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StethoScoop:

Medical Musings from Kids First Providers

StethoScoop: Medical Musings from Kids First Providers

1 month visit


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We are up to the one month visit – and this is a great time to explain the phrase you often hear us refer to: GROWTH PERCENTILES. From birth through the time they transition to an adult provider, we regularly monitor your child’s growth; height and weight, and during early childhood we also measure and track their head circumference. In order to assess growth patterns over time – these measurements get plotted on growth charts that give us the”percentile” for each measurement. The way I explain the percentile charts to parents is that they are a statistical tool to help us track a child’s growth pattern over months and years. For example, a one month old whose weight is at the 20th percentile would weigh more than 19% -and less than 79% – of other one month olds in the general population. For Pediatricians, we are watching the trend of the percentiles over time to make sure there is not a significant decline, whether over time, or suddenly. We are not expecting everyone to be average or at the 50th percentile, or at the top of the chart for their age; rather we use these values to gauge steady growth. If a 2 year old’s height is at the 15th percentile – are they too short? Well, if their weights have generally been in the 10-20 percentile range (or lower) at prior visits – then they are growing at a steady pace and as the Pediatrician I am happy – especially if their parents have a similar genetic make up. However – if that child previously measured at much higher percentiles, their growth has clearly slowed and we need to consider why there was this change. Interpreting and following these growth charts is not a simple process and it takes training and experience but I hope I was able to explain the basics. We also use percentile charts to assess Body Mass Index (BMI) as kids get older – but we will discuss that in the future. Later this week I will talk more about some of the other findings we assess at the 1 month visit. Have a great day…Dr Aronson


2 week visit


2 wk visit

For the next installation in my series focusing on “check-ups”, we will move on to the 2 week evaluation. As we discussed in my posts about the newborn visit – most babies lose weight in the 1st few days of life, and there is frequently an adjustment period as they learn to feed. When we have parents bring their babies back just a week or so after the initial visit – one of the most important things we are looking for is appropriate weight gain. As I joked in an earlier post – babies do not come with an instruction manual – some babies feed small amounts frequently, while others may take larger volumes less often. For babies that are nursing – the mothers can tell us about the schedule of feeds, but what volume is the baby drinking is typically not known. “Baby A” might drink 1 ounce every 2 hours, but “Baby B” feeds 2 ounces every 4 hours -the daily total will be the same, but the schedule is very different. Which is correct….whatever allows for regular wet and dirty diapers but also for steady weight gain, which at this age should be in the range of three quarters to one ounce per day. I often explain to parents that while there is plenty of time for a child to gain weight as they get older – the first weeks and months of a baby’s life are a critical time for growth and development of the brain, neurologic system and other organs. So if a baby is gaining weight properly , I can feel comfortable that they are getting enough nutrition for their brain, heart, lungs and so on. And if the pace of weight gain is too slow – or when they sometimes even lose more weight – we have some very important work to do. As always – feel free to post any questions or feedback on things you may have seen us do that you wanted to know more about. Check back in a few days as I continue this series. Dr. Aronson


Spring Is in the Air!


Despite the April cold temperatures, it is technically spring! We soon get to enjoy warmer weather, which unfortunately also brings spring allergies. 1 in 5 Americans have allergies, and the most common is hay fever, also known as seasonal allergies. After being cooped up for most of the winter, children cannot wait to get outside, where they are exposed to environmental allergens such as pollen, trees, grass, and mold. The most common signs and symptoms of seasonal allergies are similar to the common cold:

  • Itchy, watery, red, puffy eyes
  • Nasal congestion, sneezing, sniffling, runny nose, itchy nose
  • Post nasal drip
  • Clearing the throat
  • Itchy ears
  • Coughing

According to the American Academy of Pediatrics, allergies and asthma are the most chronic diseases among children in the United States. If your child has both asthma and seasonal allergies, spring may be a trigger season for them. You may see your child coughing more and/or using their rescue inhaler more frequently.   For asthmatics, by keeping their allergies well controlled; they in turn help prevent their asthma from flaring. Unfortunately, neither asthma nor seasonal allergies have a cure, but both are treatable and can be well managed with over the counter and/or prescription medication. Here are some other ways to help control allergies:

  • Keeping windows closed at home and in the car to keep allergens from settling inside
  • Staying outdoors for short periods of time when the pollen count is high
  • After spending time outside, washing your hands, arms, face; and changing clothes
  • Taking a shower or bath before bedtime

If you suspect your child is experiencing seasonal allergies, please call our office to discuss their symptoms and possible treatments so they could enjoy the spring weather!

