Fall 2012        Newsletter
Flu Clinics
We have a few openings in upcoming flu clinics for flu shots scheduled on the afternoons of 11/2 and 11/9 (from 1 – 4:30PM). Also, we have a Thursday night clinic on 11/29 and another Friday afternoon clinic on 11/30.
 Flu vaccines can also be given during normal office visits.  Appointments for flu shots or FluMist can be scheduled during office hours as well, though appointments are limited by nursing availability.
NEW!
Book Exchange
Take One, Try One, Return One

We believe that books and reading are vital to the healthy development of children, and so we invite you to participate in the Book Exchange which we have introduced at Pediatric Specialists.

While in the office, please visit our Book Exchange which is in our “healthy” waiting room. If you see books which you would like to read or would like to read to your children, please feel free to take these books home. There is no need to check out or sign out books. When you have 'outgrown' the books or finished reading them and they are still in good condition, we would like you to return these books so that other children or parents may also enjoy them.

To support the Book Exchange, we are asking you to donate used books which are in good condition and which you think would be appropriate for this program. We would appreciate if you would bring these books to our office. These books will be placed in the bookcase and become part of our Book Exchange for Children.

Fall Health:
Whooping Cough
Most of us think that we have never had whooping cough (a bacterial infection, also known as pertussis).  However, mild illness is common and many people may have had whooping cough and experienced only minor cold symptoms. Whooping cough is still quite prevalent and there have been recent outbreaks in this area.  In 2012 Massachusetts reported the first infant death from pertussis since 2002 as well as an increase in cases compared to 2011.  Whooping cough is highly contagious.  Symptoms can vary from mild stuffy nose and cough to severe persistent cough.  Babies who are unimmunized or partially immunized are at greatest risk as they can develop pneumonia, apnea, severe breathing problems, seizures, or can even die from pertussis. 
Our routine vaccine schedule for infants and children includes DTaP vaccine (the “P” stands for pertussis) at 2, 4, and 6 months, again at 15 – 18 months and at 4 – 6 years.  A booster dose of TdaP is again given at 11 or 12 years old.  This same booster dose can be given to adults up to age 64 and is recommended for any adults who are caring for infants.  We advise all new parents (and grandparents) to obtain a TdaP shot if they have not yet been vaccinated.
Whooping cough can be diagnosed by blood work or nasal swab.  Children who are diagnosed with pertussis are treated with antibiotics and kept out of school to minimize spread to classmates and family members.  Children who have severe cough, or cough lingering longer than 2 weeks should be evaluated in the office and possibly tested for pertussis.  Often in an outbreak situation, preventive antibiotics are recommended for close contacts of those ill with pertussis. 
Circumcision
This fall the American Academy of Pediatrics released an updated statement on newborn male circumcision.  Newborn circumcision, if requested by parents, is typically done by the obstetrician prior to the newborn’s discharge from the hospital nursery.
Literature published over the past 15 years indicates that the benefit of circumcision of newborn males outweighs the risks of the procedure.
The benefits include: decreased risk of urinary tract infection in the first year of life and decreased risk of later heterosexual acquisition of HIV and decreased transmission of other sexually transmitted infections. 
Parents should be aware of this data in making their decision about circumcision in the context of their own religious and cultural beliefs and practices.

Safety:
Trampoline Safety
Recently an updated statement was issued by the American Academy of Pediatrics regarding trampoline safety. 
Trampolines are dangerous!  Despite previous recommendations from the American Academy of Pediatrics discouraging home use of trampolines, recreational use of trampolines continues to be popular. Trampoline injury rates have declined in the past 8 years, but severe injuries still occur. Even with adult supervision, many injuries occur.  Injury rates are increased for children 5 or less; for situations with multiple jumpers; and for jumpers who attempt somersaults or flips on the trampoline.
Pediatricians continue to advise against recreational trampoline use.  For families who continue to use trampolines, some guidelines are suggested:

• Trampoline use should be restricted to a single jumper at any one time.
• Somersaults and flips are among the most common causes of devastating spine injuries and should not be performed
• Adult supervision should occur and supervising adults should be willing to enforce safety guidelines.
• Homeowners should verity that their insurance policies cover trampoline-related claims.
• Trampolines should have adequate protective padding, frequent inspection, and appropriate replacement of any damaged parts.
• The precautions outlined here should also apply to trampoline parks.  Parents should be aware that the rules at jump parks may not be consistent with the above guidelines and that jumpers may be at risk for catastrophic injury. 
• If trampolines are used as a piece of specialized training equipment for specific sport, appropriate coaching, supervision, and safety measure should be in place.  The use of safety belts or harnesses is encouraged when new skills are being developed.

