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Scroll down for info on  2018-19 Flu advisories, New car seat recommendations, Concussions, Fire Safety, Calcium, Sleep, Peanut Allergies, Tween Years, Head Lice, Breastfeeding, Insect Repellents, Bexero, Zika Virus, Electronic Screens, Respiratory Illness, Sports Injuries, Water Safety, Sunscreens, Allergies, Coughs & Colds, and Poison Oak.

2018-19 Flu Season
​It is recommended that all children over 6 months of age receive the seasonal flu vaccine in the fall to provide protection during the peak cold and flu season.  Our practice has mercury-free flu vaccines available for your family.  Please note that although the nasal mist is available this year, the American Academy of Pediatrics (AAP) recommends the administration of the inactivated influenza vaccine (a shot) for all children and adolescents. This is especially true for those with an underlying medical condition associated with an elevated risk of complications from influenza, which includes all children with a history of asthma.

American Academy of Pediatrics (AAP) Updates Recommendations on Car Seats for Children
Riding in a car remains one of the most dangerous things our children do every day.  Using the right car seat or booster seat lowers the risk of death or serious injury by 70%! 
New guidelines recommend that children remain rear-facing until they outgrow either the weight or height allowed by their specific car seat.  This is a change from the recommendation that previously had children switch to forward-facing at 2 years of age.  The AAP recommendations are summarized below.
 The  AAP recommends:
•              Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more.
•              Once they are facing forward, children should use a forward-facing car safety seat with a harness for as long as possible, until they reach the height and weight limits for their seats. Many seats can accommodate children up to 65 pounds or more.
•              When children exceed these limits, they should use a belt-positioning booster seat until the vehicle’s lap and shoulder seat belt fits properly. This is often when they have reached at least 4 feet 9 inches in height and are 8 to 12 years old.
•              When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
•              All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

 Here are some links to additional resources about car seat safety

A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis. Concussions are typically caused by a blow or jolt to the head. The following is information from the American Academy of Pediatrics about concussions, including guidance on treatment and prevention.

When do concussions occur?
Concussions can happen in any sport but more often occur in collision sports, such as football, rugby, or ice hockey. They also are common in contact sports that don’t require helmets, such as soccer, basketball, wrestling, and lacrosse. However, a concussion can also occur from a collision with the ground; a wall; a goalpost; or a ball that has been thrown, hit, or kicked. Many concussions also occur outside organized sports. For example, a child riding a bike or skateboard can fall down and bump his head on the street or an obstacle.

The symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious. Symptoms include:
Nausea or vomiting
Dizziness or balance problems
Double or blurry vision
Sensitivity to light
Sensitivity to noise
Feeling dazed or stunned
Feeling mentally “foggy”
Trouble concentrating
Trouble remembering
Confused or forgetful about recent events
Slow to answer questions
Changes in mood—irritable, sad, emotional, nervous
Sleeping more or less than usual
Trouble falling asleep

 What to do if you suspect a concussion
All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor. A doctor can confirm the diagnosis of concussion; determine the need for any specialized tests, such as CT scan, MRI, or neuropsychological tests; and decide if it is OK for the athlete to return to play. Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion may be more susceptible to another injury than an athlete with no history of concussion.

No one knows how many concussions are too many before permanent damage occurs. Repeated concussions are particularly worrisome, especially if each one takes longer to resolve or if a repeat concussion occurs from a light blow. The doctor needs to know about all prior concussions, including those that occurred outside of a sports setting, in order to make proper recommendations regarding return to play and future sports participation.

The best treatment for a concussion is complete rest from all physical and mental activity. Children should be monitored often, but there is no need for wake-up checks during sleep. Loud music, computer, and TV should be limited or stopped if they increase the symptoms. School attendance and work may need to be modified with tests and projects postponed. Students need to be excused from gym class or recess activities. Any worsening of concussion symptoms or changes in behavior (eg, agitation, grogginess, disorientation) should be immediately reported to your doctor.
Returning to physical activity
Recovery time from concussion is variable based on the individual, the severity of the concussion, and the history of prior concussions. An athlete may feel better and want to return to play before their brain has completely recovered. Given the uncertain and unpredictable time frame for recovery, all sports activity should be suspended until symptoms have completely resolved at rest. At this point, a stepwise return to physical activity can begin if the athlete’s doctor says it’s OK. The stepwise plan should be progressive and individualized. Having an athletic trainer involved in monitoring this plan can be very helpful. It is important to pay close attention to worsening symptoms (like increasing headache, nausea, or dizziness). Any concussion-related symptoms that return with exertion are a clear indicator that the concussion has not healed. Final clearance to return to full activity should also be at the direction of a physician.

Not all concussions can be prevented, but some may be avoided. Helmets should be worn for any riding activities (like horseback, all-terrain vehicle [ATV], motorbike, bike, skateboard, or snowboard) or contact sports (like football, hockey, or lacrosse). Helmets should fit appropriately and be in good condition. Athletes should be taught safe playing techniques and to follow the rules of the game. Most importantly, every athlete needs to know how crucial it is to let their coach, athletic trainer, or parent know if they have hit their head or have symptoms of a head injury—even if it means stopping play. Never ignore a head injury, no matter how minor.
“When in Doubt, Sit Them Out!"

