Pediatric Care

The care of Children is at the heart of Family Medicine. From routine physicals and immunizations to adolescent sexuality – and everything in between, we wish to be with you on your journey. We offer same or next business day appointments to ALL HFM established patients who our newly ill or injured.

For routine care, please review our selection of pediatric forms, and bring them, completed, with you if convenient.

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NEWBORN CARE

Feeding BREAST IS BEST. The first few days may not seem hungry—feed whenever the baby wants-at least 6 - 8 times a day. Breast milk digests more quickly than formula, thus they are fed more often. Formula fed infants can usually be put on an every 3 to 4 hour schedule. If not eating or eating all the time make an appointment. AND it is best for mother! 30% less diabetes for nursing at all, 48% less than not at all if nursing > 6 mos (or 2 babies who add up to > 6 mos). bit.ly/2EMD5B6 JAMA Internal Medicine, 1.16. 2018

Infants born by C-section, formula fed, or treated with antibiotics might benefit from at least a few weeks of a probiotic such as Natren’s LifeStart (B. infantis) [see also "crying" below] as they may not have acquired these “healthy bugs” from mother. In May 2013 a study found C-section babies by 3 years old were twice as likely to be obese - felt to be for lack of good "bugs."

Breast fed babies should supplement at 4-6 weeks with vitamin D3 400 units daily (stronger bones and maybe less allergies) [or mother take 6400 iu daily, herself] and with iron 7.5 mg / d (to protect neurologic development). Poly Vi Sol with Iron (1 ml/d) does both. No supplemental iron is required once on a variety of foods. Best ONLY breast/formula fed till 5-6 months then while continuing to breast feed/formula for 12 - 18 months, introduce one new food every 2 - 3 days (if not well tolerated, re-try in a few weeks). Start with vegetables, then oats and rice, other cereals, then other foods and fruits. Fruit juice and especially flavored drinks should be avoided (just sugar water). Allergy triggering foods (eggs, peanuts, wheat, soy, milk, tree nuts, and shellfish) should come after vegetables, but before 6 - 8 months of age - introduced early while the body is still learning what is "OK." Commercial baby food (i.e “My Peanut”) and “Bamba” snack food can introduce peanuts. If proven celiac DZ in family avoid gluten till 2 years (about haves risk).

Give children fish oil. Some brands are not too disgusting – when old enough try capsules. Begin after 6 months. It MAY substantially reduce the incidence of type 1 diabetes (a very important finding -- JAMA (2007; 298(12):1420-1428). It may also reduce the incidence of ADHD, reduce eczema and asthma. Aim for about 250 mg total Omega-3 (EPA + DHA) in infants and children under five, 500 mg over five. Only Cod Liver oil, however, has much D. Older children, especially in the NW may benefit from 1000 IU. of Vitamin D (best is D3) - adults, 2000 IU, potentially reducing the risk of high blood pressure, autoimmune illness, and some cancers.

Jaundice. Jaundice is the yellow coloring seen in the skin and eyes caused by bilirubin in the blood. Many babies develop jaundice. Bilirubin levels peak at about 4 - 5 days of age. If you think your baby's skin is more yellow, we should see them. Bilirubin levels climb faster in very small babies or those not feeding well. The best thing you can do to prevent jaundice is to feed the baby often.

Stools. Early stools are like sticky green-black tar. They change to yellow with eating. Formula fed babies tend to stools the consistency of oatmeal. Breast milk stools are more thin or watery with small yellow curds. Babies may stool after every feeding in the first few weeks, spacing out more as they grow older. Occasionally, they may go several days without having a stool at all. As long as they are eating normally, passing gas, not uncomfortable, and the stools not hard, they can go as long as a week without stooling.

Sleeping. An "average" baby sleeps about 14 - 20 hours a day, however patterns differ widely. By a month most can sleep a 4 - 5 hour at night. Sleeping through the night 4 - 6 months. Learn from hospital nurses to swaddle wrap. It is a "miracle" for inducing and maintaining sleep. However, don't continue beyond signs that Baby may be able to roll onto their face (and with hands and legs wrapped not be able to re-expose face). It's not unusual for babies to sleep well during the day, and then be fussy in the evening. Trying to keep a baby awake all day so that they will sleep better at night, may result in an overtired, over-stimulated infant who still won’t sleep. Babies are sensitive to Mom's fatigue and tension. If nursing, drop ALL caffeine from your diet—may stimulate your baby.

