Winter 2011 Newsletter
WELCOME to our ninth issue of the Pediatric Specialists newsletter.
Announcing our new Early Morning Urgent Care Clinic!
We now have walk-in hours from 8-9 AM Monday through Friday in the Foxboro office.  During this time patients may arrive without an appointment for evaluation of an urgent care need such as fever, sore throat, ear pain, or cough and will be seen on a first come, first served basis.  Patients with more chronic issues may be asked to schedule an appointment later in the day.  Walk-in hours will not be available on weekends or holidays.

Winter Health:
Fever Facts
Fever is a common reason for a child to come in to our office.  Fever can certainly be scary for parents and any fever in a child under 3 months is cause for major concern because of the greater risk of serious bacterial infection at such a young age.
CAUSE: Fever is one of the body’s normal defenses against attack from an infection. Fever can help the body fight infection by stimulating the immune system.  The usual fevers that children get (100 – 104 degrees) are not harmful.  The height of the fever is not a good indicator of how sick your child is.  We rely more on how sick the child is acting (e.g. not smiling, playing, or drinking fluids) to indicate the severity of their illness.   
TREATMENT:  Since fever can help your child fight the infection, treatment of fever is necessary only to keep your child comfortable.  Undressing or lightly dressing your child, offering cool drinks, and sponging off in a lukewarm bath can all help to reduce fever.  If fever medications are used be sure to give the right dosage for your child’s weight.  All parents should have a chart showing how much acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) to use according to the child’s weight (we have these charts available in our office for parents to take home).  A recent study showed that many over-the-counter medicines for children are not labeled clearly and may not provide proper dosing instruments, so if there are questions about dosing, please ask your doctor.  Acetaminophen in particular can be very dangerous if given in overdose, and for that reason the FDA has moved recently to limit acetaminophen in prescription drugs. 
Fever medicines typically take about one hour to work after they are given and will reduce fevers by 1.5 to 2 degrees.  If the fever starts out high it may often not come all the way down to a normal temperature.  Children’s fevers often run higher in the evening than in the earlier part of the day.  If your child is sleeping comfortably it is not necessary to wake her up to give her fever medicine. 
ACETAMINOPHEN:  Children 2 months and older can be given one of the acetaminophen products (e.g. Tylenol, Tempra, store brand acetaminophen) for fever.  Dosage should always be calculated based on the child’s weight, can be given every 4 hours, and care should be taken to use the correct device (e.g. dropper for infant acetaminophen, and syringe or spoon marked off in ml or cc for children’s acetaminophen liquid).
IBUPROFEN: Children 6 months and older can be given one of the ibuprofen products (e.g. Motrin or Advil).  These can be given every 6-8 hours and should also be dosed carefully according to weight. 
NO ASPIRIN!  Aspirin is never recommended for children under 21 because it is linked to Reye’s syndrome, a rare but serious disease that can affect the brain and liver following a viral infection.
Flu
It’s that time of year again, and we are continuing to administer flu vaccine.  This year the flu vaccine combines protection against H1N1 flu and seasonal flu in a single preparation, given either by nasal spray or by injection.  In the last few weeks we have begun to see some children in the office who are sick from influenza.
Children who are under nine and did not receive H1N1 vaccine last year (or have never received flu vaccine in the past) should get 2 doses of flu vaccine this year, spaced at least one month apart.  All other children need only a single dose of flu vaccine.
We are now scheduling flu vaccines in the office.  We no longer can have FluMist in stock, but do have sufficient supply of injected vaccine.
Please contact the office for an appointment for vaccine. 

Safety:
Sledding
Sledding is always a fun winter activity for kids of all ages, but results in many injuries every year (up to 75,000 injuries annually requiring medical treatment). 
To reduce the number of injuries, pediatricians recommend the following precautions:

• Wear helmets! Sleds can reach speeds of 20-25 mph and head trauma occurs in about 15% of sledding injuries that require an emergency room visit.  40% of these cases involve brain injury.
• Don’t let children sled without adult supervision.
• Don’t sled near trees and beware of dangerous obstacles that may be covered by snow.
• Choose sledding slopes that have a flat run at the end; avoid locations where the sledding hill meets a street, parking lot, or frozen pond.
• Dress children in bright colors with layers for warmth and don’t let kids remain in wet clothing.
• Invest in a sled with a steering mechanism and make sure kids sit face forward. Don’t use a cardboard box or inflatable sled.
• To avoid collisions have riders take turns sledding down a hill and make sure the kids heading back up the hill are out of the way of sledders.
• Teach kids to roll off a sled if they’re about to collide with something or if they think they’re out of control.
• Never let a moving vehicle pull a sled. 

