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Fall 2008 Newsletter
WELCOME to our third issue of the Pediatric Specialists newsletter.
Autumn Health
Flu (influenza)
DEFINITION:  Influenza (the flu) is a contagious respiratory illness caused by influenza viruses.  Symptoms of flu include high fever, cough, headache, fatigue, sore throat, nasal congestion, muscle aches, and occasionally stomach symptoms (nausea, vomiting, and diarrhea). In the US, about 5% – 20% of the population gets the flu each year.  More than 200,000 people are hospitalized with complications of the flu, and about 36,000 people die annually from the flu. Young children and children with health conditions like asthma or heart disease are at high risk for serious flu complications.  These complications can include pneumonia, ear infection, sinus infection, or dehydration. 
Flu viruses can spread from person to person by coughing or sneezing or by touching something with flu virus on it then touching one’s mouth or nose.  Someone who has the flu is contagious from one day before symptoms appear to 5 days after becoming symptomatic. 
FLU VACCINE:  The best way to prevent the flu is to be vaccinated each year.  The ACIP (Advisory Committee on Immunization Practices) recommends flu vaccine for all children from 6 months to 19 years with high priority given to children 6 months to 5 years and those with asthma or other chronic health conditions.  Yearly flu vaccination begins in September and continues through January and beyond.   There are 2 types of flu vaccine:
The “flu shot” – a killed virus (inactivated) vaccine given with a needle, available to anyone 6 months and up.  Not recommended for children with egg allergy.
The nasal spray flu vaccine – a vaccine given as a nasal spray, made with live, weakened flu viruses that do not cause the disease.  Approved for people 2 years – 49 years old.  Not recommended for children with asthma. or for those with a condition that weakens their immune system. 
Flu clinics:  We have set up evening clinics staffed by our nurses to administer flu vaccine to any of our patients who are interested.  Children who come to the clinic must be free of illness on the clinic date and should wear short sleeves for ease of administration of vaccine.  An appointment may be made by calling our office.  Scheduled flu clinics are on the following evenings (flu vaccine may also be given at regularly scheduled well check-ups):

• Thursday, OCTOBER 2
• Thursday, OCTOBER 9
• Wednesday, OCTOBER 22

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Safety:
“Back to Sleep”
October is SIDS Awareness Month.   
Although the rates of Sudden Infant Death (SIDS) have declined sharply since 1993 in conjunction with the promotion of putting babies to sleep on their backs.  Still, SIDS remains one of the leading causes of infant mortality in this country. 
The American Academy of Pediatrics and the CDC agree on the following safe sleep guidelines for infants:

• Infants should ALWAYS sleep in their backs.  Side sleeping is not as safe as back sleeping and is not advised. 
• Infants should sleep in cribs approved by the Consumer Product Safety Commission (all cribs made after 1982 are legally required to meet CPSC safety standards).  Mattresses should fit tightly into the crib frame.  Bassinets, cradles, or co-sleepers that do not have a soft or fluffy surface may also be used.  The mattress should always be firm.
• No loose pillows, stuffed toys, bumper pads, comforters, quilts or sheepskin should be placed in the crib.  Infants should be dressed in a sleeper or warm pajamas instead of using a blanket. 
• Parents who choose to share a bed with their infant should NEVER smoke or be under the influence of alcohol or drugs while sleeping with their infant.  The safest place for an infant to sleep is in their own crib or another separate sleep surface next to the parent’s or caregiver’s bed.
• NEVER place your infant on a sofa, couch, pillow, or waterbed. 
• NEVER smoke in the same room as your infant or child. 
• Pacifiers may be used (after breast-feeding is established) during nap time and bed time. 
• Supervised “tummy time” during the day is recommended to make your infant’s neck and back muscles strong. 

Back-to-school Safety

The return to school is a great time to focus on safety issues with your child.  Many of these are addressed in school, but repetition helps your child to remember what to do.
Discuss stranger safety with your child.  Have a plan of what he or she should do if approached by a stranger and how to get help.  Use simple language.  Be direct.   Be serious.

•  If a stranger speaks to you, do not speak to them.
• Walk or run from the stranger.
• When running from a stranger, run together with siblings.
• Tell a parent, teacher, or trusted adult immediately.

Reassure your child that not all people are out to get him or her, but that we can’t tell who is and who isn’t.  We need to practice stranger safety in all situations and locations.
Consider lining up emergency contacts and make your child aware of whom these emergency contacts are.  Set a password or pass phrase to be used by the emergency contact and your child in the event that someone other than you needs to pick your child up from school or activities.
Also, reinforce the meaning of appropriate and inappropriate touching.  Empower your child to say no when uncomfortable and to tell you about any of these situations.
Another issue to discuss and reinforce is the use of safety helmets.  Since 2004, it has been a MA law that anyone under the age of 16 riding a bicycle, scooter, skateboard, or in-line skates wears a helmet.  These can prevent severe and debilitating head injuries.  Be firm in the expectation for helmet use and model this behavior if riding yourself.  Also, if a helmet has been involved in a crash, it should be replaced as each helmet is designed to absorb the shock of an impact only once.
Back-to-school also signals the start of the fall sports season.  Check to see that all safety equipment including pads, helmets, and footwear fits and functions properly.  Mouth guards can absorb some of the impact of collisions in contact sports and can help to limit the severity of both mouth and head injuries.

Be proactive.  Be open.  Be safe this school year.

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Nutrition:
Skillet Pasta
Here are two recipes for quick, healthy dinners that kids enjoy, combining whole grains, vegetables, and low fat protein, and using only one pan!

