Happy 4th of July! Let’s talk about Summer Safety.

Robin Dyson, M.D.By Robin Dyson, M.D. at Lee’s Summit Physicians Group

Covid-19 is throwing this summer for a curve. Family trips, baseball games, amusement parks, local hangouts, and even public pools are either closed or limited access. Trying to find creative ways to enjoy this time off can be challenging. But it definitely has slowed the pace of life and reduced the stressful rush of having a zillion things scheduled and little time to get them all done. As a Pediatrician, I’m always concerned with keeping my patients safe while they enjoy being kids.

The number one killer of children is unintentional injury and some of our favorite summer activities top those lists:

Motor Vehicle Accidents

Summer SafetyWho doesn’t love a good summer vacation road trip, or just a visit to your local custard stand? Babies and toddlers have a larger head-to-body ratio which means that when forward facing, that bigger head can cause more head and neck injuries. So keep those littles facing back for as long as possible and make sure their straps are fitting correctly. My 2 year and older children need those 5-point harnesses to keep them safely strapped in, and my elementary kiddos need booster seats to make sure the shoulder strap doesn’t wrap around their neck and strangle them in accidents.

Kids should sit in the back seat until at least 13 years old due to the hazard of air bags which can cause crush injuries. Kids should know to stay strapped in the entire time the vehicle is in motion. Parents, please be defensive drivers and try not to be too distracted by the kids. Being an occupant in a motor vehicle is the leading cause of injury death in kids 5-19 years of age!

Pedestrian and Bike Accidents

Please teach your children to be safe on their bikes and in the roads and parking lots. Children should wear helmets on bikes, scooters, trikes and other vehicles. This will help protect from brain damage. They need to ride safely and not out into traffic. In addition, teach kids to avoid running into the street after a toy/ball. They should not be playing in the street either. Parking lots are like streets, and drivers may not see a smaller child behind them—hold hands and do not let children run through parking lots.

 

Drowning

Summer SafetyMy favorite thing to do during the summertime when I was a child was swimming. Splashing around a cool pool on a hot summer day is the bomb, but not without risks. Little baby pools are a drowning risk and do not require a 4’ fence around them like other pools. This means that if they are left out, and a toddler sees some water in it (maybe after it rained, or it was not emptied after last time), then they might wander out to the pool unattended and potentially drown. In backyard pools, we need to make sure that kids are being supervised and don’t rough house or try to dive in a shallow pool.

Remember floaties and noodles and other inflatables are only toys. They do not teach our kids to be good swimmers—in fact they can hold children more upright (the drowning position) vs. horizontal (the floating position) which gives children a false sense that they are safe. Children are best with parents in the pool with them, helping them feel comfortable floating, getting their face under water and blowing bubbles, and learning to kick to the side to get out.  Certainly, everyone needs to be wearing a life vest on open water—even the best swimmers can die when knocked unconscious from falling off a water vehicle. Drowning is the leading cause of injury death in ages 1 to 4 years of age!

Suffocation

Although not necessarily seasonal, it’s worth talking about suffocation because it is the #1 cause of injury death in children less than 1 year old. Co-sleeping is a huge risk of suffocation for babies—which is why they need their own sleeping environment. Babies can’t always push themselves away from pillows, fluffy blankets, bumpers, and even the parent sleeping next to them on a couch or bed. Watch those lazy summer afternoon naps and evenings and put those babies in their own cribs please!

 

Burn Injuries

Summer SafetyWe’ll be celebrating our country’s independence with fireworks. And wouldn’t you know, kids get burned every year! Sparklers are the leading cause of injury. They should not be pointed at or touched to anyone else. Kids should not touch the burning end or they will hurt their fingers. And they should not be lighting them or playing with lighters and matches. Adults should make sure they are properly disposed of to avoid catching something/someone on fire.

