first symptoms are similar to those of a cold: runny nose; mild fever; itching; soreness; headache. A few children experience achy joints.

After a week or so, a red rash may appear on the cheeks. It may, over the next few days, also appear on the torso and arms, buttocks and thighs. Within another week, the rash will likely fade. It might return, even months later, when the child gets overheated. By the time the rash appears, the child is no longer contagious.

When should you call our office? If your child has anemia, especially sickle cell anemia, or an autoimmune condition, call right away. Fifth disease can be dangerous for these patients. Also, if your child develops joint swelling or if symptoms worsen over time instead of improving, call us.

In normal cases, we treat symptoms with acetaminophen to reduce fever, or antihistamines to control itching. However, sickle cell patients and some others may need to be hospitalized because the blood counts can be seriously compromised. A pregnant woman with fifth disease should also be seen by a physician, because serious complications can occur.

Most of the information in this article came from the American Academy of Pediatrics article on the subject, which you can read here.

Fifth disease is more common late winter through spring, so you may want to keep an eye out for it this time of year. The good news is that most children will develop only mild symptoms that will go away without treatment.

Breast development in boys?

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As odd as it may sound, about three quarters of boys will develop some breast tissue early in their puberty. This is a normal physical reaction to the increase of hormones, including estrogen, in the male body as it matures.

Gynecomastia, as it’s called, is a source of concern for many boys because they are unprepared for it and think something may be wrong with their bodies. And, of course, it comes at a time in their lives when they may already feel insecure about their physical and sexual development, when they may already be uncomfortable in the locker room at school

Gynecomastia can start as tenderness or soreness around the nipple and can manifest in one or both breasts. Most of the time, the tissue will only grow a half inch or so, and often will be just around the nipple. It can take a couple of years to go away, but normally it will go away.

You should also know that certain medications, both prescription meds and illegal drugs, can cause gynecomastia. In particular, anabolic steroids, marijuana or heroin can lead to gynecomastia, as can insulin and other prescription drugs.

The information for this blog was gleaned from an article on the website for the American Academy of Pediatrics, an article which contains much more information about male puberty and what changes a boy may expect in his body.

If your son has gynecomastia, make sure he knows the condition is common and will resolve itself with time. Show him this article. Encourage him to talk to his physician who can assure him that nothing is wrong with his body or his development.

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!

Be careful to give accurate dosage amounts to children

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A new study in Pediatrics, a publication of the American Academy of Pediatrics (AAP), shows that a surprisingly large percentage of adults give the wrong dosages of medications to children and infants.

Incorrect dosages can be harmful, even dangerous. When the pediatrician writes a prescription or recommends an over-the-counter drug, they take into account a child’s health, age, size and other factors, including other medications he may be taking. It’s important to be accurate when dispensing those meds.

The main problem, according to the study, has to do with measuring.

Adults who measured with teaspoons and tablespoons were twice as likely to make errors as those who used milliliters as their measuring standard.
Never just pull out a spoon from your flatware or plastic ware to measure medicine. These spoons can vary widely in the amount of liquid they hold.
Purchase a measuring instrument (dropper or spoon) in the pharmacy department of your discount or grocery store. Make sure it uses milliliters for measurement.
Measure accurately.
Keep a written record of when you’ve given a medication and how much. Many people unintentionally create problems when one person in the household dispenses a drug, not knowing that someone else has already given the medicine.

If you’re ever unsure about a dosage, call your pediatrician’s office. Safety with drugs, whether prescription or OTC, is essential.

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!

Vitamin K: a very necessary injection for newborns

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An injection of vitamin K for newborns has been recommended by the American Academy of Pediatrics (AAP) since 1961. Routinely, it is given a few hours after birth for the prevention of very serious bleeding.

The Centers for Disease Control and Prevention (CDC) has produced an online brochure describing the need for a vitamin K injection.

According to the brochure, babies are born with a vitamin K deficiency because they have not yet developed the good bacteria in their digestive tract that produce the vitamin, and they can’t get enough of it from their mother’s milk or while they are in the uterus. Since vitamin K is essential in the clotting of blood, babies can get what is called vitamin K deficiency bleeding (VKDB). VKDB is very dangerous. “Without enough vitamin K, your baby has a chance of bleeding into his or her intestines, and brain, which can lead to brain damage and even death. Infants who do not receive the vitamin K shot at birth can develop VKDB up to 6 months of age. The good news is that VKDB is easily prevented. The easiest and most reliable way to give babies vitamin K is by a shot into a muscle in the leg. One shot given after birth will protect your baby from VKDB.”

Are there any dangers? One 20-year-old study seemed to find a link between vitamin K injections and childhood cancers. However, follow up studies have never been able to show such a link. (Read the CDC’s brochure for more detail.)

This is an essential, one-time injection that could save your baby’s life.