Source: Care of the Young Athlete Patient Education Handouts (Copyright © 2010 American Academy of Pediatrics)

With the recent fires in California, it is important to have a fire safety plan worked out for you home with children. Fire can spread rapidly through your home, leaving you as little as one or two minutes to escape safely once the alarm sounds. A closed door may slow the spread of smoke, heat and fire. Install smoke alarms in every sleeping room and outside each separate sleeping area. Install alarms on every level of the home. NFPA 72, National Fire Alarm Code®  requires interconnected smoke alarms throughout the home. When one sounds, they all sound. Pull together everyone in your household and make a plan. Walk through your home and inspect all possible exits and escape routes. Households with children should consider drawing a floor plan of your home, marking two ways out of each room, including windows and doors. Also, mark the location of each smoke alarm. For easy planning, download’s escape planning grid. This is a great way to get children involved in fire safety in a non-threatening way.
  • Everyone in the household must understand the escape plan. When you walk through your plan, check to make sure the escape routes are clear and doors and windows can be opened easily.
  • Choose an outside meeting place (i.e. neighbor's house, a light post, mailbox, or stop sign) a safe distance in front of your home where everyone can meet after they've escaped. Make sure to mark the location of the meeting place on your escape plan.
  • Go outside to see if your street number is clearly visible from the road. If not, paint it on the curb or install house numbers to ensure that responding emergency personnel can find your home.
  • Have everyone memorize the emergency phone number of the fire department. That way any member of the household can call from a neighbor's home or a cellular phone once safely outside.
  • If there are infants, older adults, or family members with mobility limitations, make sure that someone is assigned to assist them in the fire drill and in the event of an emergency. Assign a backup person too, in case the designee is not home during the emergency.
  • If windows or doors in your home have security bars, make sure that the bars have emergency release devices inside so that they can be opened immediately in an emergency. Emergency release devices won't compromise your security - but they will increase your chances of safely escaping a home fire.
  • Be fully prepared for a real fire: when a smoke alarm sounds, get out immediately. Residents of high-rise and apartment buildings may be safer "defending in place."
  • Once you're out, stay out! Under no circumstances should you ever go back into a burning building. If someone is missing, inform the fire department dispatcher when you call. Firefighters have the skills and equipment to perform rescues.
  • Stay Safe!

Calcium: The Teen Bone Builder
During the teenage years, the growing bones absorb more calcium from the blood than at any other time of life. By early adulthood, our bones stop accepting deposits. Not long after that, the gradual loss of calcium begins.

Milk and Milk Products: Milk and milk products provide three-fourths of the calcium in the American diet. Other foods contain calcium too, like broccoli and collard greens. However, these vegetables also contain substances that impair the body’s ability to absorb calcium.

Recommended Amount of Daily Calcium: Boys and girls aged nine to eighteen are advised to consume one thousand three hundred milligrams of calcium per day. That’s equivalent to about four and a half eight-ounce glasses of low-fat milk. Unfortunately, two-thirds of adolescent girls in the United States fail to meet this requirement. According to a survey from the U.S. Department of Agriculture, more and more teenagers are giving up milk in favor of other drinks—mostly soft drinks. Little more than half the teenagers in the poll said they drank milk regularly, as opposed to three-fourths of 1970s teens.

Calcium Supplements: The National Institutes of Health supports the use of supplements for young people who don’t get sufficient calcium through their diet. For optimal absorption, no more than five hundred milligrams should be taken at one time. Your pediatrician can guide you as to the appropriate dosage and dosing schedule. Because adolescents utilize calcium relatively efficiently, they may be best off ingesting the tablets between meals.

Good Sources of Calcium:
Most foods in the milk group: milk and dishes made with milk, such as puddings and soups.
Cheeses: mozzarella, cheddar, Swiss, Parmesan, cottage cheese.
Canned fish with soft bones, including sardines, anchovies, salmon.
Dark-green leafy vegetables, such as kale, mustard greens, turnip greens, bok-choy.
Tofu, if processed with calcium sulfate.
Tortillas made from lime-processed corn.
Calcium-fortified juice, bread, cereal.

Other Ways For Teens To Build Strong Bones: Eat dairy products and other foods fortified with vitamin D. Vitamin D supports bone development by increasing the body’s absorption of calcium from food. Most of us get all the vitamin D we need from everyday exposure to the sun; the rays trigger an internal chemical reaction, producing vitamin D.
For kids who aren’t getting enough calcium, make use of calcium-fortified milk, orange juice, cereals and granola bars. Some of these products contain so much calcium that a single serving takes a youngster halfway to her recommended daily value.

Your teen isn’t a milk drinker? There are other ways to obtain calcium through the diet. Try tempting your son or daughter with chocolate-flavored skim milk. You can also disguise milk by adding it to soups, puddings, baked products, sauces and stews.
Alternatives to milk include cheese and yogurt. Eight ounces of yogurt and two ounces of cheese contains about the same amount of calcium as eight ounces of milk and therefore each would equal one serving. Half a cup of cottage cheese, however, is lower in the mineral and counts as half a serving.

Go easy on the salt. Besides its association with high blood pressure (hypertension), which is a risk factor in heart disease, kidney disease and stroke, a diet high in salt may deprive the body of calcium by increasing the amount excreted in the urine. Since about 75 percent of the salt we eat has already been added to the various processed foods in our diet, this means not just holding back on the use of the salt shaker, but also cutting down on fast foods and other processed foods, as well as high sodium seasonings like soy sauce, bouillon cubes, meat tenderizer, tamari sauce and Worcestershire sauce.

Stay physically active. Adolescents’ bones respond to weight-bearing exercise by growing stronger and denser. Any activity that gets your teenager up and moving will do, whether it’s jogging, dancing, walking the dog, bowling or jumping jacks.
Don’t smoke tobacco or drink alcohol. In addition to their many other detrimental effects, cigarettes and alcohol decrease bone mass.

Sleep is essential for good physical and mental health.  Now that you’re a parent, how much sleep does your child need ?

Newborns sleep about 16-17 hours per day, but typically in 1-2 hour chunks of time. Infants 4-12 months old need 12-16 hours of sleep per day, including naps.  Babies don’t develop regular sleep cycles until about 6 months old and after the newborn period will need a little less sleep. It may be normal for your 6 month old to wake in the middle of the night, but hopefully they fall back to sleep after a few minutes. It’s also important to remember that different babies may have slightly different sleep needs.

AAP Recommendations for Infant Sleep Safety:
Until their first birthday, babies should sleep on their back for all sleep times.
Use a firm sleep surface for baby.
Room share – keep the baby’s sleep area in the same room with you for the first 6-12 months.
Only bring your baby into your bed to feed or comfort.
Bed-sharing is not recommended for any babies.
Keep soft objects, loose bedding, or any objects that risk suffocation out of the babies sleep area. Swaddling your baby is safe.
Try giving a pacifier at nap time and bedtime.
Breast feed your baby if possible.