Kids should also stay away from any of the other fireworks being lit—some of the rocket fireworks travel 150 miles per hour and can cause severe injuries. Many places recommend that kids should avoid playing with any fireworks altogether—doing glow sticks and watching professional fireworks displays instead.

And when discussing burns, don’t forget sunscreen! Skin cancer risk increases with each childhood sunburn.

Hope you all have a fun Summer this year, despite restrictions, and BE SAFE out there!

The Dreaded Pink Eye

Bryan L. Phillips, M.D.By Bryan Phillips, M.D. for Lee’s Summit Physicians Group

What is pink eye?

In medical lingo it’s called Conjunctivitis. Pink eye is a broad term – pretty much anything that turns your eye pink. It could be viral, bacterial, allergic, chemical or mechanical (getting poked in the eye). Today we’ll focus on allergic, viral & bacterial causes.

Allergic

Allergic is more common in the warmer months. It will cause a pink to red eye with watery to mucousy discharge. The hallmark of allergic conjunctivitis is that it’s itchy! It can be treated with oral antihistamines (Claritin, Zyrtec), nasal steroids (Flonase) and/or eye drops (patanol, zaditor). Trying to avoid the thing you’re allergic to is useful too, if possible.

Viral

Viral conjunctivitis looks a lot like allergic but is not itchy. It is usually without other eye symptoms or maybe a gritty sensation in the eye. A clue to this type of Conjunctivitis is that it often accompanies uri (cold) symptoms (runny nose, cough, maybe a fever). It can be one or both eyes. You may have a fair bit of dried discharge gluing the lashes together in the morning. The watery discharge can also cause chapping around the eye from being wet all day. Both of these problems can be helped by putting Vaseline on the eyes a couple times a day. This will protect the surrounding skin and stop the discharge from gluing the lashes together – a quick wipe with a wet cloth in the morning and you’re good to go.

Bacterial

Bacterial conjunctivitis is often isolated (no cold symptoms) and the discharge will tend to be more purulent (green or yellow, thicker) – sometimes it looks like the child is crying pus. It can look bad but doesn’t cause the child much discomfort. The eye may be glued shut in the morning as in the viral description above. In spite of the daycare & schools being alarmed, this is not very worrisome outside of the newborn period. There really aren’t any common complications and the symptoms will tend to resolve spontaneously in a few days (no more than 5-7 days). You can treat as viral above.

The role of eye drops for pink eye is a lot more fraught than years ago.

Pink Eye EmojiThere really isn’t much evidence that antibiotic drops do much – either shortening the course of the illness or making it less contagious. The downside to the drops is expense (they aren’t cheap!), they can actually cause irritation to the eye, and even more worrisome, they have been linked to the increase of MRSA (methicillin resistant staph) in the community. Apparently a round of antibiotic eye drops increases the risk of your nose being colonized with MRSA for a few weeks.

With weak evidence of any benefit but definite downsides to treatment for a mild self-limited illness, it is not wise to prescribe antibiotic eye drops for routine pink eye.

Good handwashing & some Vaseline on the eyes before bed is really all that’s required. I would only recommend an office visit if you are worried about other symptoms – like ruling out an ear infection or pneumonia, especially in light of the COVID-19 situation. I often still have to write a note for daycare or school to avoid the child being excluded – basically explaining pink eye is generally part of a simple cold and can be treated as such.

Reference: 2013 AAP managing infectious ds in child care & schools, quick referral guide, 3rd edition

Congenital Heart Defect Awareness: Izzy B’s Story

By Abbie Engelhardt, R.N. for Lee’s Summit Physicians Group

This is a personal story about my niece and congenital heart defect awareness. I wanted to share this story to raise awareness… congenital heart defects week is February 7- 14. 

My sister, Lori and I were both going to blessed with baby girls around the same time, how exciting!

Everything seemed to be fine.

Isabella RoseMy beautiful niece, Isabella Rose (aka Izzy B), came early at only 33 weeks, born on September 17, 2009. She weighed 3 lbs 6 oz. I visited her in the NICU before leaving for a cruise and she was doing well.