NUTRITION
Whole Grains
Whole grains are super nutritious! Whole grains are the seeds or kernels of a growing plant, and they come in different shapes and sizes, from tiny seeds to larger kernels.  They contain three key parts: the bran which is the tough, fibrous outer skin; the germ which is the embryo or the part that becomes a new plant; and the endosperm which is the starchier part that provides nourishment for the young plant. The bran provides fiber and valuable antioxidants.   Eating whole grains provides us with wonderful health benefits.  Whole grains are more filling and contain more fiber and nutrients. 
Examples of whole grains that should be incorporated into a healthy diet are: brown rice, whole wheat pasta, 100% whole wheat bread, whole wheat couscous, quinoa, barley, and others.

Chicken Fried Rice

(This can be adapted with any meat or vegetables on hand)

2 tsp canola oil
1 cup chopped celery
3 cups thinly sliced bok choy
1 cup sliced snow pea pods
  Or broccoli or asparagus
½ cup sliced scallions
2 ½ cups cooked brown rice
1 (8 oz) can sliced water 
   chestnuts, drained
2C cooked chicken, diced
1 tsp grated peeled fresh ginger
¼ low sodium soy sauce
2T oyster sauce (optional)
1 tsp sesame oil

Heat canola oil in large nonstick skillet over medium high heat until hot.  Add celery, cook 2 minutes.  Add bok choy, pea pods, and scallion; cook, stirring, about 4 minutes or until bok choy is just wilted.  Add remaining ingredients, cook 3-4 minutes or until heated through.      
(Serves 4)

Stovetop Whole Wheat Macaroni and Cheese

8 oz dry whole wheat macaroni
1 cup skim milk
2Tbsp whole wheat pastry flour
1 tsp dry mustard
1 cup shredded cheddar cheese
¼ cup shredded parmesan
Salt and pepper to taste

Cook macaroni in salted water.  Meanwhile in large saucepan, whisk together milk, flour, and mustard until completely blended, then cook until thickened, 6-8 minutes.  Add cheeses and stir gently until melted, then add drained pasta to sauce.  Season with salt and pepper.
(Serves 4)

Sweet Potato Muffins
1.5 cups whole wheat pastry flour
1 cup coarse graham cracker crumbs, divided
½ cup sugar
1 tsp baking powder
1 tsp baking soda
½ tsp salt
¾ pound sweet potato, peeled and grated
3Tbsp butter, melted
6 oz plain nonfat yogurt
2 eggs
¼ C finely chopped pecans or walnuts (optional)

Preheat oven to 375.  Line a 12 muffin tin with cupcake papers.
In large bowl, whisk together flour, ¾ cup graham cracker crumbs, sugar, baking powder, baking soda, and salt.  Add sweet potatoes. 
In separate bowl combine butter, yogurt, eggs; and then stir into dry ingredients until just combined.  Spoon batter into muffin tins, sprinkle tops with nuts and remaining graham cracker crumbs.  Bake until golden brown, about 25 minutes.

Ask the Doctor

Question: Is it ok to give my kids sugary cereals for breakfast?  They won’t eat the healthier kind, and the sugary ones do contain whole grains.
Answer:  A recent pediatric study tested 91 children between ages 5 and 12.  The children were divided into 2 groups, half were offered three high -sugar cereals and half were offered three low-sugar cereals.  In both groups the children could have as much milk, orange juice, bananas, and strawberries as they wanted; they could also sprinkle sugar on top. 
Both groups “loved or liked” the breakfast.  The high sugar group ate twice as much cereal and calories from sugar even though more children in the low sugar group added sugar to their cereal.  More than half of the low-sugar group added fruit to their cereal compared to only 8 percent of the high-sugar group.
So try low sugar cereal next time!
Question:  How much TV should I let my preschooler watch?
Answer:  Preschoolers generally are exposed to double the recommended limit of TV screen time.  The American Academy of Pediatrics recommends limiting screen time to 1 – 2 hours of quality programming/day for pre-school age children.  Excessive TV viewing in young children has been associated cognitive and speech delays, aggressive behavior, decreased academic performance and obesity.  Parents should question child care programs about their TV viewing policies.   
Question:  Is there anything my teenager can do to help relieve his test anxiety?
Answer: A recent report in the journal Science said that students can relieve testing worries by spending 10 minutes before exam writing about their thoughts and feelings. Students who were prone to test anxiety were shown to improve their test grades significantly by this writing exercise.  It’s felt that worrying competes with the brain’s short term memory and ability to stay focused and writing about one’s worries before an exam helps to alleviate worries during the test.

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 registration forms available in the office, and can now sign up children under 11.  Once more confidentiality measures are in place we will be able to enroll teens as well.