For some families, toddler bedtime is the hardest part of the day because they are likely to resist going to sleep as the world is so interesting to them during this highly curious and high energy developmental stage. Children 1-2 years old should sleep 11-14  hours per day (including naps). Children age 3-5 years old need 10-13 hours of sleep per day.

Here are some tips to help your toddler develop good sleep habits:
Bedtime routine – bath, stories, quiet music. Not too much active play.
Be consistent – same time, same routine – this helps them anticipate sleep.
Favorite cuddly “lovie” – Teddy bears, special blankets are all OK.
Try to avoid your child sleeping in your bed – this makes it harder to fall asleep alone.
Give it time – developing a bedtime/sleep routine can be challenging. Try to be patient and understanding. Night lights can help
The AAP program “Brush, Book, Bed” is available on the AAP website.

School Age
Children ages 6-12 years require 9-12 hours per day. This age group will occasionally take a nap on the weekends to catch up with sleep as school and activities become more demanding of their time and energy.

Studies tell us that even though teens seem very grown up in some ways, it doesn't mean they need less sleep.  Teenagers still need 8-10 hours of sleep every night to promote good health. “Sleep is critical to maintain focus and alertness, to repair and maintain brain cells, to clear out toxic metabolites and replenish energy sources.” Says Dr. Charles A. Czeisler, a professor of sleep medicine at Harvard Medical School.
Teens' sleep cycle begins to shift as they enter adolescence due to hormonal influence that occurs when they enter puberty.  Their natural tendency is to go to bed later and resist waking up in the morning. This adolescent “sleep delay” is biological, “ It’s not just in human teenagers, it’s seen in other juvenile mammals too.”

Here are some general recommendations to help your teen get enough sleep:
Maintain a regular sleep schedule – go to bed and wake up about the same time every day.
Avoid oversleeping on the weekends – a little extra sleep may help, but getting far off schedule will make weekday sleep more difficult.
“Catnap” – a short 15-20 minute nap in the early afternoon can be beneficial.
Turn off the screens! – Try to turn off screens 30-60 minutes before bedtime and avoid having your teen sleep with their phone.
Avoid caffeine, smoking, alcohol and drugs – all of these are associated with sleep problems.
Call your pediatrician/provider if you have concerns about your teen’s sleep.

The Science of Adolescent Sleep. Perri Klass MD. New York Times.
American Academy of Pediatrics Policy Statement, "SIDS and Other sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment."
American Academy of Sleep Medicine (AASM) Guidelines, "Recommended Amount of Sleep for Pediatric Populations."

 ​Peanut Allergies – The Latest Guidelines
Some children have a higher risk of developing a peanut allergy than others. Babies who have severe eczema and/or and egg allergy are at the highest risk. In the past, the AAP (American Academy of Pediatrics) advised that those children avoid peanuts until they were older. Newest research has shown that early introduction of peanut products in those kids actually could help prevent an allergy.

What does that mean?
Babies who are at a high risk of peanuts allergy (severe eczema or egg allergy) should be tested for peanut allergy at around 4 months old. We can refer you to a pediatric allergist to facilitate this.  If the tests are negative, introducing small amounts of peanut products at least 3 times a week can help prevent an allergy from developing. If the allergy tests are positive the allergist can help your family decide the best course of action. Sometimes if the test is only slightly positive the first taste of peanut butter might be in the allergist’s office.

What about other babies?
Babies who have mild or moderate eczema (your provider can help you determine this) are at a slight increase risk of peanut allergy. No testing needs to be done, but starting peanut products at 6 months is helpful to prevent an allergy.
If food allergies run in the family talk with your provider about if testing needs to be done on your baby before trying peanut products.
For babies who aren’t at risk of peanut allergy you can start peanut products whenever your family is ready but early is fine!

What kind of “peanut products?”
Peanuts themselves are a choking hazard so you can either give a small taste of smooth peanut butter or mix some smooth peanut butter in with another puree your baby has tolerated before like plain yogurt, infant cereal or a fruit or vegetable.  There is also a puffed peanut snack for babies called “Bamba” that is common overseas and now available in the US. 

For more information:

The Tween Years (Ages 9-12)
Today's precocious preteens often shock parents when they begin to act like teenagers.  Don't be fooled, they’re still children. They’ll astonish you with their ability to conceptualize, to argue brilliantly, and then to do foolish things.

The Middle School years are a time of magical blossoming, but like all huge transitions in our kids' lives, they’re filled with ups and downs. As with parenting toddlers, parents who don’t accept and constructively negotiate their child's blossoming independence invite rebellion, or even worse, deception.

The biggest danger for tweens is losing the connection to parents while struggling to find their place and connect in their peer world. The biggest danger for parents is trying to parent through power instead of through relationship, thus eroding their bond and losing their influence on their child as she moves into the teen years. 

Fortunately, there are lots of good resources out there for helping parents and tweens navigate these rough waters.  Check out these websites for some great articles:

Head Lice
Head lice are usually spread from one person to another through direct contact. While upsetting for parents, it is not a sign that the child is sick or dirty. Lice are common with studies showing up to 1 in 4 elementary school children are infested. Lice do not jump or fly, humans are the only hosts and while lice can live for up to 50 hours on objects such as clothes or brushes, it is unclear from studies if these objects are involved in transmission.  It is important to find and treat lice quickly to avoid spreading them to others.
Most people with head lice do not have any symptoms. Some people feel itching or skin irritation of the scalp, neck, and ears. This is caused by an allergic reaction to lice saliva. It can take up to 6 weeks to develop a reaction to lice saliva.

Head lice are diagnosed by examination of the scalp and hair. The louse is tiny, measuring 2-3 mm when fully mature, grayish white and very difficult to see with the naked eye. The eggs, also know as nits, are easier to see. They are white, look like dandruff and are firmly attached to the hair. Typically hatching after 10 days, they move further from the shaft as the hair grows.