Upon returning to American soil a few days later, I had heartbreaking messages from my family. Isabella was diagnosed with a congenital heart defect called Hypoplastic Left Heart Syndrome (HLHS).

She now had 3 options.

1. Comfort care.
2. A series of three heart surgeries to correct the defect.
3. A heart transplant.

This was devastating news. She was only 13 days old when it was discovered.

At that time, there was no cardiac screening for newborns.

Luckily, she was premature and being monitored in the NICU or she would’ve died before they found out she had HLHS.

Beginning January 1, 2014, Chloe’s law came into effect, which required all babies in Missouri to have mandatory screening for critical congenital heart disease (CCHD).  CCHD screening is a simple bedside test to determine the amount of oxygen in a baby’s blood. Low oxygen levels can be a sign of CCHD. The test is done using a machine called a pulse oximeter. It’s painless and takes just a few minutes.

Isabella’s parents chose the surgical route.

Since she was so tiny, she spent three months in the NICU at Children’s Mercy with a feeding tube to help her gain weight. She needed to gain weight before she could have her first surgery. She had to be 7 lbs before they could do the Hybrid Norwood procedure. Surgery was done on December 9th, 2009 and everything went well. We spent the day in the Ronald McDonald room, which is a huge blessing for families. She spent about two weeks on the vent while her body rested and recovered, she came off it on Christmas Eve.

Isabella Rose and AddilynnThere were setbacks, but she finally made it home for the first time in January 2010, just days after I had my baby girl, Addilynn. The girls met and bonded (as much as infants bond.)

Isabella’s family tried to have some normalcy, which was hard with numerous appointments (at Lee’s Summit Physicians Group and Children’s Mercy), home health, feeding tubes, medications, etc. She was a fighter, and continued to grow and make an impact on those around her.

She was able to go on vacations, go to the zoo, try ice cream for the first time (her dad snuck it to her) and get some snuggles. She was spunky. I’ll never forget the sound of her cry. We enjoyed watching the girls play together (they loved their Johnny Jumpers), along with their cousin, Blake, who was glad he was no longer the only grandchild.

Another Surgery

Time went by and the second surgery was booked for July 6, 2010. It was scary leading up to surgery as you never know what the outcome will be. We soaked up every moment we could with her. This surgery is called the Hybrid Glenn and is an open heart surgery. We again spent the day in the Ronald McDonald room waiting for updates.

Isabella Rose

Isabella made it through surgery but had some rough moments. After surgery, she wasn’t tolerating movement, her oxygen was lower than they wanted, and her heart rhythm was more irregular. Over the next few days, while her chest remained open, they made more adjustments. She was so swollen. On July 15, 2010 I got a call that she was crashing. The rest was a blur.

We all headed to the hospital. When we arrived, they said she was stable on ECMO (life support). Their plan was to keep her on ECMO for a few days to let her body rest. While she was lying there struggling, my daughter was winning a baby contest at the Cass County fair. It was so hard to be happy for my daughter and glad that she was healthy while Isabella wasn’t. They were supposed to be healthy and grow up together.

On July 19, 2010 they began to wean Isabella from ECMO. They were able to get her completely off ECMO on July 21st at 9:47 a.m. They said she was doing well. Later that evening, my sister and her husband went to the cafeteria for a brief time. When they came back to the PICU, they were coding Isabella. Her sweet little body couldn’t take it anymore. She earned her angel wings on July 21, 2010.

We all held her and cried. It was too soon. She was only 10 months old, but her story doesn’t stop there. She touched so many lives in her short time on earth. She will always be remembered, and I’m so thankful that more people are becoming aware of Congenital Heart Defects. There has been more than a 33% decline in infant deaths from states mandating screening. And as of 2018, all US states have policies supporting newborn screening for CCHD.