 


Mumps: What Parents Need to Know


Mumps has been in the news recently after outbreaks at the University of Illinois in Urbana-Champaign and at a high school in Barrington, and more recently dozens of cases at Illinois State University.  

At Kids First Pediatrics, we like to keep our families informed and up to speed. Mumps is a viral infectious disease that can cause swelling and tenderness of the salivary glands found in the cheeks and jaw. This characteristic symptom is usually preceded by a few days of fever, headache, lethargy and muscle soreness. The infection spreads through contact with saliva or mucus  after an infected individual coughs  or sneezes. The symptoms of mumps typically last a few days, sometimes up to a week,  but a small percentage of infected individuals will develop more serious complications such as  deafness, meningitis, arthritis and painful swelling of the testicles. 

Although the only treatment for mumps is supportive care and hydration – there is a highly effective way to prevent the disease. That is  timely vaccination with the MMR vaccine at the 12 month check up and a second dose at age 4-5. Touch base with us for additional information, or check our website for links to trusted, reliable medical websites.   


Newborn Visit


I am REALLY excited about the opportunity to draw back the curtains so to speak so that families will have a better grasp on some of the many things we assess during check ups.  We will start with the newborn visit and in the coming weeks and months work our way through the pre college visits.   

I have been known to joke with parents that not much changes in the baby’s first few weeks – they eat, sleep, and poop. Sounds pretty simple- but  the reality is much more challenging! For a newborn and his/her parents, a lot of things have to happen during the first week. At the time of delivery – a newborn has massive transitions to go through; from breathing on their own, to being held and the feeling of clothes on the skin, to keeping warm and a series of changes in their heart and circulatory system. One of these major developments is learning to feed; how feeding is progressing is one of the biggest focuses of the first visit to the pediatricians office. Most of the questions the new parents have involve feeding issues, and from my perspective it is the primary thing I focus on at the first visit. So many of our families are breastfeeding their newborn, which of course is great, but it can sometimes come with a series of challenges. The babies need to learn to latch and swallow efficiently.  Every mother’s body is different of course – and the timing of milk production can be variable. “How often should a baby be feeding?” “How long should they be on the breast?” “How much formula should they be drinking?” “What about dirty and wet diapers?” We are here to help you with all of those questions. Babies do not come with an instruction manual (one of my other jokes that some have you have heard) and the newborn visit is focused on making sure the early transition is going reasonably well – and if not, we can help support and make adjustments to  ensure your newborns are healthy and safe.   

I look forward to reading your comments and thoughts. My hope is that these posts will give you a small insight into some of the things we do at “routine check ups”. Check back in a few days and I will review some other parts of the newborn visit before moving on the 2 week exam.  

Have a great day – Dr Aronson 

 


Staff Holiday Traditions


We reached out to our Kids First staff this week, asking what are some of their holiday family traditions. Here’s what we found out:

Dr. Aronson: Watching the movie, “A Christmas Story” over and over again – and teasing my wife that I will get our kids a “Red Rider BB gun” or that I will get a Leg Lamp for our living room

Dr. Shepherd: I am Swedish on my maternal grandmother’s side and growing up we always went to my great-grandmother’s place on the north side of Chicago for a big Swedish smorgasbord. My great uncles would always be happily sipping Glogg. There were always lots of Swedish meatballs, limpa bread, Swedish sausage, potatoes, rice pudding, and tons of delicious cookies. Now my grandmother and great-grandmother have passed on, but my uncle keeps up the tradition and we go to his house on Christmas Eve for the smorgasbord. Eating all the traditional foods always brings me back to happy childhood holiday memories!

Dr. Kim: Fighting over outdoor lights, begging our toddler to keep the ornaments on the tree, then stuffing ourselves with repeat Thanksgiving dinner on Christmas night.

Stephanie S.: Every year I look forward to my sister-in-law’s annual cookie exchange. Rules are you have to bake enough cookies to use up 1 lb. of butter. Lots of laughs and cookies to last through Christmas.

