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Westwood-Mansfield Pediatrics Newsletter Spring 2014

Spring is Coming (Believe it or not)!


We are beginning to feel the warmth of the sunshine and the days are definitely getting longer. Keep thinking warm thoughts – before you know it we will need the air conditioning!

For all the good that spring brings, now is the time to be mindful of springtime allergies and asthma (see below), tick checks (remember the DEET), and sun protection! Stay healthy!



New Telephone Triage Hours


We are pleased to announce that we have expanded our weekday office phone hours! We will now be available to take your call from 8:30 am until 8:00 pm on Monday through Thursday (and until 5:00 pm on Fridays). In addition to opening earlier, we will no longer be turning off the phones during lunch (we will still have our answering service taking calls during the dinner hour from 5:00 pm until 6:00 pm). Please feel free to call during those times for any questions or concerns that you may have about your child or if you need to schedule an appointment.


Behavioral Health Mission 2014


Over the past year, we at Westwood-Mansfield Pediatrics (with the
help of our physician organization, the PPOC) have embarked on a mission to improve our ability to manage two of the most common pediatric behavioral health problems – depression and anxiety.

Major Depression is seen in 2% of children and 8% of adolescents at any one time (with almost 20% of teenagers experiencing depression in their lifetime). Anxiety disorders have a similar lifetime prevalence with15-20% of teenagers having had some type of anxiety disorder (including generalized anxiety, separation anxiety, social anxiety, etc) in their lives.

Our providers and staff have been involved in learning communities specifically designed to enhance our expertise in identifying and managing these problems in the pediatric population. We are in the process of hiring a therapist who will spend time in both offices and help us with short-term management of these conditions. We have learned the nuances of medication management and are able to treat more behavioral health issues in our office (without necessarily requiring a referral). In addition, we have a consulting psychiatrist to discuss complicated patients with (confidentially, of course) and are able to refer to psychiatrists when patients present with more complex issues. We have designated two Behavioral Health Nurses to help support families in crisis: Chris McCarthy (Westwood) and Brighid Collins (Mansfield).

Our Medical Home Team has made it’s mission this year to work on behavioral health. They hope to develop programs to educate families both in prevention and treatment of anxiety and depression. As in most areas of pediatric medicine, we take much more pleasure in preventing disease than having to treat it.

Remember, most children feel sad or anxious at some time. This is entirely normal. If your child’s or teen’s feelings are preventing him or her from fully engaging in life, let us know and we will do our best to help you!

Spring Time Allergies


Itchy eyes, runny noses, throat clearing – what is a person to do?

Treat his or her allergies, of course!

Each year, tree pollen season generally starts around March 15th and lasts until the end of June. Allergic rhinitis symptoms are commonly seen in children during this period, with symptoms including runny nose, sneezing, sore throat (especially at night and early in the morning) and slight cough. Local pollen counts can be easily followed at www.pollen.com by entering your zip code.

Suspect seasonal allergies if your child:

1) has prolonged colds (lasting more than 14-18 days) in the spring
2) has itchy red eyes with very little discharge
3) has a strong family history of allergies
4) complains of prolonged sneezing or early morning cough with sore throat

Oral Antihistamine Treatment (non-prescription) for the nose and eyes:

1) Zyrtec, Claritin or Allergra (or generics) – these are non-sedating antihistamines that are given once daily. They are available as pills, dissolvable pills, or liquids. The dosing is listed on the package. Claritin (loratadine) and Allegra (fexofenadine) are FDA-approved down to 2 years of age. Zyrtec (cetirizine) has been approved for use in all people older than 6 months of age.

Eye Drops (non-prescription):

1) Zaditor (or generic ketotifen) – very effective for the management of itchy eyes. Place 1-2 drops into each eye twice a day. To put into the eyes, have your child lay flat on a bed. Have your child close eyes tightly and point his or her nose straight up at the ceiling. Place 1-2 drops in the inner corner of each eye and then have your child open eyes. In addition, consider giving your children hand wipes when they are outdoors so they can wipe the pollen off their hands before they rub their eyes.

Nasal Sprays (prescription and now non-prescription):

1)Flonase (fluticasone) or others (Nasonex, Rhinocort, etc. . .) – very low-dose nasal steroid treatment that decreases the inflammation in the nose caused by breathing in pollen. If your child has used these in the past, please check to see if you need refills as all allergy medications are most effective when started two weeks before symptoms begin!

