Wednesday, December 29, 2010

Influenza Vaccine a Good Match for Circulating Strains

We are seeing a quick rise in the number of influenza cases in the office. We are identifying both influenza A and B with our rapid tests. While we have had a few patients test positive for influenza even though they received this year's vaccine, the data from the CDC is so far showing a good match between the strains contained in the vaccine and the strains that are causing illness. The strains are also sensitive to oseltamivir (Tamiflu) so far this season.

Here is an excerpt from the CDC's Influenza Update:

Antigenic Characterization:
CDC has antigenically characterized 89 influenza viruses [13 2009 influenza A (H1N1) viruses, 26 influenza A (H3N2) viruses, and 50 influenza B viruses] collected by U.S. laboratories since October 1, 2010.

2009 Influenza A (H1N1) [13]

All 13 were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2010-11 influenza vaccine for the Northern Hemisphere.
Influenza A (H3N2) [26]

All 26 were characterized as A/Perth/16/2009-like, the influenza A (H3N2) component of the 2010-11 influenza vaccine for the Northern Hemisphere.
Influenza B [50]

All 50 viruses belong to the B/Victoria lineage of viruses and was characterized as B/Brisbane/60/2008-like, the recommended influenza B component for the 2010-11 Northern Hemisphere influenza vaccine.
Antiviral Resistance:
Testing of 2009 influenza A (H1N1), influenza A (H3N2), and influenza B virus isolates for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) is performed at CDC using a functional assay. Additional 2009 influenza A (H1N1) clinical samples are tested for a single known mutation in the neuraminidase protein of the virus that confers oseltamivir resistance (H275Y). The data summarized below combine the results of both test methods and includes samples that were tested as part of routine surveillance purposes; it does not include diagnostic testing specifically done because of clinical suspicion of antiviral resistance.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among 2009 influenza A (H1N1) and A (H3N2) viruses (the adamantanes are not effective against influenza B viruses) circulating globally. As a result of the sustained high levels of resistance, data from adamantane resistance testing are not presented weekly in the table below.

To prevent the spread of antiviral resistant virus strains, CDC reminds clinicians and the public of the need to continue hand and cough hygiene measures for the duration of any symptoms of influenza, even while taking antiviral medications. Additional information on antiviral recommendations for treatment and chemoprophylaxis of influenza virus infection is available at http://www.cdc.gov/flu/antivirals/index.htm.

Wednesday, December 22, 2010

Flu Clinic Days


Starting in January, we will be scheduling flu clinics on Wednesday's from 2-5 and Friday's from 2-5. If your children haven't received their flu vaccine yet, please call our office and schedule an appointment. We still have flu shots and flu mist for all insurances and VFC.

Thursday, December 16, 2010

Monday, December 6, 2010

Guidelines on Food Allergy Updated

The National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) has released updated guidelines on diagnosis and treatment of food allergies. The summary page for parents and patients can be found HERE.

Highlights:

--Most children with allergies to milk, egg, soy, and wheat will eventually be able to tolerate these allergens, while tree nut and peanut allergies are less likely to resolve with time. Likewise, food allergies that begin in adulthood are likely to persist.

--Food allergies tend to coexist with asthma, atopic dermatitis, eosinophilic esophagitis, and exercise-induced asthma. Eliminating food allergens can improve symptoms of some of these comorbid conditions.

--The guidelines do not recommend restricting maternal diet during pregnancy or lactation to prevent the development or clinical course of food allergies, but they do recommend exclusive breast-feeding of all infants until age 4 to 6 months, unless medical reasons contraindicate breast-feeding.

According to Dr. Hugh Sampson, the guidelines concur with current American Academy of Pediatrics guidelines. "There is no evidence that delaying certain foods, even foods that are considered allergenic, (is) going to have any significant effect on the development of allergy," he said.

-Food allergies should be confirmed, because studies indicate that 50% to 90% of presumed food allergies are, in fact, not allergies.

Sunday, November 28, 2010

Christmas Eve and New Year's Eve


We will be open on Christmas Eve and New Year's Eve for sick visits only. Dr. Buchanan and Dr. Packer will be the doctors in the office on those days. We will only be open in the morning on both days. Our phones will turn on at 8:00 a.m.

Wednesday, November 17, 2010

The Great American Smokeout


Every year the American Cancer Society chooses one day to encourage people to stop smoking for 24 hours and to quit for good. It's called the Great American Smokeout, and it is tomorrow, November 18th. So, to all you parents out there who know you need to quit...tomorrow is your day. If you needed anymore motivation (although I know you don't--those darlings are enough) here are a few tidbits.
  • Living with someone who smokes (even if they only smoke outside) makes kids more likely to have ear infections, lung infections, SIDS, obesity, worse asthma and allergies.
  • Smokers are more likely to be depressed.
  • Any amount of smoke (not just high levels) causes genetic abnormalities in lung cells which can lead to cancer.
  • People who quit smoking AND change eating habits at the same time are more successful at both.
  • Children whose parents smoke are twice as likely to begin smoking.
  • Brad Pitt did it for his kids. You can too.
We know that quitting can be really really hard. There are some great resources out there. Check them out, and Butt Out tomorrow!

You can do it.


The Flu and You

Worried about getting your flu shot? Worried you don't need it, or it will give you the flu, or it will cause all kinds of bad diseases???

Read this. Then come in and get your child protected. We still have vaccine (mist and shot) available, for all insurances and all ages.