Yael: For my family tradition we enjoy lighting the Chanukah candles together and then we sing and dance around the Chanukah lights.

Lisa V: The Verdon family attends Christmas Eve Mass at St Mary’s in Evanston, where the kids participate in recreating the Nativity, dressing up as angels and shepherds! After Mass, we have family dinner and then get in pj’s to watch The Christmas Story as a family:)

Edith: I enjoy getting together with all my relatives on Christmas Eve. We play games and just enjoy each others’ company. I also look forward to my husband’s warm sorrel drink from his native Trinidad and Tobago. It’s full of spices and just tastes like Christmas.

Sarah: One of our holiday traditions is to eat different types of fried food to commemorate the miracle of the festival of lights, Chanukah, when one vial of olive oil lasted eight whole nights! On Chanukah we gather for parties to light our menorah and share in potato latkes ( pancakes) and jelly donuts! Check out this fun spin on donuts to make and enjoy with your families!

Katie: Every year Phil, Tess and I pick out our Christmas tree and we come home and decorate it while drinking hot chocolate and listening to Christmas music. Always gets us in the Christmas spirit!

Jean: In the Russo family we have the traditional Italian Feast of Seven fishes on Christmas eve. My father and mother-in-law prepare seven different kinds of fish and seafood and we spend the whole afternoon and evening eating, laughing, and spending time together.

Debbie: Since Michael was a baby we do this on Christmas Eve: after we hang our stockings and make a plate of cookies and a glass of milk for Santa, we sit by the fireplace and read “The Night Before Christmas” together. I used to read it to Michael as a baby and ever since he learned to read, he reads it to us.  He is almost 17 and we still love doing it!

Another favorite is baking cookies. My husband and my son are my “official testers” and get to decide which ones I make again the following year. They always comment on how great the house smells at Christmas time from all the baking!


Winter Car Seat Safety Tips


Winter is a tricky time for car seats. As a general rule, bulky clothing, including winter coats and snowsuits, should not be worn underneath the harness of a car seat.

In a car crash, fluffy padding immediately flattens out from the force, leaving extra space under the harness. A child can then slip through the straps and be thrown from the seat.

These tips from the American Academy of Pediatrics (AAP) will help parents strike that perfect balance between keeping little ones warm as well as safely buckled in their car seats.

How to Keep Your Child Warm and Safe in the Car Seat:

Note: The tips below are appropriate for all ages. In fact, wearing a puffy coat yourself with the seat belt is not a best practice because it adds space between your body and the seat belt.

  • Store the carrier portion of infant seats inside the house when not in use. Keeping the seat at room temperature will reduce the loss of the child’s body heat in the car.
  • Get an early start. If you’re planning to head out the door with your baby in tow on winter mornings, you need an early start. You have a lot to assemble, and your baby may not be the most cooperative. Plus, driving in wintry conditions will require you to slow down and be extra cautious.
  • Dress your child in thin layers. Start with close-fitting layers on the bottom, like tights, leggings, and long-sleeved bodysuits. Then add pants and a warmer top, like a sweater or thermal-knit shirt. Your child can wear a thin fleece jacket over the top. In very cold weather, long underwear is also a warm and safe layering option. As a general rule of thumb, infants should wear one more layer than adults. If you have a hat and a coat on, your infant will probably need a hat, coat, and blanket.
  • Don’t forget hats, mittens, and socks or booties. These help keep kids warm without interfering with car seat straps. If your child is a thumb sucker, consider half-gloves with open fingers or keep an extra pair or two of mittens handy — once they get wet they’ll make your child colder rather than warmer.Pinch Test image
  • Tighten the straps of the car seat harness. Even if your child looks snuggly bundled up in the car seat, multiple layers may make it difficult to tighten the harness enough. If you can pinch the straps of the car seat harness, then it needs to be tightened to fit snugly against your child’s chest. See image right. 
  • Use a coat or blanket over the straps. You can add a blanket over the top of the harness straps or put your child’s winter coat on backwards (over the buckled harness straps) after he or she is buckled up. Some parents prefer products such as poncho-style coats or jackets that zip down the sides so the back can flip forward over the harness. Keep in mind that the top layer should be removable so your baby doesn’t get too hot after the car warms up.
  • Use a car seat cover ONLY if it does not have a layer under the baby. Nothing should ever go underneath your child’s body or between her body and the harness straps. Be sure to leave baby’s face uncovered to avoid trapped air and re-breathing. Many retailers carry car seat bundling products that are not safe to use in a car seat. Just because it’s on the shelf at the store does not mean it is safe!
  • Remember, if the item did not come with the car seat, it has not been crash tested and may interfere with the protection provided in a crash. Never use sleeping bag inserts or other stroller accessories in the car seat.
  • Pack an emergency bag for your car. Keep extra blankets, dry clothing, hats and gloves, and non-perishable snacks in your car in case of an on-road emergency or your child gets wet on a winter outing.