        
NUTRITION

Pumpkin and Squash Recipes

Pumpkin  Muffins
(makes 12, vegan)

1 ¼  cups whole wheat pastry flour
¼  cup flax meal
1 ¼  cup sugar (or ½ cup sugar substitute and ½ cup sugar)
1 Tbsp baking powder
¼ teaspoon salt
1 ½ teaspoon cinnamon
½ teaspoon nutmeg
½ teaspoon ground ginger
1/8 teaspoon ground cloves
1 cup pureed pumpkin
½ cup + 2 Tbsp coconut or almond milk
¼ cup canola oil
¼ cup applesauce
2 Tbsp maple syrup

Preheat oven to 400 degrees.
Mix all dry ingredients (flour thru cloves) in large bowl.  In separate bowl mix wet ingredients (pumpkin thru maple syrup).
Pour batter into greased muffin trays, filling about 2/3 of the way up.  Bake at 400 degrees for 15- 20 minutes, until toothpick inserted in center of muffin comes out clean.

Butternut Squash and Apple Soup
(makes 14 cups)

3 Tbsp olive oil
4 cups chopped yellow onions
1-2 Tbsp mild curry powder
5 lbs butternut squash (2 lge)
1 ½  lbs apples (4 medium)
2 tsp salt
½  tsp black pepper
2 cups water
2 cups apple cider or apple juice

Heat olive oil over low heat in large soup pot.  Add onions and curry powder and cook 15 – 20 minutes until tender, stirring occasionally. 
Peel squash, remove seeds and cut into chunks. Peel, core, and cut apples into chunks.
Add squash, apples, salt, pepper, and 2 cups of water to pot with onions.  Bring to a boil, cover, simmer over low heat for 30 – 40 minutes until squash and apples are tender.
Puree soup (either in food processor, blender, or with immersion blender), adding 1 – 2 cups apple juice to bring soup to desired consistency.

Pumpkin Chocolate Chip    Cookies
(makes about 150 small cookies)

3 cups pumpkin
2 eggs
2 tsp vanilla
2 tsp nutmeg
2 tsp cinnamon
2 tsp baking soda
2 tsp baking powder
1 cup canola oil
3 cups sugar
1 tsp salt
5 cups flour
1 ½  cups chocolate chips

Preheat oven to 350 degrees.
Mix first 10 ingredients (pumpkin through salt) in large bowl.  Mix in flour, then add chocolate chips. 
Drop by rounded tablespoons onto ungreased cookie sheet.
Bake 15 minutes at 350 degrees.

Ask the Doctor

Question: I’ve heard that if a tooth gets knocked out I should put it in milk.  Is that true?
Answer: Most permanent teeth injured or knocked out by trauma can be saved if the right steps are taken. 
If your child knocks his tooth out call the dentist or seek medical care as soon as possible.  Find the tooth and pick it up by the top part (white crown).  Do not touch the root.  Rinse it quickly with cold milk (or water if you do not have milk).  Do not scrub or dry the tooth and do not try to clean it with alcohol or peroxide.  Put the tooth back into the socket in the gum and press down on the tooth with your thumb.  Have your child bite down on a wad of gauze or a washcloth to hold the tooth in place until you get to the dentist’s office. 
If you cannot  replant the tooth in the socket after 5 minutes, store it in Hank’s Balanced Salt Solution (sold OTC under the brand names Save-a-Tooth or EMT Tooth Saver), a cup of cold milk, some of your child’s saliva, or as a last resort a cup of water until you get to the dentist.
If a baby tooth gets knocked out, do not try to replace it in the socket.  Just apply gauze to control bleeding and call the dentist. 
Question:  My teenager has trouble falling asleep at night.  Is there any natural method to help him fall asleep?
Answer:  A recent study done with college students found that a version of counting sheep did help!  Students were instructed to pick a non-arousing topic to think about such as song lyrics, TV program plots, or recipes and instructed to focus on this topic while trying to fall asleep and again if they woke during the night.  After one month, the students in the study were found to have a large reduction in insomnia from baseline as well as reduced nighttime arousal.
We always remind teens and parents as well that it is important for all screens (cell phone, computer, TV) to be turned off one hour before bedtime.  Screen use before bed has been scientifically shown to cause a lowering of serum melatonin levels which thus interferes with the onset of sleep.  Turn off the phone and don’t leave it under your pillow!

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 improve your experience at Pediatric Specialists. 
For the Foxboro office, please send feedback and comments to:

patientrelations@pediatricspec.com

New Staff!
We welcome April Shapiro, RN and Heather Wallace, RN to our wonderful nursing staff.

Patient Gateway
Is Here!

Patient Gateway is an on-line tool for patients to access information from their medical charts, print out health forms, and use email to contact the office and request appointments or prescription refills.  We have enrollment forms in the office.  Please sign up next time you come in!  We are hoping to have all our patients registered soon and currently use this system for all email communication.

Early Morning Urgent Care Clinic Continues

Our walk-in hours from 8-9 AM Monday through Friday in the Foxboro office have been a great addition to our practice.   As always, parents can book a same day sick appointment by calling during business hours. We will continue the walk-in hours until Memorial Day

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