Fly high Izzy B! You will always be loved and missed.

Isabella Rose

 

More Information on HLHS

HLHS is a birth defect that affects normal blood flow through the heart. As a baby develops during pregnancy, the left side of the heart does not form correctly. It affects a number of structures on the left side of the heart that do not fully develop.

For example:

  • The left ventricle is underdeveloped and too small.
  • The mitral valve and/or aortic valve is not formed or is very small.
  • The ascending portion of the aorta is underdeveloped or is too small.

The CDC estimates that each year 1,025 babies in the United States are born with HLHS. In other words, 1 in every 3,841 babies born in the US annually is born with HLHS.

Hypoplastic left heart syndrome, along with other CHDs, are a hidden condition and most kids look completely healthy.

As I mentioned previously, cardiac screening is simple and inexpensive. If the results are negative, the baby’s test results didn’t show signs of CHD. This type of screening doesn’t detect all CHDs, so it’s possible to still have a CHD with a negative screening result.

If the results are positive (fail or out of range), it means that the baby’s test results showed low levels of oxygen in the blood, which can be a sign of CHD. This doesn’t always mean that the baby has a CHD, it just means that more testing is needed.

Pulse oximetry screening is most likely to detect seven specific CHDs.

These include:

  • Hypoplastic left heart syndrome
  • Pulmonary atresia
  • Tetralogy of fallot
  • Total anomalous pulmonary venous return
  • Transposition of the great arteries
  • Tricuspid atresia
  • Truncus arteriosus

Resources:

Car Seat Safety: Protecting Your Precious Cargo

By Abbie Engelhardt, R.N. for Lee’s Summit Physicians Group

Our children are our greatest blessings, so we need to keep them safe. Car seat safety is a great place to start.

Specifications for your car seat and state car seat laws are thing every parent must know. Laws, like anything else, do change over time, so it’s important that you’re up-to-date on the current laws in the state of Missouri.

Current Missouri Car Seat Laws

  • Children under the age of 4 or that weigh less than 40 pounds must be placed in an appropriate child safety seat.
  • Children ages 4-7, or that weigh less than 80 pounds, must sit in an appropriate safety or booster seat unless they are taller than 4’9” or over the weight limit.
  • All children over the age of 8, that weigh at least 80 pounds, and are at least 4’9” tall must be secured with a safety belt at all times.

Car Seat Safety: Protecting Your Precious Cargo

Types of Acceptable Restraints for Children in Missouri

  • Rear-facing seats – This type of child safety seat has the child restrained and turned to face the rear of the car. This type of safety seat provides head, neck, and back support. This will also reduce stress to the infant’s body in the event of a crash. These are often “infant-only” seats. These are used for children that are less than a year old and weighing less than 20 pounds.
  • Forward-facing seats – As the name implies, these safety seats have the child facing towards the front of the car. They are designed for toddlers that are at least 1 year old and 20 pounds.
  • Convertible seats – This is a type of safety seat that can be converted from a rear-facing seat for infants to a forward-facing seat for older or larger children. You change the type of seat when the child reaches a year old and over 20 pounds.
  • Booster seats – This type of seat, as the name implies, gives the child a boost so that they can be in the right position to wear a seat belt. The booster seat must be low enough to allow for the seat belt to fit snugly across the hips, shoulders, and chest, without resting against the face or neck, which can be dangerous. These are for children that are between 40-80 pounds and under 4’9”.
  • Safety belts – this is what older children and adults must rely on for car safety. Missouri has strict seat belt laws to help ensure that both children and adults are securely held in their seats. This type of restraint is used for children that weigh more than 80 pounds and are above 4’9” tall. Children 12 and under should always be buckled into the back seat of the car.

Penalties

Car Seat Safety: Protecting Your Precious CargoThese laws are in place to help ensure the safety and security of children riding in motor vehicles. Failure to properly restrain your child can have negative legal consequences. In Missouri, parents can face fines of $50 for failure to properly comply with car seat laws. In many cases, charges will be dropped if the parent shows that they have obtained a proper car seat for the child.