Babies should sleep on their back – AND more. Recommended since 1992, there has been about an 80% reduction in sudden infant deaths (SIDS). However, we are seeing children with misshapen heads with flat spots. Try to alternate the head position. Limit the time your baby spends in a car seat, infant swings and infant seats, which can apply pressure to the back of the head. Provide "tummy time" when baby is awake and well supervised. Also, reduce SIDS by babies NOT having their heads covered to sleep. Pacifier use and breast feeding may also reduce the risk. The use of a fan blowing across the room (a gentle air circulation) may help.

Crying. Crying is your baby communicating. Crying is not harmful - you needn't stop the crying, but of course do look for a reason. Most babies have a "fussy period" daily. A baby that cries >2 hours, and will not be consoled, should probably be examined. >3 hours suggests “colic.” This very frustrating but harmless condition (more common if mother has migraines or smoked), resolves by 3 months. Repeated research (J Pediatr. 2015 Jan;166(1):74-78.e1.) shows about 50% reduction with L. reuteri probiotic drops: biogaia.com ($20/mo). Also Gerber “Soothe” with and without vit D. Some research suggests that most colic is caused by the "ulcer bug" H. pylori (Arch Pediatr Adolesc Med. 2012;166(7):648-650). L. reuteri may competitively suppress H. pylori. “Burping” after feeding does NOT reduce colic and doubled the risk of regurgitation. QUIET A BABY: R arm held across baby’s chest with L hand and cradling diaper area - baby at 45* shaking gently, stirring or rocking movements. https://www.youtube.com/watch?v=j2C8MkY7Co8 . The swaddle, to the side or tummy. LOUD swish in ear, thumb in YOUR mouth. Hair dryer to clothed abdomen on LOW. Low pitched noise of open mouth “out” -steady. Gurgling sound of water retention in your mouth while breathing “in” bent over baby (like magic!).

Circumcision. Boys do not require circumcision and your son will not be alone if he remains “natural.” There are risks of bleeding, infection and disfigurement, though we have done hundreds without complication. Benefits include less urine infections or STDs (60% reduced HIV, 30% reduced herpes and 35% less cancer causing HPV). American college women prefer the look of a circumcised penis. Most insurances do not cover this so-called “cosmetic” procedure. Advance payment is required. Do before 3 weeks of age.

Cord Care. The umbilical cord will fall off in about 1 - 2 weeks, occasionally later. It does not require special care, but you may choose to aid its drying, by applying rubbing alcohol 3 - 4 times a day with a cotton swab. As the cord begins to separate and fall off you may notice a small amount of bleeding. See us if you notice a lot of redness or a foul smell.

Miscellaneous: One piece outfits with sewn-in in “footsies” should be washed INSIDE OUT. Otherwise, hair from those that change diapers accumulates at the toes, can wrap around one and cause its amputation. Water is too hot unless you can hold your hand under it for 30 seconds. Pacifiers are better than the thumb, but should be flattened where they cross the teeth (Nuk like) – and never on a necklace. Avoid wake time use as may interfere with ability to experiment and learn social interaction by facial expressiveness (esp in boys). Baby slings should not be sooo soft and shapeless that baby’s face is pushed into either fabric or mother's own chest to suffocate. 2nd-hand smoke from parents nearly doubles office calls, ear infections and behavior issues like ADHD. QUIT. Acetaminophen (Tylenol is one brand) may increase risk of asthma. Ibuprofen (Motrin / Advil) may be better choice. "Drool rash" and some diaper rashes can be prevented with "Gloves-in-a-Bottle" available at HFM. Growing up with a dog (less so, cat) in the first year appears to reduce illness, ear infections, allergies and later asthma by 20 - 40%. Antibiotics before 6 mos may lead to 23% greater risk of obesity at age 3 by altering gut flora (the mix of "healthy" bugs). SimplyThick should not be used (to reduce "spit up" or regurgitation) in infants, esp if born before 37 weeks. OTC eye and nasal drops or sprays can be seriously toxic to small children if taken orally. Keep out of their reach. Going to fly? or Simple Earache? – ask for staff to make up ear numbing drops (no longer available by Rx). Consider hot-water device for ears at www. EarEase.com. Some sleep-aid sound generators exceed occupational limits for adults (!). Place across the room, or at very low volume. Must be on a timer. The use of continuous night lights may increase incidence of children and adults becoming nearsighted (BMJ. 1999 May 22; 318(7195): 1369). If must use, turn off when parent retires, put on timer, or shield so very low light. Eczema was reduced by 67% in high risk (1* family with asthma, hay fever, atopic dermatitis) by once daily application (everywhere but scalp and diaper area) of Cetaphil cream, Aquaphor or sunflower seed oil from 3 weeks to 6 mos of age. (BEEP study 2012). Whole fruit is good (once able to swallow safely), Fruit juice is NOT for any age. It is sugar water and vitamins. None at all less than 1 year. Chewing helps elongate the jaw. Less tooth crowding. Let them gnaw on something like beef jerky. Commercial Baby Food does NOT have enough arsenic to worry about. Rice has most. The IQ of Chinese and Japanese have not suffered. Bangladesh where well water has 100 x the amount of babyhood have shown loss of IQ.