Wednesday, November 10, 2010

Retraction, of sorts

After reading Tuesday's post about Vicks VapoRub, Dr. Bosworth reminded us of a few of the potential pitfalls of using VapoRub. A few years ago there were some deaths associated with camphor (one of the ingredients in VapoRub) toxicity. The camphor levels in these incidents were very high, and were likely ingested. So, take home point #1: Don't eat it.

Last year a study came out that showed respiratory distress in small infants and children who used VapoRub, as it caused them to have more mucus production. Take home point #2: Don't use it near the mouth or the nose.

Tuesday, November 9, 2010

VapoRub...helpful or just a big hoax?



Vicks VapoRub. Grandmas swear by it. But does it really work? A new study in Pediatrics is validating Grandmas everywhere. 138 sick kids in Pennsylvania were divided into three groups: some got VapoRub plastered on their chest, some got Vasoline, and some got nothing. The kids who woke up smelly ended up doing the best. The VapoRub group had less cough and congestion and slept better. There was no difference in runny nose. About half of the VapoRub kids had minor skin reactions, such as tingling, burning or red skin.

So this cold season, it might not hurt to follow Grandma's and lather on the Vicks.

Breast or bottle...it's all the same to mom



There is a commonly held idea (with some scant research to back it up) that babies who eat formula sleep longer. But no one has ever looked at how much sleep mom gets with a breastfed baby compared to one who takes formula. And really, isn't it how well rested mom is that counts?

Researchers in West Virginia decided to do some sleuthing. They took 80 moms and followed them for 12 weeks. Some breast fed exclusively, some bottle fed exclusively, and some did both. They had the moms keep sleep diaries and they wore monitors to measure their sleep. Somewhat surprisingly, they found that there was no real difference in the amount of sleep that mom enjoyed.

At first glance, the results seem a little counterintuitive. If babies sleep longer with formula filled tummies, shouldn't mom sleep longer too? The authors theorized that breastfeeding moms were able to fall asleep faster. They didn't have to wake up completely to mix formula, and some of the hormones associated with breastfeeding promote drowsiness in babies, making it easier to get them back to sleep.

However it works, it is one more reason to try and stick with breastfeeding.

Day After Thanksgiving


We will be open the day after Thanksgiving 11/26/10 for sick visits only. We hope that you won't need us but if you do...know that we are open. Dr. Bosworth and Teresa McNaught will be the providers in the office. The phones will turn on at 8:00 a.m.

Thursday, November 4, 2010

Get your books

As a follow-up to yesterday's post, the Salt Lake County Library is having their annual book sale. It will be held tomorrow and Saturday (November 5-6) from 10:00 to 6:00 at the Sandy Library (10100 South Petunia Way, which is around 1400 East). Most items are under a dollar, cash or check only. They don't allow strollers, so bring your Baby Bjorn.

I can see more extensive libraries and smarter kids already.

Wednesday, November 3, 2010

Read to Me


Want to boost your child's chances of finishing high school or going to college? Load up your shelves with books. A new study out of the University of Nevada found that simply having books in the home was a better predictor of a child's future education level than was how much schooling their parents had. Having a library of 25 books (children's or adult) in the home gave children a greater chance of getting an extra year of education. A library of 500 or more led to an extra 3.2 years of education!

Now, it's likely the effect does not come from just having books in the home, but rather how they are used and regarded. But it is a good reminder to all of us to keep fodder for young minds handy...so head out to the library or the bookstore and stock those shelves.

Monday, November 1, 2010

After Hour Appointments



We have after hour sick appointments Monday - Thursday from 5:00 p.m. to 8:00 p.m. There is a "after hours" fee for all these appointments, but it is cheaper than an ER visit.

Thursday, October 28, 2010

Southpoint Pediatrics WELCOMES

Nathanael Ridge, Ph.D, PAS-III
He received his Masters in Science from Baylor College of Medicine, Doctorate of Philosophy and Bachelors in Science from Brigham Young University.
He will be joining our office 2-3 days a week beginning in January 2011.
He will be seeing patients with:
ADHD
Depression
Anxiety
and other mental health issues
Call our office mid December and we can begin scheduling appointments

Monday, October 25, 2010

Teething Tablet Recall


The FDA has issued a recall for all types and lot numbers of Hyland's Teething Tablets. Some of these tablets have been found to contain belladonna. Belladonna is a plant (also known as Deadly Nightshade) that has been used for centuries as a medicine and a poison. In large quantities it can have harmful effects in children, such as a racing heartbeat, dry mouth and skin, drowsiness, and dilated pupils. The FDA has received reports of children exhibiting signs of belladonna toxicity after taking the tablets.

If you have any of these teething tablets, stop using them and return them to the store.

More information here.

Tuesday, October 19, 2010

Fructose intolerance

I thought this was an interesting article...something that we probably don't think about often enough. The original article can be found here.


Low-Fructose Diet May Ease Kids’ Abdominal Pain

Cutting Back on Fructose Relieved Symptoms in Children With Fructose Intolerance
By Katrina Woznicki
WebMD Health News

young boy with stomachache

Oct. 18, 2010 -- New research suggests that a low-fructose diet reduces recurrent abdominal pain in children with fructose malabsorption. The condition causes gas, bloating, and cramping because of an inability to properly digest fructose.

Fructose is a sugar found naturally in fruits, honey, and some syrup. It is also used to sweeten many processed foods and drinks. Researchers led by Daniel Lustig, MD, a pediatric gastroenterologist at Mary Bridge Children’s Hospital and Health Center in Tacoma, Wash., studied 245 patients aged 2 to 18 who had unexplained chronic abdominal pain,constipation, gas, bloating, and/or diarrhea. Nearly two-thirds of the group was female and the median age was 11.