Proper Safety Seat Usage

Proper use of the safety seat is imperative for it to do its job properly. You need to make sure the safety seat is NOT placed in front of an airbag. And you need to make sure the car seat is tightly secured and anchored in place. The child must ALWAYS be buckled into the car seat.

Make sure you use the proper safety seat for the age, height, and weight of your child. One common mistake is putting a child that is too small in a front-facing seat or putting a child who is too big into a car seat that is meant for a smaller or younger child.

Infants should never ride in a forward-facing seat.

Bulky outerwear and blankets can prevent harness straps from snugly securing your child. Buckle the harness, and then place a coat or blanket over the harness to keep your baby warm. Only use aftermarket covers, essentially fitted blankets, designed to give additional warmth that are approved by the car seat manufacturer for your specific car seat. Such covers have been tested with the seat and won’t compromise your child’s safety.

For a bigger child, after securing him or her into the car seat, turn the coat around and put it on backward (with the arms through the armholes), so the back of the coat serves as a blanket resting on the top of the harness.

If you’re considering a used car seat for your child, make sure it comes with instructions and a label showing the manufacture date and model number. Make sure it hasn’t been recalled, isn’t expired or more than 6 years old and has no visible damage or missing parts. Confirm that it has never been in a moderate or severe crash. If you don’t know the history of the seat, don’t use it.

References

 

Happy Spitter or Acid Reflux?

Lisa B. Fletcher, M.D.By Lisa B. Fletcher, M.D. with Blue Springs Pediatrics

As an expectant parent, we envision a beautiful, chubby, happy bundle of love that nurses every 3-4 hours and sleeps and smiles in between. And then they start puking on you!!! What’s this you ask? It’s making you smell sour and exponentially increasing your laundry efforts. Though your pets might appreciate it, every parent just wants it to stop! WE DO TOO!!!

Pediatricians are commonly asked about spitting up in newborns and infants.

This is probably one of the most common problems we evaluate in this age group. It’s a problem that can cause a lot of parental distress. So what are the differences in a child with simple spitting up, GER: gastroesophageal reflux, and a child who actually has GERD: gastroesophageal reflux disease? Let’s discuss the characteristics of both.

GER

This is the passage of gastric contents into the esophagus and is a normal physiologic process that occurs in healthy infants, children, and adults. Most episodes are brief and do not cause symptoms or esophageal injury or result in other complications.

GER is extremely common in healthy infants. Studies show that stomach contents may reflux into the esophagus 30 or more times daily in infants. Many, but not all, of these reflux episodes result in spitting up or vomiting. Studies show that 50% of infants birth to age 3 months reflux, 60% of infants 4 months of age reflux, and 20% of infants age 6-7 months reflux. GER decreases near the end of the first year of life and is not common in children over 18 months of age.

GERD: Happy Spitter or Acid Reflux?

So, when your read the results of these studies you realize that you are not alone in your experience! Many parents have lived through the same thing.

GERD

In contrast, gastroesophageal reflux disease (GERD) occurs when the reflux episodes are associated with complications such as esophagitis or poor weight gain. The range of symptoms and complications of GERD in children vary with the age of the child. The evaluation of an infant with frequent regurgitation focuses on determining if an underlying disease is causing the symptom and/or if the reflux is causing secondary complications.

To generalize: the baby with true GERD is having bad heart burn all of the time. It hurts to eat, and it hurts when they spit up. Sometimes these babies have other special health circumstances: prematurity, genetic abnormalities or anatomic differences. These are things we are looking for to determine if the baby is at risk.

Common complications include the following:

  • Irritability
  • Poor weight gain
  • Recurrent pneumonia
  • Barrett’s esophagus (inflamed distal esophagus)
  • Esophageal Stricture

So how can we tell which diagnosis is correct?