A fine-toothed comb is usually needed to make the diagnosis. Hair can be wet or dry and should be combed through to remove tangles. The fine- toothed comb is pulled from the roots to ends and then examined after each stroke for lice or eggs. Repeat at least once. Finding nits without lice is not necessarily a sign of infestation as they can persist for months after treatment. The closer the nits are to the scalp, the more likely there is active infection

A number of options are available. One of the commonest non-prescription medications is Permethrin, better knows Nix or Rid. Follow the manufacturer's instructions carefully for applying the insecticide. Typically, you wash the hair with shampoo, rinse it, and towel-dry it. Apply the insecticide cream or gel liberally to the scalp and leave on for 10 minutes before rinsing with water. A second treatment is normally required 7-10 days later.
Wet-combing is a way to remove lice from the hair with careful and repeated combing. It is a good option for treating very young children or if you want to avoid using insecticides. Wet-combing is time consuming and must be repeated multiple times over a period of a few weeks. The technique is the same as that used in the diagnosis of head lice.  Each session should take 15-30 minutes, and should be done every 3-4 days for 2 weeks after you no longer find an adult louse.

Studies have examined lotions and other materials (olive oil, butter, mayonnaise, petroleum jelly [Vaseline]) that are applied to the head, and then allowed to dry, with the goal of suffocating lice. However, lice are difficult to suffocate; wet-combing probably works as well and is less messy. Close contacts should be examined for lice and those who share the same bed should be treated, even if no lice or eggs are found
Children should not be removed from school, but it is recommended that the school be informed.

Clothing, bedding, and towels used within 48 hours before treatment should be washed in hot water and dried in an electric dryer on the hot setting. Dry cleaning is also effective. You can use a vacuum to clean furniture, carpet, and car seats. Items that cannot be washed or vacuumed can be sealed inside a plastic bag for two weeks. Items that the person used more than two days before treatment are not likely to be infested because head lice cannot survive off the body for more than 48 hours. You do not need to have your home sprayed for lice.


Happy World Breastfeeding Week!!!!
The following message is brought to you by the folks at UNICEF and the World Health Organization:
"Breastfeeding is not only the cornerstone of a child's healthy development; it is also the foundation of a country's development."  
I am proud to be a lactation consultant in a pediatric practice which recognizes just how important breastfeeding is, both on a personal level (helping parents meet their breastfeeding goals) and on a global level.  At Primary Pediatrics, we do our best to provide you with well-informed care which gives you support every step of the way as you embark on what we hope will be this very gratifying aspect of parenting your child.
The theme of this year's World Breastfeeding Week is "Breastfeeding: A Key to Sustainable Development."  In a meeting of world leaders in 2013, breastfeeding was identified as one of 17 sustainable goals that is key in ending poverty, protecting the planet, and ensuring prosperity.  Now, THAT's powerful.  Click on the link below to learn more about how breastfeeding makes a difference not only in your child's health, but the health of your community and the earth:


Thank you!
Georganne Walker, CPNP, IBCLC

 Other resources:

General breastfeeding information (multiple languages):
Returning to work information:
Dr. Jack Newman's website:
Collection/storage of breast milk:
Medications and lactation:
Resource books about breastfeeding:



Choosing an Insect Repellent for Your Child
Mosquitoes, biting flies, and tick bites can make children miserable. While most children have only mild reactions to insect bites, some children can become very sick. One way to protect your child from biting insects is to use insect repellents. However, it’s important that insect repellents are used safely and correctly. Read on for more information from the American Academy of Pediatrics (AAP) about types of repellents, DEET, using repellents safely, and other ways to protect your child from insect bites.


Types of Repellents
Insect repellents come in many forms, including aerosols, sprays, liquids, creams, and sticks. Some are made from chemicals and some have natural ingredients. Insect repellents prevent bites from biting insects but not stinging insects. Biting insects include mosquitoes, ticks, fleas, chiggers, and biting flies. Stinging insects include bees, hornets, and wasps.

Available Repellents
DEET: Chemical repellents with DEET (N,N-diethyl-3-methylbenzamide) are considered the best defense against biting insects.  DEET lasts about 2 to 5 hours depending on the concentration of DEET in the product.
Caution should be used when applying DEET to children.

Picaridin: In April 2005 the Centers for Disease Control and Prevention (CDC) recommended other repellents that may work as well as DEET: repellents with picaridin and repellents with oil of lemon eucalyptus or 2% soybean oil. Currently these products have a duration of action that is comparable to that of about 10% DEET.  They last about 3 to 8 hours depending on the concentration. Although these products are considered safe when used as recommended, long-term follow-up studies are not available. Also, more studies need to be done to see how well they repel ticks.

Essential oils: Repellents made from essential oils found in plants such as citronella, cedar, eucalyptus, and soybean and last usually less than 2 hours.
Chemical repellents with Permethrin: These repellents kill ticks on contact.  When applied to clothing, it lasts even after several washings. Should only be applied to clothing, not directly to skin. May be applied to outdoor equipment such as sleeping bags or tents.

NOTE: The following types of products are not effective repellents: Wristbands soaked in chemical repellents. Garlic or vitamin B1 taken by mouth. Ultrasonic devices that give off sound waves designed to keep insects away. Bird or bat houses. Backyard bug zappers (Insects may actually be attracted to your yard). ​


About DEET
DEET is a chemical used in insect repellents. The amount of DEET in insect repellents varies from product to product, so it’s important to read the label of any product you use. Studies show that products with higher amounts of DEET protect people longer. For example, products with amounts around 10% may repel pests for about 2 hours, while products with amounts of about 24% last an average of 5 hours. But studies also show that products with amounts of DEET greater than 30% don’t offer any extra protection. The AAP recommends that repellents should contain no more than 30% DEET when used on children. Insect repellents also are not recommended for children younger than 2 months.

Tips for Using Repellents Safely
Dos: Read the label and follow all directions and precautions. Only apply insect repellents on the outside of your child’s clothing and on exposed skin. Note: Permethrin-containing products should not be applied to skin. Spray repellents in open areas to avoid breathing them in. Use just enough repellent to cover your child’s clothing and exposed skin. Using more doesn’t make the repellent more effective. Avoid reapplying unless needed. Help apply insect repellent on young children. Supervise older children when using these products. Wash your children’s skin with soap and water to remove any repellent when they return indoors, and wash their clothing before they wear it again.