These precautions can make sure your child is as safe as can be when traveling to their next well-child visit or over the river and through the woods to grandmother’s house.


Holiday Safety & Mental Health Tips


The holidays are an exciting time of year for kids, and to help ensure they have a safe holiday season, here are some tips from the American Academy of Pediatrics (AAP).

Trees

  • When purchasing an artificial tree, look for “Fire Resistant” on the label.
  • When purchasing a live tree, check for freshness. A fresh tree is green, needles are hard to pull from branches and needles do not break when bent between your fingers. The trunk butt of a fresh tree is sticky with resin, and when tapped on the ground, the tree should not lose many needles.
  • When setting up a tree at home, place it away from fireplaces, radiators or portable heaters. Place the tree out of the way of traffic and do not block doorways.
  • Cut a few inches off the trunk of your tree to expose the fresh wood. This allows for better water absorption and will help keep your tree from drying out and becoming a fire hazard.
  • Be sure to keep the stand filled with water, because heated rooms can dry live trees out rapidly.

Lights

  • Check all tree lights (even if you’ve just purchased them) before hanging them on your tree. Make sure all the bulbs work and that there are no frayed wires, broken sockets or loose connections.
  • Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights, and a person touching a branch could be electrocuted.
  • Some light strands may contain lead in the bulb sockets and wire coating, sometimes in high amounts. Make sure your lights are out of reach of young children who might try to put lights in their mouths, and wash your hands after handling them.
  • Before using lights outdoors, check labels to be sure they have been certified for outdoor use. To hold lights in place, string them through hooks or insulated staples, not nails or tacks. Never pull or tug lights to remove them.
  • Plug all outdoor electric decorations into circuits with ground fault circuit interrupters to avoid potential shocks.
  • Turn off all lights when you go to bed or leave the house. The lights could short out and start a fire.
  • Lights and candles are fire hazards. If you use electric lights, look for frayed or exposed wires, and make sure no wires are pinched by furniture and no cords run under rugs.
  • Don’t use the same extension cord for more than three strands of lights and turn off all lights before going to bed.
  • Space heaters are involved in 79% of fatal home heating fires. If space heaters are in use, there should be a 3-foot open zone–make sure they are not close to curtains, blankets or potentially flammable materials. Always turn off and unplug when unattended.

Decorations

  • Use only non-combustible or flame-resistant materials to trim a tree. Choose tinsel or artificial icicles of plastic or nonleaded metals.
  • Never use lighted candles on a tree or near other evergreens. Always use non-flammable holders, and place candles where they will not be knocked over.
  • In homes with small children, take special care to avoid decorations that are sharp or breakable. Keep trimmings with small removable parts out of the reach of children to prevent them from swallowing or inhaling small pieces. Avoid trimmings that resemble candy or food that may tempt a young child to eat them.
  • Wear gloves to avoid eye and skin irritation while decorating with spun glass “angel hair.” Follow container directions carefully to avoid lung irritation while decorating with artificial snow sprays.
  • Remove all wrapping papers, bags, paper, ribbons and bows from tree and fireplace areas after gifts are opened. These items can pose suffocation and choking hazards to a small child or can cause a fire if near flame.
  • Keep potentially poisonous holiday plant decorations, including mistletoe berries, Jerusalem cherry, and holly berry, away from children.