The children underwent breath hydrogen tests to determine if they had fructose intolerance. Nearly 54% of the group tested positive for fructose intolerance.

Children who tested positive were put on a low-fructose diet and counseled by a registered dietitian. They were later re-evaluated for pain. Sixty-seven percent of the children who tested positive for fructose intolerance reported resolution of abdominal pain and other symptoms after being on the low-fructose diet. Of note, about 48% of children who tested negative for fructose intolerance also reported resolution of their abdominal pain without a low-fructose diet.

The findings were presented today at American College of Gastroenterology's (ACG) 75th Annual Scientific meeting in San Antonio.

Lustig says fructose intolerance appears to be more common in teenage girls. Fructose intolerance can be mistaken for other gastrointestinal disorders that cause abdominal cramping and pain, such as Crohn’s disease, ulcerative colitis, or irritable bowel syndrome.

“With fructose in everything from fruit to pre-packaged products, soft drinks, and honey, it is difficult to avoid so the challenge is finding those foods without fructose and still maintain a healthy nutritional balance," Lustig says. "While there is definitely a subset of patients who respond well to a low-fructose diet, it's challenging for patients who are fructose intolerant to maintain, especially teenagers. But the good news is that over half of patients who are fructose intolerant are able to maintain a low-fructose diet and are able to notice an immediate improvement in their symptoms.”

Friday, October 15, 2010

Hepatitis A Outbreak

The Health Department notified us that there have been several cases of Hepatitis A in Utah recently. Hepatitis A is usually food-borne, but can also be passed by close personal contact.

Our patients receive vaccinations against Hepatitis A at the 12 month and 18 month visits, so most of your children should be protected. Some teenagers may not have received the vaccine when they were little, although we try to catch them up when they start 7th grade. If you have any questions about your child's immunization status, feel free to call us at 801 565-1162 to check on it.

Symptoms of Hepatitis A to watch for would include: vomiting, diarrhea, jaundice (yellow coloring of the skin and eyes) and tiredness. If you or your child has these symptoms, please get checked.

Friday, October 8, 2010

Skinny Jean Syndrome


As one who occasionally dons the skinny jean, I was curious to read about
Skinny Jean Syndrome.

Apparently, it is the when your skinnies are so skinny that they can block some of the normal nerve conduction in the legs and lead to numbness and tingling. Today Dr. Lash saw his first case!

So all you hip moms and kids...maybe try jeggings?

Thursday, October 7, 2010

Flu Clinic Days


There has been some confusion about our flu clinic days. Flu clinic days are by appointment only to minimize wait time. Patients that show up without an appointment may still receive the vaccine but will likely have to wait longer.


We have flu vaccine for all ages and for all insurance companies, self pay or under-insurance patients.


Flu Clinic Days:


Select Tuesdays 9-5


Wednesdays 2-5


Fridays 2-5


Saturdays 9-1

Wednesday, October 6, 2010

New Blog

The other day we were talking about how to best display pictures of our darling patients. Seeing as we are über high-tech now, with our blog and facebook page, we thought we'd see if there is any interest in a side blog showcasing the new baby pics, halloween costumes, Christmas cards, and just cute pictures.

If you're interested in showing off your little one, just send us a pic at southpointpediatrics@gmail.com

The new blog will be southpointpatients.blogspot.com (it's still a work in progress as of yet)

Friday, October 1, 2010

Flu Shot Clinic at Rio Tinto Stadium Saturday, Oct 2

I received this email from Real Salt Lake. It would be a great way for you parents to get your flu shots!

Drive-thru Flu Shot Clinic" Sponsored by Salt Lake Regional Medical Center and Community Nursing Services


Drive-Thru Flu Shot Clinic

When: October 2, 2010 from 9am - 1pm.
Where: Rio Tinto Stadium – south parking lot.

Available to anyone 6 months and older.

Insurances accepted: Aetna, Altius, Blue Cross, DMBA, PEHP, SelectHealth, Summit Care, United Health Care, Medicare part B and some Medicare Advantage Plans. Cash price for the shot is $20. Roll in… Roll up… Roll out.

Sponsored by Salt Lake Regional Medical Center and Community Nursing Services.
For more information call: (801) 207-8777

Thursday, September 30, 2010

Influenza A is Here, Croup Too

I received this email from the Utah State Health Department:

In the past few weeks three influenza-associated hospitalizations have been reported along the Wasatch Front. Confirmatory testing at the state lab has identified seasonal influenza A (H3) in all three patients. National data indicates that this season's influenza vaccine is a good match to currently circulating strains. The current Advisory Committee on Immunization Practices (ACIP) recommendation for influenza vaccine is a universal recommendation that all individuals should be vaccinated.

Additionally, clinics and emergency rooms across the state are showing an increase in patient visits for respiratory symptoms. Surveillance indicates that respiratory activity is not limited to influenza alone, and that other respiratory viruses, like rhinovirus and enterovirus, are circulating in the community.



We are also seeing a lot of croup in the office this week. If your child has a croupy (barky, seal-like) cough, it will usually improve within 3-4 days. We should see your child if he/she is having noisy or labored breathing with the croup that won't respond to home measures, such as a vaporizer or humidifier, or sitting in a steamy bathroom for 20 minutes.

Wednesday, September 29, 2010

One Flu Shot or Two?

The seasonal flu and the H1N1 flu shots are combined this year, so that means fewer pokes (and better protection) for your kids.