Dont's: Never apply insect repellent to children younger than 2 months. Never spray insect repellent directly onto your child’s face. Instead, spray a little on your hands first and then rub it on your child’s face. Avoid the eyes and mouth.Do not spray insect repellent on cuts, wounds, or irritated skin. Do not use products that combine DEET with sunscreen. The DEET may make the sun protection factor (SPF) less effective. These products can overexpose your child to DEET because the sunscreen needs to be reapplied often.


Reactions to Insect Repellents
If you suspect that your child is having a reaction, such as a rash, to an insect repellent, stop using the product and wash your child’s skin with soap and water. Then call Poison Help at 1-800-222-1222 or your child’s doctor for help. If you go to your child’s doctor’s office, take the repellent container with you.


A new vaccine to prevent Meningococcal Meningitis Serotype B
Q. What is Meningococcal Meningitis Serotype B?
An infection that involves the linings covering the brain and spinal cord. The disease often starts with symptoms that are similar to those of the flu, but rapidly progress to cause brain damage, loss of a limb and death.
Q. Is this a new illness?
A. No, but it was rarely seen in the United states and is most common in Europe and Africa. In recent years there have been outbreaks in six major universities including 3 in California.  We have had one case in our practice.
Q.  Who needs this vaccine?
Individuals between ages 17 and 25 years of age who are in group situations such as college, the army, or traveling to foreign countries, etc. are the most vulnerable to this disease.
Q   Don’t we already have a Meningococcal Vaccine?
Yes, but it does not prevent this type of the disease and it is doubtful that the 2 vaccines can be combined in the future.
Q.  How is it given?
 A.  Two injections are given at least 1 month apart to achieve full immunity. 
Q  Will insurance cover the Vaccine?
We expect that they will, since the United States Center for  Communicable Disease has approved the vaccine.  We will be monitoring all of the insurance companies that we take to see that they do.
Q. Is the Vaccine effective?
 A.   80 to 85% of those receiving the two doses of the vaccine  have  achieved immunity to Meningococcus Serotype      B.
Q. Is the vaccine safe? 
 While there have been a number of symptoms directly and indirectly related to the vaccine (local pain, redness, swelling at the site of the injection, headache, etc.) there has been only one significant allergic reaction in over 3,000 patients after taking the vaccine.
We are now giving this vaccine to all of our patients over 16 years of age who are at risk ( college, military, foreign travel, etc.) for this devastating disease. If you would like your child to have this immunization we would be happy to schedule an appointment to have the vaccine alone, or given at any checkup over 16 years of age, or appointment where your child is not acutely ill.


Zika virus is an emerging mosquito-borne virus that was first identified in humans in 1952 in Uganda and the United Republic of Tanzania. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Asia and the Pacific. Zika virus disease is caused by a virus transmitted primarily by Aedes mosquitoes. People with Zika virus disease can have symptoms that can include mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache. These symptoms normally last for 2-7 days. There is no specific treatment or vaccine currently available. The best form of prevention is protection against mosquito bites.
During large outbreaks in French Polynesia and Brazil in 2013 and 2015 respectively, national health authorities reported potential neurological and auto-immune complications of Zika virus disease. Recently in Brazil, local health authorities have observed an increase in Guillain-Barré syndrome (a neurologic disorder with numbness in limbs and weakness) which coincided with Zika virus infections in the general public, as well as an increase in babies born with microcephaly in northeast Brazil. Substantial new research has strengthened the association between Zika infection and the occurrence of fetal malformations and neurological disorders. However, more investigation is needed to better understand the relationship. Other potential causes are also being investigated

Zika virus diagnosis can only be confirmed by laboratory testing for the presence of Zika virus RNA in the blood or other body fluids, such as urine or saliva.
Travellers should take the basic precautions to protect themselves from mosquito bites. This can be done by using insect repellent regularly; wearing clothes (preferably light-coloured) that cover as much of the body as possible; installing physical barriers such as window screens in buildings, closed doors and windows; and if needed, additional personal protection, such as sleeping under mosquito nets during the day. 
Repellents should contain DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester) or icaridin (1-piperidinecarboxylic acid, 2-(2-hydroxyethyl)-1-methylpropylester). Product label instructions should be strictly followed. Special attention and help should be given to those who may not be able to protect themselves adequately, such as young children, the sick or elderly.


Electronic Screen Cautions

In a world where children are "growing up digital," it's important to help them learn healthy concepts of digital use and

citizenship. Parents play an important role in teaching these skills.

Here are a few tips from the American Academy of Pediatrics (AAP) to help parents manage the digital landscape they're exploring with their children.

1) Treat media as you would any other environment in your child's life. The same parenting guidelines apply in both real and virtual environments. Set limits;

kids need and expect them. Know your children's friends, both online and off. Know what platforms, software, and apps your children are using, where they

are going on the web, and what they are doing online.

2) Set limits and encourage playtime. Tech use, like all other activities, should have reasonable limits. Unstructured and offline play stimulates creativity. Make unplugged playtime a daily priority, especially for very young children. And—don't forget to join your children in unplugged play whenever you're able.

3) Families who play together, learn together. Family participation is also great for media activities—it encourages social interactions, bonding, and learning. Play a video game with your kids. It's a good way to demonstrate good sportsmanship and gaming etiquette. And, you can introduce and share your own life experiences and perspectives—and guidance—as you play the game.

4) Be a good role model. Teach and model kindness and good manners online. And, because children are great mimics, limit your own media use. In fact,

you'll be more available for and connected with your children if you're interacting, hugging and playing with them rather than simply staring at a screen.

5) Know the value of face-to-face communication. Very young children learn best through two-way communication. Engaging in back-and-forth "talk time" is critical for language development. Conversations can be face-to-face or, if necessary, by video chat, with a traveling parent or far-away grandparent.

Research has shown that it's that "back-and-forth conversation" that improves language skills—much more so than "passive" listening or one-way interaction with a screen.

6) Create tech-free zones. Keep family mealtimes and other family and social gatherings tech-free. Recharge devices overnight—outside your child's bedroom

to help children avoid the temptation to use them when they should be sleeping. These changes encourage more family time, healthier eating habits, and

better sleep, all critical for children's wellness.