Toy Safety

  • Select toys to suit the age, abilities, skills and interest level of the intended child. Toys too advanced may pose safety hazards for younger children.
  • Before buying a toy or allowing your child to play with a toy that he has received as a gift, read the instructions carefully.
  • To prevent both burns and electrical shocks, don’t give young children (under age 10) a toy that must be plugged into an electrical outlet. Instead, buy toys that are battery-operated.
  • Young children can choke on small parts contained in toys or games. Government regulations specify that toys for children under age three cannot have parts less than 1 1/4 inches in diameter and 2 1/4 inches long.
  • Children can have serious stomach and intestinal problems — including death — after swallowing button batteries or magnets. In addition to toys, button batteries are often found in musical greeting cards, remote controls, hearing aids and other small electronics. Small, powerful magnets are present in many homes as part of building toy sets. Keep button batteries and magnets away from young children and call your health care provider immediately if your child swallows one.
  • Children can choke or suffocate on uninflated or broken balloons; do not allow children under age 8 to play with them.
  • Remove tags, strings, and ribbons from toys before giving them to young children.
  • Watch for pull toys with strings that are more than 12 inches in length. They could be a strangulation hazard for babies.
  • Parents should store toys in a designated location, such as on a shelf or in a toy chest, and keep older kids’ toys away from young children.

Food Safety

  • Bacteria are often present in raw foods. Fully cook meats and poultry, and thoroughly wash raw vegetables and fruits.
  • Keep hot liquids and food away from the edges of counters and tables, where they can be easily knocked over by a young child’s exploring hands. Be sure that young children cannot access microwave ovens.
  • Wash your hands frequently, and make sure your children do the same.
  • Never put a spoon used to taste food back into food without washing it.
  • Always keep raw foods and cooked foods separately, and use separate utensils when preparing them.
  • Always thaw meat in the refrigerator, never on the countertop.
  • Foods that require refrigeration should never be left at room temperature for more than two hours.

Happy Visiting

  • Clean up immediately after a holiday party. A toddler could rise early and choke on leftover food or come in contact with alcohol or tobacco.
  • Remember that the homes you visit may not be childproofed. Keep an eye out for danger spots like unlocked cabinets, unattended purses, accessible cleaning or laundry products, stairways, or hot radiators.
  • Keep a list with all of the important phone numbers you or a baby-sitter are likely to need in case of an emergency. Include the police and fire department, your pediatrician and the national Poison Help Line, 1-800-222-1222. Laminating the list will prevent it from being torn or damaged by accidental spills.
  • Always make sure your child rides in an appropriate car seat, booster seat, or seat belt. In cold weather, children in car seats should wear thin layers with a blanket over the top of the harness straps if needed, not a thick coat or snowsuit. Adults should buckle up too, and drivers should never be under the influence of alcohol or drugs. See Winter Car Seat Safety Tips from the AAP for more information. 
  • Traveling, visiting family members, getting presents, shopping, etc., can all increase your child’s stress levels. Trying to stick to your child’s usual routines, including sleep schedules and timing of naps, can help you and your child enjoy the holidays and reduce stress.

Fireplaces

  • Before lighting any fire, remove all greens, boughs, papers, and other decorations from fireplace area. Check to see that the flue is open.
  • Use care with “fire salts,” which produce colored flames when thrown on wood fires. They contain heavy metals that can cause intense gastrointestinal irritation and vomiting if eaten. Keep them away from children.
  • Do not burn gift wrap paper in the fireplace. A flash fire may result as wrappings ignite suddenly and burn intensely.
  • If a glass-fronted gas fireplace is used, keep children and others well away from it with a screen or gate. The glass doors can get hot enough to cause serious burns and stay hot long after the fire is out.