Some kids will need TWO doses of the flu shot this year, some only ONE:

The American Academy of Pediatrics and the CDC (Centers for Disease Control and Prevention) recommendations for this influenza season is based on previous vaccinations of season influenza and if your child received any H1N1. Please click here to see if your child will require a booster dose (2 doses) of the seasonal influenza vaccine this season seperated by at least 30 days. Children 9 years and older will only require 1 dose of the influenza vaccine.

Basically, if your child under the age of 9 years had ANY doses of H1N1 vaccine last year, and has had at least TWO seasonal flu shots in the past, he or she will only need ONE dose this year. If your child didn't receive any H1N1 vaccine, you need to get TWO doses this year. If your child has only received ONE dose of seasonal flu vaccine (regardless of number of H1N1 doses) you need TWO doses this year.

We are happy to help you figure out this mess! Just give us a call 801 565-1162.

Tuesday, September 28, 2010

VFC 6-35 months Flu Shots Are In

Today we finally received our shipment of VFC (Medicaid, CHIP, No Insurance and Under-Insured) 6-35 months influenza shots.

Here is our current flu vaccine supply....

Regular Insurance

6-35 months influenza shot

3 years and older influenza shot

2 years and older FluMist - Nasal

VFC (Medicaid, CHIP, No Insurance and Under-Insured)
6-35 months inflenza shot
3 years and older inflenza shot
2 years and older FluMist - Nasal



Please verify with your insurance, PRIOR to your appointment, if the influenza vaccine is a covered benefit. Any balances not covered, will be your responsibility.

Call our office today to schedule your child's influenza vaccine appointment.

Friday, September 24, 2010

Office Hours/Flu Supply

Our office hours:

Monday - Friday from 8:00 a.m. to 5:00 p.m.

After hours appointments available Monday - Thursday from 5:00 to 8:00

Saturdays from 8:30 a.m. to 12:00 p.m. (urgent care visits)



Flu Clinic Days:

Select Tuesdays: 9-5

Wednesdays: 2-5

Fridays: 2-5

Saturdays: 9-1

Current supply of flu vaccine:


Regular insurance
6-35 months influenza shot

3 years and above influenza shot

2 years and above FluMist - nasal
VFC
(Medicaid, CHIP, No insurance and under insured)

3 years and above influenza shot

2 years and above FluMist - nasal
We still DO NOT have any VFC influenza shots for infants 6-35 months.

**Please verify with your insurance company if the influenza vaccine is a covered benefit. Any balances not covered, will be your resonsibility.**

Wednesday, September 22, 2010

Similac Recall


Abbott Nutrition is issuing a voluntary recall of certain Similac powder infant formulas. Apparently, there is a remote possibility of the presence of a small common beetle in the product produced in a single manufacturing facility. Yuck.

The recall includes certain Similac powder infant formula sold in plastic containers and in 8-ounce sample cans, and 12.4-ounce and 12.9-ounce cans.

To find out if your formula is involved, go to www.similac.com/recall/lookup and type in the lot number. (It looks like the site is getting a ton of traffic, and when I tried it took awhile to load.)

Also, Abbott has set up a hotline at (800) 986-8850.

Tuesday, September 21, 2010

Current Flu Vaccine Supply


Here is what we have currently in stock for flu vaccine...


Regular Insurance:


6-35 months influenza shot


3 years and above influenza shot


2 years and above FluMist - Nasal


VFC (Medicaid, CHIP, No Insurance and Under-Insured)

3 years and above influenza shot


2 years and above FluMist - Nasal


We DO NOT have 6-35 months influenza shots


**Please verify with your insurance, prior to your visit, if the influenza vaccine is a covered benefit. Any balances not covered, will be your responsibility.**

Tuesday, September 14, 2010

VFC Flu vaccine

Today we received a limited shipment of VFC flu vaccines. Here is our flu vaccine supply as of today...


Regular insurance:


6-35 months influenza shot


3 years and above influenza shot


2 years and above FluMist - Nasal



VFC (Medicaid, CHIP, No insurance and under-insured)


3 years and above influenza shot


2 years and above FluMist - Nasal


We DO NOT have any 6-35 months VFC influenza shot


**Please verify with your insurance company if the influenza vaccine is a covered benefit, any balances not covered will be your responsibility**

Friday, September 10, 2010

Flu Vaccine Update

Today we received a shipment of flu vaccine for ages 6 months and above for patients with regular insurance. We still have no VFC (Medicaid, CHIP, no insurance or under-insured) flu vaccine but anticipate a shipment next week.


Here is summary of the flu vaccine we have...

6-35 months influenza shot

3 years and above influenza shot

2 years and above FluMist - Nasal

No VFC influenza vaccines yet

We have flu clinic days on

Select Tuesdays 9-5

Wednesdays - 2-5

Fridays - 2-5

Saturdays - 9-1

**Please verify with your insurance company, prior to your visit, if the influenza vaccine is a covered benefit. Any balances not covered by your insurance will be your responsibility.**

Tuesday, September 7, 2010

Flu Vaccine

We anticipate a shipment of flu vaccine for VFC (Medicaid, CHIP, No insurance or under-insured) patients the week of September 13th. There will be a limited supply of Flumist and a limited supply of the flu shot for children 2 years and above.

We have FluMist and flu shots for children 2 years and above for regular insurance (No Medicaid, CHIP, or under-insured)

We have received some calls from VFC patients wanting to pay for the flu vaccine that is not governmently funded instead of waiting for the shipment of VFC, we can give you a flu vaccine but you will be required to pay in full, the price of the vaccine, and the admin fee (per child) at the time of service before receiving the vaccine.