7) Don’t use technology as an emotional pacifier. Media can be very effective in keeping kids calm and quiet, but it should not be the only way they learn to

calm down. Children need to be taught how to identify and handle strong emotions, come up with activities to manage boredom, or calm down through breathing, talking about ways to solve the problem, and finding other strategies for channeling emotions.

8) Apps for kids – do your homework. More than 80,000 apps are labeled as educational, but little research has demonstrated their actual quality. Products pitched as "interactive" should require more than "pushing and swiping." Look to organizations like Common Sense Media for reviews about age-appropriate apps, games, and programs to guide you in making the best choices for your children.

9) It’s OK for your teen to be online. Online relationships are part of typical adolescent development. Social media can support teens as they explore and discover more about themselves and their place in the grown-up world. Just be sure your teen is behaving appropriately in both the real and online worlds.

Many teens need to be reminded that a platform's privacy settings do not make things actually "private" and that images, thoughts, and behaviors teens share online will instantly become a part of their digital footprint indefinitely. Keep lines of communication open and let them know you're there if they have

questions or concerns.

10) Remember: Kids will be kids. Kids will make mistakes using media. Try to handle errors with empathy and turn a mistake into a teachable moment. But some indiscretions, such as sexting, bullying, or posting self-harm images, may be a red flag that hints at trouble ahead. Parents should take a closer look at your child's behaviors and, if needed, enlist supportive professional help, including from your pediatrician. Media and digital devices are an integral part of our world today. The benefits of these devices, if used moderately and appropriately, can be great. But, research has shown that face-to-face time with family, friends, and teachers, plays a pivotal and even more important role in promoting children's learning and healthy development. Keep the face-to-face up front, and don't let it get lost behind a stream of media and tech.


Respiratory illnesses occur year round. They are more common in the Fall, when kids return to school, and peak in the

winter months, usually December and January. The commonest culprit is a virus, such as rhinovirus, adenovirus or RSV.

Symptoms and severity will vary from person to person and across different age groups. One virus may cause a trivial

head cold in an adult and then more severe symptoms in an infant or toddler. We usually categorize them as affecting the upper respiratory tract

(congestion, sneezing, runny nose, cough from post nasal drip) or lower respiratory tract (cough, respiratory distress, wheeze). Some will effect both.

Treatment is generally supportive which is another way of saying that we treat the symptoms while your body fights the infection. Antibiotics are rarely

needed unless complications, such as an ear infection, chronic sinusitis or secondary bacterial pneumonia, develop. Saline nasal drops can unblock

dried nasal secretions; a nasal aspirator can help to clear the nasal passages. Placing the head of the bed/crib at an angle can assist drainage of

upper airway secretions, helping a child sleep better.  The AAP (American Academy of Pediatrics) does not recommend the use of nasal

decongestants or cough syrup in young children. Honey can be used in children over the age of one year and has been shown to be more effective

than cough medicine in treating cough. If your child has asthma or has wheezed in the past, you should commence a trial of Albuterol with the onset

of cough as many will benefit, even in the absence of wheeze or respiratory distress. Tylenol and Motrin (over the age of six months) can be

administered for pain or fever.

Most respiratory viruses are contagious and are transmitted in droplet form or by direct contact. To prevent transmission, we recommend good hand

hygiene and coughing/sneezing into your arm taking care to cover both your nose and mouth. We recommended that all family members get the

annual flu vaccine.

More American children are competing in sports than ever before. Sports help children and adolescents keep their bodies fit and feel good about

themselves. However, there are some important injury prevention tips that can help parents promote a safe, optimal sports experience for their child.

Injury Risks
All sports have a risk of injury. In general, the more contact in a sport, the greater the risk of a traumatic injury. However, most injuries in young

athletes are due to overuse. Most frequent sports injuries are sprains (injuries to ligaments) and strains (injuries to muscles), and stress fractures

(injury to bone) caused when an abnormal stress is placed on tendons, joints, bones, and muscle. In a growing child, point tenderness over a bone should

be evaluated further by a medical provider even if there is minimal swelling or limitation in motion. Contact your pediatrician if you have

additional questions or concerns.

To Reduce the Risk of Injury:
•Time off. Plan to have at least 1 day off per week from a particular sport to allow the body to recover.
•Wear the right gear.  Players should wear appropriate and properly fit protective equipment such as pads (neck, shoulder, elbow, chest, knee, shin),

helmets, mouthpieces, face guards, protective cups, and/or eye-wear. Young athletes should not assume that protective gear will protect them from

performing more dangerous or risky activities.
•Strengthen muscles. Conditioning exercises during practice strengthens muscles used in play.
•Increase flexibility. Stretching exercises before and after games or practice can increase flexibility. Stretching should also be incorporated

into a daily fitness plan.
•Use the proper technique. This should be reinforced during the playing season.
•Take breaks. Rest periods during practice and games can reduce injuries and prevent heat illness. 
•Play safe. Strict rules against headfirst sliding (baseball and softball), and spearing (football) should be enforced.
•Stop the activity if there is pain.
•Avoid heat injury by drinking plenty of fluids before, during and after exercise or play; decrease or stop practices or competitions during

high heat/humidity periods; wear light clothing.

Sports-Related Emotional Stress
The pressure to win can cause significant emotional stress for a child. Sadly, many coaches and parents consider winning the most important

aspect of sports. Young athletes should be judged on effort, sportsmanship and hard work. They should be rewarded for trying hard and for

improving their skills rather than punished or criticized for losing a game or competition.  The main goal should be to have fun and learn lifelong

physical activity skills.

After a sports injury, when to see the doctor
A safe and speedy return to activity following a sports injury or an illness depends on early recognition and treatment. Knowing when to see your

doctor is an important step in this process. With major injuries or illnesses, there is little doubt about the need to seek medical attention. However,

it is much more difficult to know when to seek help if there is no obvious trauma or if the symptoms don’t get in the way of playing. Many overuse

injuries, such as tendonitis or stress fractures, happen over time and often have subtle symptoms. The result can be a delay in diagnosis and treatment,

and delays can lead to a more serious or disabling injury.