Protect Your Childs Mind: AVOID TV. The CONTENT of much on TV is bad enough (the usual lessons being self-indulgence, irresponsibility, violence, disrespect for authority, and cynicism). Its NEUROLOGIC effect on young children may be worse. We are convinced the epidemic of Attention Deficit Disorder in part results from a direct assault on the young brain still “under construction.” Young brains should be “programmed” for real life – not constant stimulation (with which no teacher can compete). Slower paced, life affirming children’s programming like the old Mr. Roger’s Neighborhood are much safer in this regard then the more hyperkinetic Sesame Street. The average 1-year-old is exposed to about two hours of TV a day -- about 3.6 hours a day by 3 years of age. Each hour beyond 2 of daily TV increases the risk of attentional problems at age 7 by 10%. Dr. Dimitri Christakis of Children's Hospital in Seattle: "… it's the rapidity of image-change that's potentially damaging to children's brains. They are experiencing events unfolding in a surreal fashion -- this is not how life unfolds. … is it good for them? Our study suggests that it very well may not be." (Pediatrics April 2004). The same researcher in 2007 reported that even the “Brainy Baby” or “Baby Einstein” videos had the same effect. Among babies ages 8 months to 16 months, every hour spent daily watching those programs translated into six to eight fewer words in their vocabularies as compared with other children their age. In boys, subsequent violence and oppositional disorders have been related to the violent content (yes, even in cartoons) of what they watch. 2010 data is even worse. For each additional hour of TV exposure per day at 29 months there is at 10 years of age a 6% percent decrease in math achievement, 7% decrease in overall classroom engagement, 10 percent increase in victimization by classmates, 9% nine percent decrease in general physical activity, 9% higher consumption of soft drinks, and a 5% increase in weight. In other words, TV made children passive, sluggish, dull, fatter, victims (Pagani. Archives of Pediatrics and Adolescent Medicine, May 2010). Further each hour beyond 2 of week-night TV watched between ages 5 - 15 correlated with a 30% increased risk of a criminal conviction by age 26 (Roberts, NZ). AND it is bad for adults increasing diabetes, heart disease and death (JAMA 2011; 305: 2448-2455). The best recommendation: READ to your baby, spend TIME with your baby, TALK to your baby, INTERACT with your baby. UPDATED: (still true): JAMA Pediatr. Published online January 28, 2019

Vaccinations. We strongly recommend administration of routine childhood vaccines. Vaccinations have reduced childhood illness from over 5 million cases (with 11,000 deaths) per year to 84,000 cases (with 102 deaths) per year – a 99% reduction. Currently, 1 of 20 children NOT immunized will get Whooping Cough (1 of 500 if immunized). US children are increasingly exposed to recent arrivals from “3^rd world” nations, and Americans are choosing to travel more and at younger ages. The benefits are well worth the minimal risks (no practitioner at HFM – with over 80 years of combined experience has ever encountered a serious event). Our own children and grandchildren were immunized. Childhood vaccines have not contained mercury for many years and do not cause autism. Finally, it is not ethical to benefit from others being immunized while refusing for your child. On-time administration does NOT alter outcomes neuropsychologicaly—those kids actually did slightly better at 7-10 years old vs delay or spaced. Pediatrics 2010;125:1134–1141.

However, delaying routine immunizations by at least 2 months (we choose to start at 5 months) appears to lower the risk of later asthma by 1/2 (!) This amazing research is not yet confirmed, but children born now, cannot wait to find out for sure. J Allergy Clin Immunol. 2008;121:626-631. This advice is NOT prudent to implement, however in the face of any current epidemic or plans to travel.