Here is the price for each vaccine if you would like to pay...

Flumist= $42.00 per child. This includes the admin fee

Flu shot (2 years and above) = $34.00 per child. This includes the admin fee

Wednesday, September 1, 2010

Labor Day

Our office will be open on Monday, September 6th from 9 until 12. Hopefully none of your kids get sick over the holiday weekend...but if they do, we'll be there!

Tuesday, August 31, 2010

Flu Vaccines

Today we received a shipment of flu shot vaccine (limited supply) for children 2 years and older. We are still waiting for our shipment of the flu shot for children 6 months to 2 years.

We do not have any VFC (Medicaid, CHIP, No insurance or under-insured) flu vaccine currently.

Please call our office to schedule your appointment. We also ask that you verify with your insurance before coming in to make sure that flu vaccine is a covered benefit.

**Insurance companies will require that you pay a portion of the vaccines not covered by them**

Saturday, August 28, 2010

Possible Measles Case in Salt Lake County

The Utah Health Department has identified a probable measles case in an unimmunized Salt Lake County child. They haven't released any more details about the child. They have asked the public to be aware of possible measles-like illness.

Measles typically presents with 2-4 days of fever, cough, runny nose, conjunctivitis and generally feeling lousy; this stage is called the "prodrome". This is followed by the classic measles rash, with red spots and bumps, beginning on the face and then spreading to the trunk, arms and legs. Many children also have sores in their mouth as well.

Children typically receive vaccinations for measles at 12 months and at 4-5 years of age. If your child is behind on these immunizations, please contact our office at 801 565-1162 so we can update your child's immunizations.

Information about measles including diagnosis and preventing transmission can be found at:
Utah Department of Health: http://health.utah.gov/epi/diseases/measles/index.html
CDC: http://www.cdc.gov/measles/index.html

or call our office. If you think your child might have these symptoms, let us know so we can arrange to see your child.

Tuesday, August 24, 2010

That Time of Year Again

It is time again for flu vaccines. We've decided to use the blog as a way to keep everyone appraised of what flu vaccine we have. Our office manager will be updating it as changes occur. But as a precaution, just call the day of your appointment to make sure we have available vaccine for your child.


Starting September 1st, we will begin scheduling appointments in our flu shot clinics. In order to better serve our patients, our flu shot clinics are by appointment only. This keeps waiting time down and decreases the chance of exposure to other sick children.

Our clinic times will be:

Select Tuesdays 9:00 - 5:00
Wednesdays 2:00 - 5:00
Fridays 2:00 - 5:00
Saturdays 9:00 - 1:00


We currently have the FluMist which is approved for children over 2 years of age that do not have asthma, diabetes, an egg allergy, or other health issues, or have close contact with someone receiving chemotherapy.

We only have FluMist for regular insurance....We do not have any VFC (government funded) flu vaccines. VFC vaccines are used for uninsured patients, patients on CHIP or Medicaid, or patients whose insurance has no vaccine coverage.

We hope to receive a shipment of flu shots (for regular insurance) the week of September 7th.

Please call and verify with your insurance if the following flu vaccine CPT codes are a covered benefit. You should also verify if a co-pay will be required:

90660 - Flumist (nasal influenza vaccine)
90655 - Thimerosol Free 6-35 months pre-filled syringes influenza vaccine
90658 - Multi-dose vial 3 years and older influenza vaccine


**Any balances not covered by your insurance company will be your responsibility**

Monday, August 9, 2010

9 Foods to Try and Avoid...When You Can

We know that most days if the kids are fed, relatively clean, and not killing each other it is a success. But with the obesity epidemic looming, what we put into our kids' bodies is becoming more and more important. With this in mind, here are 9 foods not live on. That said, Dr. Lash and I violate every single one of these rules. Especially the french fries...who can resist???

Original article here

9 Foods Not to Give Your Kids

By Joe Wilkes

If you've followed the news on childhood obesity lately, you know the state of affairs is pretty grim. Childhood obesity rates have tripled over the past two decades, and most signs point to the next generation being the first whose life expectancy will be shorter than their parents'. Much of the blame for this trend has deservedly been laid at the feet of the producers and marketers of unhealthy food aimed at our youngest consumers, whose parents face an uphill battle: trying to pit fresh, healthy foods devoid of mascots or sidekicks against superheroes and cartoon animals in a struggle to tempt their children's palates and stomachs.

Boy Eating a Carrot

Since most kids have hummingbird metabolisms that adults can only envy, it's often easy to give them a free pass and let them eat whatever they want. But eventually those metabolisms slow down and the pounds settle in. Also, as physical activity decreases and processed food intake increases annually, kids aren't burning calories the way their parents might have when they were their age. And even if the kids aren't getting fat, they are establishing eating habits they'll take into adulthood. As parents, you can help foster a love for healthy eating and exercise that will last your kids a lifetime—hopefully a long one!

Eating can so often be a classic power struggle where kids try to finally locate their mom and dad's last nerve. (I can remember family dinners with my brother and parents that could teach Hezbollah a thing or two about standoffs.) There are a number of strategies you can use to mitigate this type of deadlock. One is to let your kids help with the selection and preparation of the food. If they picked out the veggies at the farmers' market and helped cook them, they might be less inclined to feed them to the family pet. Another is to frame eating vegetables and healthy food as being its own reward. Otherwise, by offering dessert as a reward for finishing vegetables, you create a system where unhealthy food is a treat and healthy food sucks. With these thoughts in mind, let's take a look at some of the most unhealthy foods being marketed to your kids today, and some healthier alternatives you can offer to replace each of them.