General comments
Athletes should see a doctor for:
•Symptoms that do not go away after rest and home treatment
•Any condition that affects training or performance that has not been given a diagnosis or has not been treated
•Any condition that may be a risk to other teammates or competitors



 Drowning accounts for about 4000 fatal deaths in the U. S. per year.  It is the leading cause of accidental death for children

under the age of five.  Some risk factors for drowning include the inability to swim, or an overestimation of swimming

ability, as well as risk taking behavior (especially in teenage boys), and the use of alcohol and illicit drugs. 

There are many things parents can do to improve their child’s safety in and around water.  According to Jeffrey Weiss, M.D.,

FAAP, “parents need to provide layers of protection for their children.”

The first and most obvious is learning to swim.  Developmentally, children are ready for swim lessons around 4 years of age, although not every

child is ready at the same age.  There is also some evidence that children between the ages of 1 and 4 are less likely to drown if they have had formal

swimming instruction, but the American Academy of Pediatrics is not recommending mandatory swim lessons for this age group.  Consideration of a

child’s frequency of water exposure, emotional development, and physical capabilities all need to be taken into consideration when deciding if a child

is ready to learn how to swim. 

There is no substitute for constant adult supervision of children around pools or any body of water including lakes, streams, waterfalls, drainage ditches,

rivers, and the ocean.  So even if your child “knows how to swim,” vigilance around water is of utmost importance.  Parents are instructed to NEVER

leave a child unattended near a body of water.

Formal CPR instruction for parents is also recommended by the American Academy of Pediatrics (AAP).  You can contact your local Red Cross or American Heart Association to inquire about CPR classes.

A fence that surrounds a pool on all sides cuts drowning risk in half; however, laws about fencing vary depending on where the pool is located.  Small

inflatable pools present a drowning risk because they are exempt from building codes.  It is very easy for young children to lean over the soft edges of

these pools and fall in.  Remember, drowning can take place in very shallow bodies of water.  

As mentioned before, drug or alcohol use can contribute to accidental drowning in the teen group, even if the child is able to swim. 
For more information about water safety, go to the AAP website for parents: and type water safety into the search box.
Have a

Have a happy, safe summer!


SUNSCREENS for children - a confusing subject

Since sunscreen is widely used and recommended by almost all of the authoritative skin organizations, it

should be easy to choose a brand or type that you can use for your child. Unfortunately, this is not the case.


We actually suggest that you read the well developed article in "wikipedia" on sunscreen. No doubt you may find

it quite confusing and anyone who can commit it to memory should apply to be a contestant on jeopardy. Never-

the less, it gives insight as to shy sunscreen should be used and how difficult it is to choose the right one.


As noted in the article, SPF depends on the needs of the individual person. In terms of the use of sunscreen on children, a few caveats will be helpful:

  • Babies absorb almost all substances more and faster through the skin than older children and adults. Long term studies on most substances used
  • on the skin of babies are few and far between. This is not to say that skin products should not be used on babies, but only in moderation since we
  • don't know what we may learn years from now. As far as use of sunscreen on small babies, it is better to keep them out of direct sunlight for any prolonged period of time. Use light clothing, shady areas, hats, etc. rather than sunscreen when practical.
  • Use sunscreen as directed on the label but try to cover only exposed areas rather than the whole body.
  • Periodically take the child out of direct sunlight when outdoors for a "sunlight time out".
  • Remember that the lighter skinned the person, the more important it is to be aware of overexposure.
  • Finally, have a wonderful summer, climate change not withstanding.




Here are some common clues that could lead you to suspect your child may have an allergy:

Repeated or chronic cold-like symptoms that last more than a week or two, or develop at about the same time every year.

These could include an itchy, runny nose, nasal stuffiness, sneezing, throat clearing, and itchy, watery eyes.
Recurrent coughing, wheezing, chest tightness, difficulty breathing, and other respiratory symptoms may be a sign of asthma. Coughing may be an isolated symptom; symptoms that increase at night or with exercise are suspicious for asthma.
Recurrent red, itchy, dry, sometime scaly rashes in the creases of the elbows and/or knees, or on the back of the neck, buttocks, wrists, or ankles.
Symptoms that occur repeatedly after eating a particular food that may include hives, swelling of face or extremities, gagging, coughing or wheezing,

vomiting or significant abdominal pain.
Itching or tingling sensations in the mouth, throat and/or ears during certain times of year or after eating certain foods, particularly fresh (raw) fruits. 

Typically, however, cooked forms of the food are tolerated.


Dust mites (microscopic organisms found in bedding, upholstered furniture and carpet as well as other places)
Furred animals (dogs, cats, guinea pigs, gerbils, rabbits, etc.)
Pests (cockroaches, mice, rats)
Pollen (trees, grasses, weeds)
Molds and fungi (including molds too small to be seen with the naked eye)
Foods (cow's milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish)


Nasal allergy symptoms can be caused by a variety of environmental allergens including indoor allergens such as dust mites, pets, and pests as well as

outdoor allergens such as pollens.  Molds, which can be found indoors and outdoors, can also trigger nasal allergy symptoms.

Allergy testing should be performed to determine whether your child is allergic to any environmental allergens.
An important step in managing allergy symptoms is avoidance of the allergens that trigger the symptoms.
If your child is allergic to pets, the addition of pets to your family would not be recommended. If your child has allergy symptoms and is allergic to a pet

that lives in your home, the only way to have a significant impact on your child's exposure to pet allergens is to find the pet a new home.
If your child is allergic to pests present in the home, professional extermination, sealing holes and cracks that serve as entry points for pests, storing

foods in plastic containers with lids and meticulous clean up of food remains can help to eliminate pests and reduce allergen levels.
Dust mites congregate where moisture is retained, and food for them (human skin scales) is plentiful. They are especially numerous in bedding,

upholstered furniture, and rugs. Padded furnishings such as mattresses, box springs, and pillows should be encased in allergen-proof, zip-up covers,

which are available through catalogs and specialized retailers. Wash linens weekly and other bedding, such as blankets, every 1 to 2 weeks in hot water.