Holiday Mental Health Tips

  • Try to keep household routines the same. Stick to your child’s usual sleep and mealtime schedules when you can, which may reduce stress and help your family enjoy the holidays.
  • Take care of yourself both mentally and physically. Children and adolescents are affected by the emotional well-being of their parent or caregivers. Coping with stress successfully can help children learn how to handle stress better, too.
  • Make a plan to focus on one thing at a time. Try a few ideas to balance the hustle and bustle of things like shopping, cooking, and family get-togethers during the holidays: Stop and pay attention to what is happening at the moment, focus your attention on one thing about it ,and notice how you are feeling at the time. Withhold immediate judgment, and instead be curious about the experience.
  • Give to others by making it an annual holiday tradition to share your time and talents with people who have less than you do. For example, if your child is old enough, encourage him or her to join you in volunteering to serve a holiday meal at your local food bank or shelter or sing at a local nursing home. Help your child write a letter to members of the armed forces stationed abroad who can’t be home with their own family during the holidays.
  • Remember that many children and adults experience a sense of loss, sadness or isolation during the holidays. It is important to be sensitive to these feelings and ask for help for you, your children, family members or friends if needed.
  • Kids still need to brush their teeth twice a day!
  • Don’t feel pressured to “over-spend on gifts.” Consider making one or two gifts. Help your child make a gift for his or her other parent, grandparents, or other important adults and friends. Chances are, those gifts will be the most treasured ones and will teach your child many important lessons.
  • Most important of all, enjoy the holidays for what they are — time to enjoy with your family. So, be a family, do things together like sledding or playing board games, and spend time visiting with relatives, neighbors, and friends.

Medical Mission to Haiti


Dear Kids First Family,
My husband, Tim, and I are looking forward to our upcoming journey to Haiti to provide medical care at Mountain Top Ministries, through a nonprofit organization called Little by Little. Recently, I came across a beautiful quote: “Fearlessly pursue what sets your soul on fire!”

Tim and I have dreamed of participating in a mission trip together. Together we are fearlessly pursuing this dream! In Haiti, I can serve through my medical care, and Tim is happy to step back from his usual role as project manager (both at work and home) to a role of tell-me-what-to-do-I’m-here-with-a-smile! The medical care needed in this area is endless. The care we can provide is boundless, and we are humbled and excited to be able to serve.

We are scheduled to leave on January 2, 2017 and will return home January 9, 2017. Gramps and Busia (Tim’s loving parents) have graciously offered to maintain our home front for their four grandchildren.
When we arrive to Mountain Top Ministries (MTM), we plan to partner with the community and help
treat anyone who finds their way to the clinic. We will also provide care for the MTM schoolchildren and orphans from the surrounding area. Our first focus is to relieve suffering by using our resources against infections, infestations such as intestinal worms and scabies, malnutrition, and to treat the simple diseases we encounter.

Tim and I are utterly humbled, surprised and grateful that Dr. DiVincenzo, Dr. Shepherd and Dr. Aronson are sponsoring a huge portion of our trip! Their generous contribution allowed for this trip to happen–they are helping us pursue what sets our souls on fire!

If you would like to make a donation, the money we are raising will be used to purchase medical necessities and basic hygiene materials for the Haitians who seek our care. We appreciate all of your support! Support to us includes thoughts and prayers, as these are the equally important.

If you choose to donate monetarily, please write in the “notes” section: Stephanie and Tim Brennan, January 2017 Haiti Team. Donation can be made directly to this website.


Thanksgiving Dessert


Anyone who knows Dr. Adam Aronson well, knows that fall brings two of his favorite things: football and Thanksgiving. This makes Emmitt Smith’s pumpkin spice pound cake pretty much his slice of heaven. We posted the original recipe below, as well as some ways to make this recipe (and others like it) a little healthier.

Emmitt Smith’s Pumpkin Spice Pound Cake

Ingredients
1 cup vegetable oil
3 cups sugar
5 large eggs
3 cups flour
2tsp baking powder
1/2 tsp baking soda
1/2 tsp salt
2 tbs allspice
2 tbs cinnamon
2 tbs nutmeg
2 cups canned pumpkin
1/3 cup water
1 tsp. vanilla
1 tsp. butter flavoring
2 tbs. orange extract

Cooking Instructions
1. Preheat oven to 325 degrees.

2. Grease and flour a 10-in. tube pan/Bundt pan. Combine the vegetable oil adn sugar. Add eggs one at a time, beating well. Set aside. In a separate bowl, combine flour, baking powder, baking soda, salt and spices and set aside.

3. Alternatively mix 3 parts flour mixutre and 2 parts pumpkin mixture into the sugar and egg mixture.

4. Mix at lowest speed after each addition until just blended. Bean an additional 3-4 minutes. Pour into a tube pan and bake for 1 hour and 15 minutes.

To make this recipe a bit healthier, substitute whole wheat flour for white flour, reduce sugar to only 2 cups, substitute apple sauce for the cup of oil and leave out the butter flavoring.