Note: The following recommendations are for school-aged children. Infants and toddlers have different specific nutritional needs, not addressed in this article.

  1. Chicken nuggets/tenders. These popular kids' menu items are little nuggets of compressed fat, sodium, high fructose corn syrup (HFCS), and in some form chicken. Depending on the restaurant, chicken might not even be the first ingredient. Oftentimes, the nuggets or tenders are made of ground pieces of chicken meat and skin, pressed into a shape, Grilled Chicken and a Saladflavored with HFCS and salt, and batter-fried in hydrogenated oil (the bad, trans-fatty stuff). Then, as if that weren't unhealthy enough, you dunk it in a HFCS- or mayonnaise-based sauce. With all the fat, salt, and sugar, it's easy to understand why they're tasty, but the nutritive value weighed against the huge amount of calories and fat consumed is incredibly lacking. Even healthier-sounding menu items can be deceiving, like McDonald's® Premium Breast Strips (5 pieces), which pack 665 calories and 40 grams of fat—and that's before you factor in the dipping sauce. (By comparison, a Big Mac® with sauce has 540 calories and 29 grams of fat.)

    Instead: If you're cooking at home, grill a chicken breast and cut it into dipping-size pieces either with a knife or, for extra fun, cookie cutters. Make a healthy dipping sauce from HFCS-free ketchup, marinara sauce, mustard, or yogurt. Let your kids help make the shapes or mix up the sauce. Try and go without breading, but if you must, try dipping the chicken breast in a beaten egg, and then rolling it in cornflake crumbs before you bake it. It'll be crunchy and delicious, but not as fatty.

  2. Sugary cereal. I can remember as a child, after going to friends' houses for overnights and being treated to breakfast cereals with marshmallows that turned the milk fluorescent pink or blue, feeling horribly deprived when faced with the less colorful and sugary options served up in my home kitchen. But now I can appreciate my mom and her unpopular brans and granolas. True, they didn't have any cartoon characters on the box or any toy surprises, but they also didn't have the cups of sugar, grams of fat, and hundreds of empty calories that these Saturday-morning staples are loaded with.

    Instead: Read the labels and try to find cereal that's low in sugar and high in fiber and whole grains. Remember, "wheat" is not the same as "whole wheat." Also, avoid cereals (including some granolas) that have hydrogenated oils, artificial colors, or chemical preservatives. Add raisins, sliced bananas, berries, or other seasonal fruit to the cereal for extra flavor and nutrition. Again, letting your child help design a healthy bowl of cereal from choices you provide will get you a little more buy-in at the breakfast table.

  3. Lunch meat and hot dogs. Kids love hot dogs, bologna, and other processed meats, but these are all full of potentially carcinogenic nitrates and nitrites, sodium, saturated fat, and artificial colors and fillers. A study in Los Angeles found that kids who ate 12 hot dogs a month had nine times the risk of developing leukemia.1 And more health risks are being discovered all the time. Leaf through any research about Hot Dogskids' nutrition, and you're bound to read about the bane of the cafeteria—Oscar Mayer's Lunchables®. These and similar prepackaged lunches are loaded with processed meats and crackers made with hydrogenated oils. These innocent-looking meals can boast fat counts of up to 38 grams. That's as much fat as a Burger King®Whopper® and more than half the recommended daily allowance of fat for an adult.

    Instead: Get unprocessed meats, like lean turkey breast, chicken, tuna, or roast beef. Use whole wheat bread for sandwiches; or if your kid's dying for Lunchables, fill a small plastic container with whole-grain, low-fat crackers, lean, unprocessed meat, and low-fat cheese. This can be another great time to get out the cookie cutters to make healthy sandwiches more fun. For hot dogs, read labels carefully. Turkey dogs are usually a good bet, but some are pumped up with a fair amount of chemicals and extra fat to disguise their fowl origins. Look for low levels of fat, low sodium, and a list of ingredients you recognize. There are some tasty veggie dogs on the market, although a good deal of trial and error may be involved for the choosy child.

  4. Juice and juice-flavored drinks. Juice—what could be wrong with juice? While 100 percent juice is a good source of vitamin C, it doesn't have the fiber of whole fruit, and provides calories mostly from sugar and carbohydrates. Too much juice can lead to obesity and tooth decay, among other problems. The American Academy of Pediatrics suggests 4 to 6 ounces of juice per day for kids under six, and 8 to 12 ounces for older kids. Juice drinks that aren't 100 percent juice are usually laced with artificial colors and that old standby, high fructose corn syrup, and should be avoided. Your best bet is to make your own juice from fresh, seasonal fruit. You won't have to worry about all the additives, and it's another way you can involve your kids in the cooking process. Let them design their own juice "cocktail." (And if you were even considering soda, see "Top 10 Reasons to Give Up Soda" in the Related Articles section below.)

    Instead: Water is still the best thirst quencher. Explain the importance of good hydration to your kids, and try to set a good example yourself by carrying around a healthy reusable hard plastic or stainless steel water bottle. Get your kids used to carrying a small bottle of water in their backpack or attached to their bike. If they're very water averse, try water with a splash of fruit juice in it. But just a splash. The idea is to get your kids used to not having things be overly sweet, overly salty, or overly fatty. Another great beverage is milk. Growing kids need plenty of milk (or fortified nondairy milks, like soy or almond)—which is filled with nutrients, calcium, and (in the case of dairy and soy) protein—but they don't need too much fat, so choosing low-fat or nonfat options will help ensure that they get their milk without actually beginning to resemble a cow.

