Spring/Summer 2011 Newsletter
WELCOME to our tenth issue of the Pediatric Specialists newsletter.
Early Morning Urgent Care Clinic will close for the summer!
Our walk-in hours from 8-9 AM Monday through Friday in the Foxboro office have been a great addition to our practice.   We will not have the early morning hours during the summer, but as always, parents can book a same day sick appointment by calling during business hours.  We continue to have our extended evening hours,  and are open until 9PM Monday – Thursday.  We look forward to resuming our Early Morning Walk-in Hours after Labor Day.

Spring Health:
Overuse Injuries
As the spring sports season begins, overuse injuries are a common issue for young athletes.  Since children are still growing mentally and physically they are more prone to certain injuries than adults.
The National Athletic Trainers’ Association issued a position paper in March 2011 which detailed recommendations for preventing injury in young athletes.  The American Academy of Pediatrics has stated that the goal of youth sports participation “should be to promote lifelong physical activity, recreation and skills of healthy competition,” not the hopes of gaining a college scholarship or becoming an Olympian or professional athlete!
Every child who participates in sports should have an annual physical exam and many organized sports require documentation of physical health.  We encourage you to schedule your summer physicals now!
The National Athletics Trainers’ Association report makes the following recommendations for training of pediatric athletes:

• Preseason and in-season preventive training programs are recommended for reducing overuse injury risk.
• All pediatric athletes should participate in a general fitness program beginning at least 2 months before their sports season starts.

Pediatric athletes should have at least 1-2 days off per week from practices, competitions and sports-specific training.

• Progression of training intensity, time, and distance should only increase by 10% each week to avoid overload.
• Data suggest a general guideline of no more than 16-20 hours/week of vigorous physical activity for pediatric athletes.
• Baseball pitchers should follow established guidelines on pitching limits for young athletes.
• Participation in multiple sports and recreational activities throughout the year should be encouraged to enhance general fitness and motor development.
• Pediatric athletes should take time off between sports seasons and 2-3 nonconsecutive months away from a specific sport if they participate in that sport year round. 

The full report can be found at www.journalofathletictraining.org with search term “pediatric overuse injuries.”

Safety:
Camp Safety
Many children are now looking forward to their summer experience at sleep-away camp.  Here are some tips to keep kids safe and healthy at camp.

• Encourage safe physical activity.  Pack protective gear such as helmets and life jackets, if the camp does not provide them.  Remind kids not to swim if they are alone or if they have diarrhea, and not to drink the water they swim in.
• Teach kids that concussions are serious.  Any child with a suspected concussion should not participate in physical activity until cleared by a medical professional.
• Encourage kids to keep hydrated.  They shouldn’t wait until they feel thirsty to drink. Remind them to drink plenty of water or other non-carbonated, sugar-free beverages throughout the day.
• Avoid wild animals!  Instruct kids that if they are bitten or scratched by a wild animal, they should immediately wash the wound with soap and water and report the bite to healthcare personnel.
• Avoid head lice!  Teach kids to avoid head-to-head contact during play and not to share hair accessories, hats, helmets, etc.
• Pack plenty of insect repellent and sunscreen to wear to protect themselves against  mosquitoes, ticks, and the sun.
• Find out how the camp handles illness.  Teach kids to notify camp personnel if they feel ill, and encourage them to use good personal hygiene. 

HAVE A GREAT TIME!  Sleepaway camp can be a wonderful learning experience and a great opportunity to experience nature and further personal growth and independence.

NUTRITION
        from the
          Farm Stand
Summer farm stand season is almost here and more and more families now participate in a CSA farm which is a great way to introduce kids to vegetables.  Often if children are involved in vegetable gardening they have more interest in eating what they see grown.  

Homemade Hummus with Kale
This hummus comes out a pretty green and is an easy way to get kids to eat more leafy greens.

1 can chickpeas
2 Tbsp tahini
½ tsp salt
2Tbsp olive oil
¼ C water
¼ C sundried tomatoes (packed in oil)
1 small head kale, deveined and steamed.
Fresh herbs (optional)

Rinse chickpeas and puree in food processor with tahini, salt, olive oil, and water. 
Rinse steamed kale with cold water.  Squeeze into a ball with your hands, squeezing out as much water as possible.  Break kale ball apart and add to food processor with sundried tomatoes.  Gently pulse until kale mixed in and there are still chunks of tomatoes remaining.

Serve with cut up raw veggies, or whole grain chips, bread, or crackers.

