Dr. John Bean Answers the Most Frequently Asked Questions by New Parents on What to Expect After You Take Your Newborn Home.

When is the first office visit?

The first office visit with your pediatrician will occur between three and five days of age. At this visit we check the baby’s weight (weight loss is common in the first few days of life), feeding schedule and mother’s milk production if breastfeeding. We check your baby for jaundice which is quite common in newborns in the first weeks of life. Most infants will have mild degrees of jaundice but if more severe it may require further evaluation and occasionally treatment. A general physical examination will be done at this visit and we will discuss how everyone is adjusting to the newest family member. This visit also provides an opportunity for parents to ask questions of me and my staff. Questions are welcomed in our office to ensure adequate and appropriate information is shared about the newborn and the important transition that is occurring at this time. A second visit will be set up for approximately 2 weeks of age and a complete examination will be done. Most babies at this age will be at or above their birth weight if feeding has been well established.

What is the immunization schedule?

We recommend the first Hepatitis B vaccine in the hospital after delivery. The next set of immunizations will be at the 2, 4 and 6-month checkups. There are a multitude of immunizations that will be discussed at these visits. Fortunately, some are combined into a single injection and one of the newest vaccines is given orally. These series of vaccines are called the primary series. There are more immunizations between 1 and 2 years and beyond that will be discussed and scheduled as the baby grows. At each of these well-baby checkups a complete examination with particular attention to the infant’s growth and development will be performed. Common areas of discussion center on feeding, sleeping and infant behavior and development.

Do you provide preventive guidance?

Absolutely. We include discussions on what to anticipate between visits and provide guidelines for sleeping, feeding and the developmental milestones to look for. Much of pediatrics is devoted to prevention and early identification of problems. Every visit should include some discussion and transmission of information regarding what to expect prior to the next visit. Sleeping is a good example – often by counseling parents on what the normal variation in sleep is like and recommending age-appropriate interventions, good sleep patterns can be established early. One thing to always remember is that every baby and every family is different and recommendations will vary. We think it is very important for a pediatrician to be flexible in making recommendations that will be best for each individual family.

Over my years of practice I often have been asked, “What should a parent consider in choosing the right pediatrician for their children?” I believe that choosing the right pediatrician for your children requires careful thought and a little research.

There are key points you may want to consider. As you begin your search for a pediatrician, try using the following guidelines to help you make your decision. They will give you confidence that you have made the right choice.

Ask for Referrals

Begin by asking your obstetrician for recommendations. Trusted, friends, relatives, and neighbors who have children are also helpful resources. Once you have the names of several pediatricians, you will want to make certain that they are accepting new patients and are listed as providers under your insurance plan.

Check Professional Credentials

It is important that you choose a pediatrician who is board-certifies. Board-certifies doctors are eligible to become a Fellow of the American Academy of Pediatrics. Look for the initials FAAP after their names. This means the pediatrician has completed a prescribed period of residency in the specialty of pediatrics, passed oral and written exams and handled a minimum number of cases. You can verify a pediatrician’s board certification and FAAP status by visiting www.azmd.gov and viewing the physician’s profile.

Schedule a Get-Acquainted Interview

Call and set up an interview with the pediatrician. Ask the doctor questions that are important to you and your child and pay attention to the way you feel about your interaction. If your child is 2 or older, take him or her along so you can also evaluate the rapport between the two. Is the doctor a good listener? Do you have a sense of trust in the doctor? And finally, does the pediatrician ask about your child’s health, home and family?

Other observations: How large is the practice? Are you likely to see different providers at each visit? Does the pediatrician have a special interest in subspecialty? For example, if your child has allergies or asthma, look for a pediatrician who has a special interest in those areas.

Medical Philosophy

Take time to explore the doctor’s attitudes about health issues that are important to you. You may want to know the pediatrician’s views on the following topics; circumcision, breast feeding, discipline, complementary or alternative health methods, nutrition and diet. You may want to discuss the use of antibiotics and vaccinations. If you have important cultural, religious or moral beliefs related to your child’s care, express these to the pediatrician. Is the doctor compassionate and open-minded to your thoughts and feelings?

Physician Availability

When you are caring for a sick child, a physician’s availability becomes a critical issue. What is the doctor’s policy regarding sick visits and urgent care? What procedure does the doctor recommend in emergency situations? Ask if phone advice is available. If so, who provides it? You may want to inquire about the procedure for contacting the doctor after hours. How long will you have to wait for a non-urgent appointment? Who will cover for your pediatrician while he/she is away?