(The minimum

temperature to kill mites is 130 degrees Fahrenheit. If you set your water heater higher than 120 degrees, the recommended temperature to avoid

accidental scald burns, take care if young children are present in the home.)
If your child is allergic to outdoor allergens, it can be helpful to use air conditioners when possible. Showering or bathing at the end of the day to

remove allergens from body surfaces and hair can also be helpful. For patients with grass pollen allergy, remaining indoors when grass is mowed

and avoiding playing in fields of tall grass may be helpful during grass pollen season. Children with allergies to molds should avoid playing in piles

of dead leaves in the fall. Pets tracking in and out of the house can also bring pollen and mold indoors.

Allergies - From the AAP



     COUGH MEDICINE: Over the counter cough and cold medicines can cause serious side effects in young children.

The risks of using these medicines outweigh any benefits from reducing symptoms. Therefore, the FDA (Food and Drug

Administration) has recommended that OTC cough and cold medicines never be used in children under 4 years of age. From age 4-6, they should be

used "only if recommended by your child's doctor". After age 6, the medicines are safe to use, but follow the dosage instruction on the package.

Fortunately, you can easily treat coughs and colds in young children without these non-prescription medicines.


     HOME REMEDIES:  A good home remedy is safe, inexpensive, and as beneficial as OTC medicines. Here are a few:

   1. Runny nose - Just suction it or blow it. And remember, when your child's nose runs like a faucet, it's getting rid of viruses. Medicines: antihistamines

such as Benadryl do not help the average cold. However, they are useful and approved if the runny nose is due to nasal allergies (hay fever).

   2. Blocked nose - use nasal washes. Use saline nose spray or drops to loosen us the dried mucus, followed by blowing or suctioning the nose.

If not available, warm water will work fine. Instill 2-3 drops in each nostril one at a time then suction or blow. Teens can just splash warm ater into the nose. Repeat until the return is clear. For infants on a bottle or breast, use nose drops before feedings. Saline nose drops and sprays are available in all

pharmacies without a prescription. To make your own, add 1/2 teaspoon of table salt to 1 cup/8 ounces of warm tap water. With sticky, stubborn

mucus, remove with a wet cotton swab. There is no medicine that can remove dried mucus or pus from the nose.

   3. Coughing - Use homemade cough medicines. Age 3 months to 1 year: give warm clear fluids (e.g. water or apple juice), about 1-3 teaspoons

four times per day. Avoid honey because it can cause infantile botulism. Under 3 months, see your child's doctor. Age 1 year and older: use 1/2 to

2 tsp of honey as needed. It thins the secretions and loosens the cough. If honey is not available, corn syrup can be used. Recent research has shown

that honey is better than drugstore cough syrups at reducing the frequency and the severity of nighttime coughing. Age 6 and older: Use cough drops

to coat the irritated throat. If not available, hard candy can be used. For coughing spasms, expose the child to warm mist from a shower.

   4. Fluids - Help your child drink plenty of fluids. Staying well hydrated thins the body's secretions, making it easier to cough and blow the nose.

   5. Humidity - If the air in your home is dry, use a humidifier. Moist air keeps the nasal mucus from drying up and lubricates the airway. Running a

warm shower for a while can also help humidify the air.



If symptions aren't bothering your child, they don't need medicine or home remedies. Many children with a cough or nasal congestion are happy, play

normally and sleep peacefully. Only treat symptoms if they cause discomfort, interrupt sleep, or really bother your child such as a hacking cough. Since

fevers are beneficial, only treat them if they slow your child down or cause some discomfort. That doesn't usually occur until 102 degrees F or higher. Acetaminophen (Tylenol) or ibuprofen (Motrin/Advil) can be safely used in these instances to treat fever or pain. See dosage tables for indications and age limitations.



Call immediately if breathing becomes difficult or rapid; your child starts acting very sick; your child is under 3 months old and has a fever.

Call during office hours if the fever lasts more than 3 days unless your child is under three months old; the nose symptoms last more than 14 days; the

eyes develop a yellow discharge; you can't unblock the nose enough for your infant to drink adequate fluids; you thin you child may have an earache or

sinus pain; your child's sore throat lasts more that 5 days; and you have other questions or concerns.           


POISON OAK - Present Year-Round

Summer is the time we see the most cases of Poison Oak because more people are venturing into rural and country areas. However,Poison Oak is present all year-round and the plant can cause a rash even when there are no leaves on its branches.Poison Oak is a native plant found in the western United states. Similar plants (poison ivy and poison sumac) are found east of the Mississippi but not in California. Poison Oak grows wildly from sea level to over 5,000 feet in elevation.


Approximately 80-85% of all individuals are allergic and those who aren't may develop the allergy at any time. The offending substance is an oil called urushiol that is produced by the plant and is rapidly absorbed by the skin, causing irritation, itching and blisters 1-6 days later. The rash may last for up to 2 weeks and is usually treated by procedures to decrease itching and medicine to decrease inflammation (antihistamines, topical steroids) or, if severs, systemic corticosteroids. Each time a person contracts Poison Oak they may become more sensitive and have a greater reaction. Long periods between exposures may decrease the body's reaction to Poison Oak.


We have personally, and with our patients, found that the use of TECNU (over-the-counter at pharmacies and grocery stores) applied to exposed areas prior to encountering Poison Oak then washed off and reapplied as soon as possible to be effective in preventing skin outbreaks. TECNU seems to denature the oil. If used greater than 8 hours after exposure it is much less likely to be effective.Since the offending toxin is oil, it can remain on the fur of animals (i.e. pets), clothing, wood products, etc. for long periods of time and can expose sensitive people or articles and therefore should be washed down with soap and water or TECNU.


Once a person is exposed to Poison Oak, a shower or bath will assure he/she will not expose others to the toxin, even if the rash has wet or weeping blisters. If other members of the family get the rash, the most likely cause of exposure will be from articles, pets, or other substances that still retain the oil. 

If the patient has a significant rash, he/she should be seen by a physician as the diagnosis is a visual one and the doctor will need to determine the best therapy depending on the severity of the condition.


(Adapted from



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