2)Nasacort OTC – this is the first over-the-counter nasal steroid treatment approved for ages 2 and older. It is hard to know how this will influence coverage of prescription nasal steroids. If similar to the antihistamines listed above, there will likely be a trend for all nasal steroids becoming over-the-counter, and insurance companies not paying for the prescription versions. Certainly if you have never used a nasal steroid spray before, or if your prescription coverage does not cover these medications well, trying Nasacort OTC certainly would be reasonable.

All allergy medicines work best when they are started two weeks before your child’s allergy season. Your child should come into the office if no better after being on medication for two weeks. Additionally, when the greenish pollen (often oak) starts to cover our cars and the ground, children tend to develop itchy eyes and are continually rubbing their eyes. Doing this re-injects pollen into the eyes, causing swollen eyes and a slight discharge – this causes an allergic conjunctivitis (not infectious conjunctivitis) which is not contagious. Making sure children wash off when they come in after an afternoon of play can prevent some allergens from getting in the eyes and nose.

For more information, please see Dr. Hartman’s video.



504 Plan versus IEP : Which is Best for your Child?

excerpted for the National Center for Learning Disabilities

iepAlthough it already seems late in the school year, this is a time of year when children’s academic struggles often become very clear to parents and teachers.

Is your child struggling in school? Are you worried they aren’t making adequate progress? Have you heard the terms 504 Plan, IEP/IDEA but don’t know what they are and which one would be appropriate for your child?

Identified below, are the two important federal laws you should familiarize yourself with.

These two federal laws are what guarantee a free appropriate public education (FAPE) and provide services or accommodations to eligible students with disabilities in the U.S. They are:
Section 504 of the Rehabilitation Act of 1973 (called Section 504), as amended
Individuals with Disabilities Education Act (called IDEA)
Section 504 and IDEA are the laws that provide special education, other services, and appropriate accommodations for eligible children with disabilities in the United States. Individual states may also have laws governing these matters. When state laws and federal laws are different, schools must follow the federal laws, unless the state law provides the child with more rights or protection. These two federal laws also say that children with disabilities must be educated — as much as possible — with children who do not have disabilities.

But there are also differences between Section 504 and IDEA. Parents, health professionals, and teachers should know what each law provides so that they make the best choice for the child.

Which One is Right for My Child?

There is no one “right” choice for every child. Seeking services under Section 504 or IDEA will depend on what the child needs and the degree of impairment demonstrated in the educational environment.

For students who will be able to learn with simple accommodations or only minor changes to the child’s day, Section 504 may be a good choice.
Receiving services under Section 504 is faster and more flexible and is a good way for eligible students to get accommodations.

For students who may need a wider or more intense range of services, IDEA may work better. IDEA also provides parents with more rights and responsibilities to actively participate in the educational decisions about their child. Children who do not qualify for IDEA may qualify for Section 504, depending on their degree of impairment. While the federal law is the same, the procedures for implementing Section 504 vary greatly from state to state, and even from one school district to another within the same state. It is important to know how your state and school district implement these federal laws.

Section 504

Section 504 is a federal civil rights statute that says schools cannot discriminate against children with disabilities. It says that schools that receive federal dollars must provide eligible children with disabilities with an equal opportunity to participate in all academic and non-academic services the school offers. The school must also provide appropriate accommodations based on their individual needs.

These accommodations are often simple changes that can help the child with the disability. Sometimes these accommodations include special services such as using a tape recorder for note taking, giving the student a quiet place to work, or access to a computer in school for written work. Students who are eligible to receive services under Section 504 receive instruction through the regular education curriculum and at the same level as their peers without disabilities. Students under Section 504 must also participate in state required assessments.

IDEA (Individuals with Disabilities Education Act)

The Individuals with Disabilities Education Act (IDEA) is the federal law that provides special education and related services needed for an eligible child with a disability to benefit from the child’s education. Services received under IDEA are often referred to as “special education.”An Individualized Education Program (IEP; sometimes called an Individualized Education Plan) is designed specifically for each eligible child with disabilities to provide a free appropriate public education (FAPE).
To learn more about what each law involves, visit this website
Who is Eligible for a 504 Plan or IEP?
What do each document Provide?
What is the Evaluation Process for each
Discipline Under each law
Tips for Working with the School

Other helpful websites:

Federation of Children with Special Needs
Special Education (MA Department of Education)

If you have specific concerns about your child’s educational needs, please contact one of our providers or Lisa Drenkhahn, Westwood-Mansfield Pediatrics’ Educational Care Coordinator.

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