  5. VegetablesFrench fries. High in calories, high in fat, and high in sodium—and unsurprisingly the most popular "vegetable" among kids. Fries offer virtually none of the nutrients found in broccoli, carrots, spinach, or other veggies not cooked up in a deep fryer, and the fat they're fried in is often trans fat, the unhealthiest kind for the heart. To top it all off, studies are beginning to show cancer-causing properties from acrylamide, a toxic substance that is created when starchy foods like potatoes are heated to extreme temperatures. In some tests, the amount of acrylamide in French fries was 300 to 600 times higher than the amount the EPA allows in a glass of water.2

    Instead: Vegetables like baby carrots, celery sticks, and other crudités are great options, but if potatoes must be had, there are some options that don't involve melting a brick of fat. A scooped-out potato skin with low-fat chili and a little cheese can provide lots of fiber and vitamins, with even higher amounts if the chili has beans. You can also try making baked fries, using slices of potato with a light brushing of olive oil. Or the classic baked potato could be a hit, with plain yogurt or cottage cheese instead of sour cream and butter.

  6. Potato chips, Cheetos®, Doritos®, etc. These are full of fat, oftentimes saturated, and way more sodium than any child or adult should eat. Some chips also have the acrylamide problem discussed in #5, French fries, above. Also, watch out for innocent-seeming baked and low-fat chips that contain olestra or other fake fats and chemicals that could present health issues for kids.

    Instead: Kids gotta snack, and in fact, since their stomachs are smaller, they aren't usually able to go as long between meals as adults. Cut-up vegetables are the best thing if your kids want to get their crunch on, but air-popped popcorn and some baked chips are okay, too. You can control how much salt goes on the popcorn, or involve your child in experimenting with other toppings like red pepper, Parmesan cheese, or dried herbs. Try making your own trail mix with your kids. They might be more excited to eat their own personal blend, and that way you can avoid certain store-bought trail mixes, which sometimes contain ingredients like chocolate chips and marshmallows that aren't exactly on the healthy snack trail.

  7. Fruit leather. Many of these gelatinous snacks like roll-ups or fruit bites contain just a trace amount of fruit, but lots of sugar or HFCS and bright artificial colors. Don't be misled by all the products that include the word "fruit" on their box. Real fruit is in the produce section, not the candy aisle.

    Instead: If your child doesn't show interest in fruit in its natural state, there are some ways you can make it more interesting without losing its nutritional value. For a healthy frozen treat, try filling ice-cube or frozen-pop trays with fruit juice or freezing grapes. Or buy unflavored gelatin and mix it with fruit juice and/or pieces of fruit to make gelatin treats without the added sugar and color (let it solidify in big flat casserole dishes or roasting pans—another good time for the cookie cutters!) Try serving some raisins, dried apricots, apples, peaches, or other dried fruits that might give you that chewy, leathery texture without the sugar.

  8. Doughnuts. These little deep-fried gobs of joy are favorites for kids and adults alike, but they are full of fat and trans-fatty acids, and of course, sugar. Toaster pastries, muffins, and cinnamon buns aren't much better. The worst thing about doughnuts and these other pastries, aside from their nutritional content, is that they're often presented to children as acceptable breakfast choices. These delicious deadlies need to be categorized properly—as desserts, to be eaten very sparingly. And you can't have dessert for breakfast.

    Instead: Honestly, a slice of whole wheat toast spread with sugar-free fruit spread or peanut butter isn't going to get as many fans as a chocolate-filled Krispy Kreme® doughnut, but at some point, you have to stand firm. Be the cop who doesn't like doughnuts. Doughnuts—not for breakfast. Period.

  9. Pizza. In moderation, pizza can be a fairly decent choice. If you order the right toppings, you can get in most of your food groups. The problem comes with processed meats like pepperoni and sausage, which add fat and nitrates/nitrites (see #3, Lunch meat and hot dogs, above); and the overabundance of cheese, which will also provide more calories and fat than a child needs.

    Instead: Try making your own pizza with your kids. Use premade whole wheat crusts, or whole wheat tortillas, English muffins, or bread as a base. Then brush on HFCS-free sauce, and set up a workstation with healthy ingredients like diced chicken breast, sliced turkey dogs, and vegetables that each child can use to build his or her own pizza. Then sprinkle on a little cheese, bake, and serve. If your child gets used to eating pizza like this, delivery pizzas may seem unbearably greasy after awhile.

Someday your children will come to realize that caped men in tights and sponges who live under the sea might not have their best interests at heart when it comes to food. Until then, however, why not involve them in the process of selecting and preparing healthier alternatives? Some of these cleverly disguised wholesome foods might become their favorites. Who knows, they may even tempt some of the overgrown children among us!

  • 1Peters J, et al. "Processed meats and risk of childhood leukemia (California, USA)" Cancer Causes & Control 5: 195-202, 1994
  • 2Tareke E, Rydberg P, Karlsson P, et al. "Analysis of acrylamide, a carcinogen formed in heated foodstuffs" J. of Agri and Food Chem. 2002;50:4988-5006

Saturday, August 7, 2010

Piping Hot from Dr. Buchanan

Enjoy this youtube video of Dr. Buchanan's brush with fame. He played bagpipes with Peter Breinholt last week at the Sandy Amphitheater.