Practice Location and Hospital Affiliation

Even healthy children may need to see a pediatrician frequently, so consider how convenient the doctor’s office is to your home or work. Examine the office facility. Is parking convenient? What is the waiting room like – if it’s overcrowded this may signal long waiting times. Are the examination rooms and treatment areas clean and organized? Ask your pediatrician which hospitals he/she is affiliated with. Physician hospital coverage for newborns and older children will vary among pediatricians. You will want to discuss hospital coverage arrangements with the pediatrician.

Ultimately, by investing a few hours of your time, you will have the peace of mind that comes from finding a dedicated partner in helping you raise a healthy, happy child.

Our children are out of the class room and into the backyard. Playing outside is a summer time fun. But outside playtime comes with sun exposure. Here are a couple of sun safety tips for the summer fun.

Sun Protection

• Cover-up. Wear lightweight cotton pants, long-sleeved shirts and hats. Don’t forget the shades! Sunglasses look cool and will help shield the eyes from the UV radiation that causes cataracts. Find a medium to dark pair with large lenses that wrap around the sides.
• Schedule outdoor time. Plan activities to avoid the time from 10:00 am to 4:00 pm when the UV rays are the strongest.
• Carry shade. Use the stroller’s umbrellas for little ones or bring a sun umbrella or canopy to create shade when there are no trees or awnings available.
• Use Sunscreen. Choose a sunscreen that says “broad spectrum” this means it covers both UVB and UVA rays. Use at least an SPF (Sun protection factor) of 30. Use a sunscreen lotion that contains either zinc oxide or titanium dioxide. Apply 15 to 30 minutes before heading out and re-apply every 2 hours.
• For our little ones, less than 6 months: keep them out of direct sunlight because their skin is not yet protected by melanin.
• You can apply a small amount on their face and back of hands, but keep them covered with lightweight clothing.
• Talk to us about Vitamin D supplements for our breastfed little ones.

Sun Burns

• Use cool water to help the skin cool, can apply medicated lotions or aloe to soothe skin, and use Acetaminophen or Ibuprofen for painful sunburns.
• If blisters develop from a sunburn, do not pop them.
• Hydrate from the inside with extra oral fluids, use water or diluted juice to replace fluid loss.

 
Resources:

American Academy of Pediatrics. Sun Safety: Information for parents about sunburns & sunscreen. Retrieved from: www.healthychildren.org

Environmental Working Group. Sun safety guide for children. Health child health work. Retrieved from: https://healthychild.org/assets/HCHW_sunsafety_guide_v41.pdf

As another school year ends and everyone is excited for the summer, we at Old Pueblo wanted to give you some thoughts to go with all your summer activities, and most importantly, for this fall when the sport practices and games begin again.

There has been a lot of talk in the medical community about concussions and their severity and according to the American Academy of Neurology, there are new guidelines that help highlight concussions and its effect on the developing pediatric brain.

A concussion is defined as an alteration of brain function, typically affecting memory and orientation. It is considered a functional disturbance, not a structural injury. One of the most important new guidelines is that if a concussion is suspected, sit the player out immediately. Athletes who are recovering from a concussion will have a slower reaction time and slower cognition processing time, which leaves them more vulnerable to another unexpected hit. Another important new guideline is that the timing of return to play completely depends on the individual, the symptoms, and how quickly those symptoms resolve. Returning to play is based on a stepwise approach that includes a normal clinical neurological examination, the patient’s self-report of no symptoms, a return to normal school and work performance, and an ability to perform through a full normal day. This should all be evaluated by a trained healthcare professional.

Concussion signs and symptoms include headache, sensitivity to light and sound, changes in reaction time, balance, and coordination, and also changes in memory, judgment, speech, and sleep. These symptoms are often reported by the athlete and they might complain about “pressure in their head”, “double or blurry vision”, “feelings of sluggish, hazy, foggy, or grogginess”, or they may just report “not feeling right.” Any mild bump or blow to the head can be serious, you do not need to ‘blackout’ in order to have a concussion. Boys are at higher risk for a concussion when playing rugby, football, hockey, and soccer; whereas girls are at the highest risk with soccer and basketball. It was also mentioned that bicycling and skateboarding have a concussion risk, so helmets are essential and it is important to make sure they fit. Remember, you cannot see a concussion and some children may not experience and/or report symptoms until hours or days after the injury. Most people with a concussion will recover quickly and fully. Concussions usually resolve within 7-10 days. But always seek medical attention with a trained healthcare provider. The CDC offers great resources of free information for parents, coaches, and athletes so they too can help recognize, prevent, and respond to a concussion.