Skillet Pasta with Sausage

1/2C sun-dried tomatoes
2t olive oil
1 medium onion
3 cloves garlic, minced
12 oz chicken or turkey Italian sausage, sliced
8 oz whole grain penne or rotini
2C chicken broth
1C fat free evaporated milk
1 oz grated Parmesan
6 oz baby spinach

Pour 1C boiling water over sun-dried tomatoes to rehydrate.  Soak for 5 minutes, drain, and chop.
Heat olive oil in large (12”) nonstick skillet.  Sauté onion over med heat for 5 minutes until soft.  Add garlic, sausage, and tomatoes and sauté for 2 minutes.  Sprinkle uncooked pasta over sausage.  Pour in chicken broth and milk, bring to simmer, then turn heat down to med low and cover pan.  Cook, stirring occasionally until pasta is tender, about 10 minutes.  Stir in spinach a handful at a time and stir until wilted, about 2 minutes.  Stir in grated Parmesan. Season with salt and pepper to taste.
Serves 4-6

Skillet Pasta with Chicken and Broccoli
1/4 C sun-dried tomatoes
4 tsp olive oil
1 lb boneless, skinless chicken, cut into 1 inch squares
1 medium onion, chopped
3 cloves garlic, minced
¼ tsp oregano
1/8 tsp red pepper flakes (optional)
8 oz penne or rotini
2C chicken broth
1C fat free evaporated milk
12 oz broccoli florets
1 oz grated Asiago or Parmesan cheese
Pour ½ C boiling water over sun-dried tomatoes to rehydrate.  Soak for 5 minutes, drain, and chop.
Heat 2 tsp olive oil in 12” nonstick skillet.  Sauté chicken 2-3 minutes until cooked through.  Remove chicken to bowl.
Add remaining oil, onion, ½ tsp salt to skillet and cook over med heat 2-5 minutes until onion is soft.  Stir in garlic, oregano, red pepper and cook until fragrant, about 30 seconds. 
Add ziti, broth, milk and 1 c water.  Bring to simmer and cook over med high heat until pasta is tender, about 10 minutes.  Add broccoli and sun dried tomatoes, cover and cook over med heat until broccoli is tender, 3-5 minutes.
Uncover, return heat to high, and stir in grated cheese and cooked chicken.  Stir until blended and heated through 1-2 minutes.  Off heat add salt and pepper taste.
4-6 Servings.

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Staff Update
We welcome two new nurses to our staff:  Kandice Fogarty,RN and Carinne Vaillancourt, MA
We continue to benefit from our association with Heather Stone, RD, LDN.  Heather is available to meet with patients in our office for nutritional counseling.  Appointments may be arranged by contacting her directly at 508- 577-3765.

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Ask the Doctor

Question:  My child takes medication for ADHD.  Does he need to have an EKG done?

Answer:  You may have noticed recent media reports suggesting that children who take stimulant medicine for attention deficit disorder need to have an EKG done.  The American Academy of Pediatrics recommends that a screening EKG be done if “the patient’s history, family history or the physical examination raise concern.”  Children on medication for attention deficit disorder are monitored by regular medication checks in our office every 3-4 months.  If you have concerns about this issue please discuss them with your health care provider at your next visit. 
Question: How do I teach my infant the concept of “no?”
Answer:  Infants as young as 9 months old should learn the concept of “no” for several reasons.  Learning this concept helps them learn what behavior is acceptable; helps demonstrate to them that they are a separate person from you; helps them learn to stop a behavior when told to do so; and helps them learn how to problem solve and be creative. 
You can teach your 9 month old infant this concept by using the following tips:

• Set the rules:  Determine which behaviors are dangerous to your child or intolerable to you and discourage these by using the word “no.”  Changing the environment (e.g. moving objects are hazards out of reach) to make your home “baby-proof” will minimize the number of times you need to say “no.”
• Appropriate facial expression.  Your face should be serious and your voice lower when saying “no.”  Infants do pay close attention to your face and tone of voice and respond more readily to a low voice and serious demeanor. 
• Move the infant.  Once you have said “no” the baby should be moved away from the provoking situation.
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  Distract the baby.  Once the baby is in a safe place, provide a toy or book to distract him or her. 
• Be consistent.  Children learn when parents are consistent in their actions.  All caregivers should agree on when to say “no” and should be consistent with the baby.  Even once infants understand the concept of “no” they may not have the self-control to resist approaching the forbidden situation so the “no” response needs to be consistently offered by the parent. 

Question:  Will my child need shots at his next check-up?
 Answer:  OOPS!  Although we may have promised “no shots until 12 years old” our recommendations have changed in line with the current American Academy of Pediatrics and Advisory Committee on Immunization Practices recommendations. 
All children 7 – 18 years old who have previously received one dose of the chicken pox vaccine (Varivax) will now need to get a booster dose.  This second dose of vaccine will help prevent breakthrough chicken pox which has continued to occur in some children who have only received a single dose of the vaccine. 
We also are now recommending that a meningitis vaccine (Menactra) be given once for children between 11 and 18 years old.  This vaccine was previously recommended prior to college entry but  is now recommended at a younger age. 
For girls between 11 and 21, we now offer the HPV vaccine (Gardasil).   This vaccine is given as a 3 dose series over a period of 6 months.
As mentioned in the article on influenza above, we are also recommending Flu vaccine for all children between 6 months and 18 years old. 
As always all vaccines will be reviewed and discussed by your health care provider at every well child visit.

Suggestions:
We always appreciate your help in improving our practice and welcome any feedback you provide.  Please let us know if there is any way we can improved your experience at Pediatric Specialists. 
For the Foxboro office, please send feedback and comments to:
customerservicefoxboro@pediatricspec.com and for the Wrentham office to customerservicewrentham@pediatricspec.com.  
Feedback or submissions for our newsletter can be sent to drspitzer@pediatr
icspec.com