Friday, July 16, 2010

yummy gummys


My little Ella has struggled with constipation since she was 2 months old. As a pediatrician, I know all things you are "supposed" to do (lots of fruits and vegetables, lots of water, Miralax if needed) but in the real world it doesn't always work. Some days I just plain forgot to feed her the 4 prunes she needed to stay regular! But there is nothing sadder (and more guilt-inducing) than watching your child cry and struggle when you know you could have done something about it. Thank heavens for Fiber gummies. I discovered these a few months ago, and they have been life changing. They have loads of fiber, and best of all Ella asks for them by name (she never did that with the prunes!)

Now, they are not perfect. They can be a choking hazard for children who are too small (I actually buy the kind from Costco and cut them in half so she can chew them). Also, like any gummy, they can promote tooth decay. I try to brush her teeth after, or at least give her an apple slice. And they don't replace a healthy, well-balanced diet.

But in our home, the benefits outweigh the risks, no question.

Sunday, July 4, 2010

healthy children

The AAP (American Academy of Pediatrics) has launched a new website to help parents.


The site contains all kinds of useful information, from colic to toilet training to (gasp) dating.

One of the cool features is the Symptom Checker. It's great for those "Do I really need to go in for this?" kind of questions.

Here's an example. Say your child has a fever and looks okay, but don't know if you need to call or go in. You can pick "fever" from the list of symptoms and here's what you get:

Call 911 Now (your child may need an ambulance) If

  • Not moving or very weak
  • Unresponsive or difficult to awaken
  • Difficulty breathing with bluish lips
  • Purple or blood-colored spots or dots on skin

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Not alert when awake
  • Any difficulty breathing
  • Great difficulty swallowing fluids or saliva
  • Child is confused (delirious) or has stiff neck or bulging soft spot
  • Had a seizure with the fever
  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do not give your baby any fever medicine before being seen)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • Very irritable (e.g., inconsolable crying or cries when touched or moved)
  • Won't move an arm or leg normally
  • Signs of dehydration (very dry mouth, no urine in more than 8 hours, etc.).
  • Burning or pain with urination
  • Chronic disease (e.g., sickle cell disease) or medication (e.g., chemotherapy) that causes decreased immunity

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Age 3-6 months with fever
  • Age 6-24 months with fever present over 24 hours but no other symptoms (e.g., no cold, cough, diarrhea, etc.)
  • Fever repeatedly above 104° F (40° C) despite fever medicine
  • Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

Parent Care at Home If

  • Fever with no other symptoms and you don't think your child needs to be seen

Cool, huh? So say you decide you don't need to call, but you still want to help your child. Click on the care advice link, and you get this:


  1. Reassurance: Presence of a fever means your child has an infection, usually caused by a virus. Most fevers are good for sick children and help the body fight infection. Use the following definitions to help put your child's level of fever into perspective:
    • 100°-102°F (37.8° - 39°C) Low grade fevers: beneficial, desirable range
    • 102°-104°F (39 - 40°C) Mild fever: still beneficial
    • Over 104°F (40°C) Moderate fever: causes discomfort, but harmless
    • Over 105°F (40.6°C) High fever: higher risk of bacterial infections
    • Over 106°F (41.1°C) Very high fever: important to bring it down
    • Over 108°F (42.3°C) Dangerous fever: fever itself can harm brain
  2. Treatment for All Fevers: Extra Fluids and Less Clothing
    • Give cold fluids orally in unlimited amounts (reason: good hydration replaces sweat and improves heat loss via skin).
    • Dress in 1 layer of light weight clothing and sleep with 1 light blanket (avoid bundling). (Caution: overheated infants can't undress themselves.)
    • For fevers 100°-102° F (37.8° - 39°C), this is the only treatment needed (fever medicines are unnecessary).
  3. Fever Medication:
    • Fevers only need to be treated with medicine if they cause discomfort. That usually means fevers above 102°F (39°C).
    • Give acetaminophen (e.g., Tylenol) or ibuprofen (e.g., Advil). See the dosage charts.
    • The goal of fever therapy is to bring the temperature down to a comfortable level. Remember, the fever medicine usually lowers the fever by 2° to 3° F (1 - 1.5° C).
    • Avoid aspirin (Reason: risk of Reye's syndrome, a rare but serious brain disease)
    • Avoid alternating acetaminophen and ibuprofen (Reason: unnecessary and risk of overdosage)
  4. Sponging:
    • Note: Sponging is optional for high fevers, not required.
    • Indication: May sponge for (1) fever above 104° F (40° C) and (2) doesn't come down with acetaminophen (e.g., Tylenol) or ibuprofen (always give fever medicine first).
    • How to sponge: Use lukewarm water (85 - 90° F) (29.4 - 32.2° C). Do not use rubbing alcohol. Sponge for 20-30 minutes.
    • If your child shivers or becomes cold, stop sponging or increase the water temperature.
  5. Contagiousness: Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.
  6. Expected Course of Fever: Most fevers associated with viral illnesses fluctuate between 101° and 104° F (38.4° and 40° C) and last for 2 or 3 days.
  7. Call Your Doctor If:
    • Fever goes above 104° F (40° C) repeatedly
    • Any fever occurs if under 12 weeks old
    • Fever without a cause persists over 24 hours (if age less than 2 years)
    • Fever persists over 3 days (72 hours)
    • Your child becomes worse
There are all kinds of symptoms to choose, as well as dosing guides for common medications (Benadryl, Motrin, Tylenol, etc). While it's not going to cover every question (that's why we are here), it's a great starting place and you can trust all of the information you find.