Spinach Strawberry Salad
This is a delicious and nutritious salad that has a slightly sweet taste that the kids will love.
10 ounces of fresh spinach leaves (wash well and tear into small pieces)
1 quart of strawberries, sliced
1/2 cup sliced almonds
2 tablespoons of sesame seeds
1 tablespoon of poppy seeds
1/2 cup sugar
1/2 cup of olive oil
1/4 cup white vinegar
Mix sesame and poppy seeds in a medium bowl along with sugar, olive oil, and vinegar. Chill for one hour. In the meantime, mix together the spinach leaves, almonds, and strawberries. Pour dressing over the salad and toss well. Place in the refrigerator for about 10 minutes before serving.
Pasta with Fresh Tomato Basil Sauce
1 (9-ounce) package refrigerated fresh fettuccine
2 tablespoons olive oil
3 garlic cloves, minced
4 cups cherry tomatoes, halved
1/2 teaspoon salt
1 cup fresh basil leaves, torn
1/4 teaspoon freshly ground black pepper
2 ounces Parmigiano-Reggiano cheese, shaved (about 1/2 cup)
1. Cook pasta according to package directions, omitting salt and fat. Drain; place pasta in a large bowl.
2. While pasta cooks, heat oil in a medium saucepan over medium heat. Add garlic to pan; cook 1 minute, stirring frequently. Add tomatoes and salt; cover and cook 4 minutes. Remove from heat; stir in basil and pepper. Add tomato mixture to pasta; toss well to combine. Top with cheese.

Ask the Doctor

Question: Should I be worried about heat stroke?  I’ve heard about this but I’m not sure if it’s a real thing?
Answer:  Heat illness in children is a real concern during the hot summer months.  Children are at greater risk of heat illness than adults.  Heat illness can come in the form of heat syncope (fainting), heat cramps, heat exhaustion, and heat stroke.
Heat syncope (fainting) typically occurs after prolonged standing or sudden rising from sitting or lying position, or from vigorous activity.  Most often occurs early in the summer when kids are not yet acclimated to exercise in the heat.  Children may have a feeling of dizziness, blurry vision, nausea or rapid heart rate before fainting.  The treatment is removal from heat, rest, and fluids.
Heat cramps are brief, intermittent, painful muscle cramps which are usually in legs, abdomen, or shoulders.  They may be due to electrolyte depletion.  Treatment is rest, removal from heat, fluid and salt replacement.
Heat exhaustion is the most commonly reported heat-related illness in athletes. It occurs because of excessive sweating in a hot, humid environment which causes dehydration.  Symptoms can include nausea, vomiting, diarrhea, hyperventilation, rapid heart rate, and flu-like symptoms.  Children with these symptoms need medical evaluation and may need intravenous fluid replacement and blood work to assess electrolyte balance.  Athletes with these symptoms should not return to practice for several days and must be cleared by a medical provider before return to play. 
Heat stroke is the most severe form of heat illness and can be potentially life threatening.  The initial symptoms can be similar to heat exhaustion as described above but affected children have altered mental status and are confused or “out of it.”  This is a medical emergency and requires resuscitation, aggressive cooling, intravenous fluid and intense medical monitoring. 
Prevention:  the American Academy of Pediatrics recommends the following steps to prevent heat illness:

• Limit activities when heat index chart indicates heat in red zone
• Recognize that younger children take a longer time to acclimatize to heat than older children and adults
• Hydrate before and after exercise on hot days
• Wear light-colored clothing.

Question:  I often bribe my child to get him to change his behavior.  I feel guilty about this, is it ok?
Answer: There has actually been scientific research on the most effective way to use rewards (bribes) to shape behavior.  So, bribes are ok!  And they work if used in the right way. Here are suggestions from recent research:

• Choose a specific, positive behavior.  For example: eat at least 3 bites of a vegetable every dinner for a week.  Not: don’t annoy me.
• Choose smart rewards.  Work with your child to choose the prize, so that’s it’s something they truly desire.  It does not need to be expensive.
• Stay positive.  Don’t nag, give lots of praise.  It is not about fixing a negative but taking on a challenge! 
• Small steps first.  Start with easy goals and small rewards and slowly build.  For example for stopping a thumb-sucking habit, try avoiding thumb for one day between breakfast and lunch.  Consider using a detailed progress chart.

These tips can be used for adults too!  Think about using them for yourself to motivate healthy change!
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:

customerservicefoxboro@pediatricspec.com and for the Wrentham office to customerservicewrentham@pediatricspec.com.  Feedback or submissions for our newsletter can be sent to lspitzer@pediatr
icspec.com. Also, please submit your email address if you’d like to be added to our mailing list.
PATIENT GATEWAY

IS HERE!

Patient Gateway is an on-line tool for patients to access information from their medical charts, contact the office and request appointments.  We have enrollment forms in the office.  We can presently enroll children under 12 and expect to shortly start enrolling older children as well.