Thank you and remember….”If in doubt, sit them out!!!”

Our country has seen a growing epidemic of obesity over the past 30 years. In the 1960’s, only 5% of children were considered overweight.

In 2000, that percentage grew to 15% and continues to increase. Children have no desire to be overweight so what’s happening?

Research has shown that one fourth of children watch 4 or more hours of TV per day. A child who has 0-2 hours of “screen time” (TV, Computer, Video Game) has a 10% chance of being overweight as opposed to a child who has 4-5 hours per day and a 30% chance of obesity. TV watching also exposes the kids to many “junk food” commercials in addition to the lack of exercise and frequent snacking that usually accompanies TV viewing. Children need at least 30 – 60 minutes of vigorous exercise (activity that makes them sweat) every day.

We are also a fast food society. Our lifestyles often necessitate meals that are quick and easy. However, the studies have shown that fast food portions are larger than what is usually served at home and the fat content and caloric density are significantly higher. Ask your kids what their favorite foods are and you will likely hear pizza, mac and cheese, french fries, chicken strips, hot dogs, burgers, ice cream – What happened to fruits and veggies? Studies have also shown that regular meals at home as a family resulted in decreased intake of soda and fried foods and an increase in fruits and vegetables. Plus, eating as a family allows greater family interaction and the opportunity to model good eating habits for your kids.

Another major factor is the vast consumption of soft drinks, juice and sport drinks by many of our children. These beverages are loaded with sugar and a recent study showed that 30% of teen girls and 50% of teen boys drank more than 3 sodas a day on a regular basis. As can be expected with this kind of intake, water and low fat milk consumption take a major decline.

As parents, we have to take responsibility for our children’s weight problems. There are no easy solutions – it takes work and persistence. Consult with your pediatrician – height, weight and BMI (body mass index) should be measured on every school age child as part of their yearly physical exams. Establishing good eating habits and making time for regular exercise can be accomplished. Here are a few key ideas – don’t try to do all at once. Start with one and incorporate into your family routine. Then add another and another…

1. Eat meals as a family 5-7 nights a week – eat out only once
2. Eat healthy snacks (read the labels and go for: 2 grams of fiber per serving size)
3. Downsize the portions
4. Go for “5 a day” – 2 servings of fruit and 3 servings of vegetables every day
5. Limit sodas, juice and sport drinks ( 4-6 oz of juice/day, one soda a week)
6. Limit screen time to 2 hours/day and let the kids earn additional screen time by exercising more than 30 minutes per day
7. Join a team – soccer, basketball, anything to get them active
8. Be a good role model!

As the fall and winter season develops, many children will experience cough and wheezing episodes. Two questions that quickly arise are – Does my child have asthma and will he/she outgrow it?

About 50% of children less than 6 years will have at least one wheezing episode and about a third will develop persistent asthma. Asthma must be distinguished from many other conditions and treated appropriately. Asthma that is not well treated can place a heavy burden on a family, not only because of the child’s diminished health but the time and expense of office, emergency room, and hospital visits and missed school and work.

A good history of symptoms (recurrent cough and wheezing especially at night and early morning), a family history and exposure to environmental factors (smoke) are essential in making a diagnosis. A detailed physical examination with attention to the child’s growth and other body systems will help to rule out other causes. Laboratory and X-ray examinations may also be indicated. The child’s response to treatment will also help in establishing an asthma diagnosis.

Once the diagnosis is established, effective treatment for asthma is available to control and treat asthma flare ups. Of the children who continue to have persisting asthma, many will have fewer and fewer problems with wheezing over the first 10 – 12 years of life. However, some will continue to have persisting asthma into adulthood. Research is showing that there are certain risk factors that will increase the likelihood of asthma persisting. Medicine is not at a stage where we can definitely prevent it from persisting into adulthood but effective control can be realized with proper treatment. By building a three way partnership between the child, parent and pediatrician an effective asthma plan can be realized that will lead to an active healthy life.