More information. At each routine child care visit we will provide age appropriate guidance. Birth and Child rearing are both natural processes that predate all of us professionals. Parents should learn to trust their own observations and instincts. We encourage confidence in your own abilities -- reminding new parents that their babies are remarkably resilient and will probably thrive even if you fail to follow perfectly the latest "expert" advice. Mostly, they need a safe environment, good nutrition, and lots of love and attention. Mom, Dad, (and extended family) we feel privileged to assist you in your vital role. Rev. 2.8.2021

Helpful reading for parents

Complete Guide to Your Children's Health, by the American Medical Association
This straightforward, comprehensive reference comes from the American Medical Association, so you know it's good material. The book features helpful pictures, charts, and diagrams on everything from childproofing to teething, as well as easy-to-read symptom charts and an A to Z health encyclopedia. The developmental information, including lists of physical and cognitive milestones and warning signs of potential problems, is divided by age group and includes simple activities and games designed to help your baby learn.

Your Child: What Every Parent Needs to Know: What's Normal, What's Not, and When to Seek Help, by the American Academy of Child and Adolescent Psychiatry
Written by a panel of doctors from some of the most prestigious universities in the United States, this book focuses on children's behavior and development. It's a little more touchy-feely than the AMA's Complete Guide, but it does a great job of explaining the range of normal behavior, as well as identifying minor problems (biting, hitting) and more serious disorders — including developmental delays. Look for the helpful list of language development milestones and warning signs, as well as solid information on mental retardation and learning disorders.

Magic Trees of the Mind: How to Nurture Your Child's Intelligence, Creativity and Healthy Emotions From Birth Through Adolescence, by Marian Diamond, Ph.D., and Janet Hopson
Child development and brain researcher Marian Diamond, Ph.D., and science writer Janet Hopson have co-authored this comprehensive guide that helps explain to parents exactly how young minds can be stimulated and developed. According to the authors, early mental challenges accelerate brain growth and enhance future learning and memory skills. Along with recommended toys and games, the book also lists top CD-ROMs and videos.

Read-Aloud Handbook, by Jim Trelease
Jim Trelease, a father, journalist, and long-time read-aloud crusader, is truly passionate about his subject, and it shows. In this entertaining, informative book, he's compiled statistics and personal success stories that will convince both avid readers and more reluctant ones that reading to children is a vital part of their development. Plus, you get Trelease's comprehensive list of the best books to read aloud to children of all ages.

Touchpoints, by Dr. T. Berry Brazelton
This is Brazelton at his best, mapping the behavioral and emotional development stages of children. The touchpoints that give the book its name are those predictable moments that happen before a significant or rapid step in your child's development. A third of the book deals with the first year, and he takes you from the first touchpoint — pregnancy and the developing fetus — through birth and beyond: evaluating your newborn's reflexes, learning your baby's style, how to bond and learn from your child, and so on. He also covers issues such as fear, divorce, and a child's ability to emotionally manipulate the adults who love him.

Your Pregnancy Week by Week, by Glade B. Curtis

In clear, lucid prose it charts a course from preparing for pregnancy to week 40 — and gives you blow-by-blow details on what's happening to you and your baby at every stage.

Sleeping Through the Night, by Jodi Mindell
Lack of sleep may be an occupational hazard for parents, but there's hope. In Sleeping Through the Night, Jodi Mindell draws on her vast experience as a pediatric sleep expert to recommend solutions to one of the most common problems that plague parents: Kids who won't — or can't — sleep through the night. Mindell, director of the Sleep Disorders Center at Allegheny University of the Health Sciences in Pennsylvania, offers practical advice on how to establish consistent bedtime routines and tells you how much sleep your child really needs (for example, most 3-year-olds still need a nap in the afternoon and a little more than 11 hours of sleep all day). She also suggests ways sleep-deprived parents can cope with the stresses of being up all night and working all day.

Websites:

http://familydoctor.org/family-health/ - American Academy of Family Physicians. Reliable ad free.

http://www.babycenter.com - excellent site, but, owned by Johnson and Johnson -expect subtle advertising

http://www.freerangekids.com - Fighting the belief that our children are in constant danger from creeps, kidnapping, germs, grades, flashers, frustration, failure, baby snatchers, bugs, bullies, men, sleepovers and/or the perils of a non-organic grape. A rational support source for raising self-reliant, confident kids.

https://letgrow.org/our-mission - Similar goals as above.

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