Uncomplicated GER can be diagnosed in infants who have no warning signs, good weight gain, feeding well, not unusually irritable, and have a normal physical examination. Most infants presenting with frequent GER will fall into this category; they are sometimes referred to as “happy spitters.” The history and physical examination usually are sufficient for establishing the diagnosis, and specific laboratory testing is not required.

Some of the Warning Signs that would trigger further investigation are as follows:

  • Nonspecific symptoms
    • Prolonged vomiting
    • Profound lethargy
    • Significant weight loss
  • Symptoms of gastrointestinal obstruction or disease
    • Vomiting bile
    • Projectile vomiting in an infant three to six weeks of age
    • Bloody vomiting
    • Rectal bleeding
    • Significant abdominal bloating and tenderness
  • Symptoms or signs suggesting a brain abnormality or systemic disease
    • Bulging fontanel
    • Headache, positional triggers for vomiting or vomiting on awakening
    • Altered consciousness, seizures, or focal neurologic abnormalities
    • History of head trauma

Evaluation of the infant with Warning Signs

Depending on the history and physical exam, evaluations could include radiographic imaging, blood work, and referrals to different pediatric specialists.

Treatment of GER

Lifestyle measures that may be helpful include feeding breast milk as much as possible to infants who are fed both breast milk and formula, avoiding tobacco smoke, and avoiding overfeeding. Other conservative measures to improve the symptoms that may be worthwhile include a trial of thickened feeds, upright positioning after feeds, or a limited two-week trial of a hypoallergenic diet (intolerance of cow’s milk or other dietary protein may have similar symptoms).

Pharmacotherapy is not indicated for infants with uncomplicated reflux (GER) based on lack of efficacy and several safety concerns. Studies show that acid-suppressing medications are not effective in infants for treatment of symptoms such as regurgitation and irritability. Even in infants with frequent regurgitation, prone positioning for sleep is not recommended, because of an increased risk for sudden infant death syndrome (SIDS).

Treatment of GERD

GERD: Diet mattersAvoidance of cow’s milk and soy protein: Food protein intolerance (typically to cow’s milk) sometimes has a clinical presentation that mimics GERD. Breastfed infants can be treated with careful elimination of all cow’s milk proteins and beef from the mother’s diet. Major sources of soy protein may need to be eliminated as well.

In formula-fed infants, we suggest switching to an extensively hydrolyzed formula. If there is a strong suspicion of a food protein intolerance (because of bloody stools or symptoms of eczema) and the infant does not respond to a hydrolyzed formula, a trial of an amino acid-based (“elemental”) formula or elimination of other dietary proteins may be necessary.

Infants who respond to the dietary change are generally maintained on a milk-free diet until one year of age, at which time many (although not all) infants will have become tolerant to the protein. Infants who do not respond to dietary restriction initially may respond to a trial of other lifestyle changes as outlined below.

Thickening feeds – A trial of thickening feeds is worthwhile for most infants with problematic reflux, except perhaps in infants who are preterm or overweight.

Positioning therapy – Keeping an infant upright (on a parent’s shoulder) for 20 to 30 minutes after a feed seems to reduce the likelihood of regurgitation

Pharmacotherapy  – Acid-suppressing medications are indicated in the following situations:

A limited trial of acid suppression (e.g. two weeks) is recommended for infants with mild esophagitis on endoscopic biopsies in addition to the lifestyle changes described.

A three- to six-month course of acid suppression for infants with moderate or severe esophagitis documented by endoscopic biopsies, in addition to the lifestyle changes described.

Medicines used for GERD

  1. Proton pump inhibitors: PPI’s are drugs that decrease acid production in the stomach by inhibiting the proton pump in the stomach.The PPIs omeprazole, lansprazole, esomeprazole and pantoprazole have all been studied in young children. Omeprazole and esomeprazole are approved by the FDA for use in infants older than one month of age with erosive esophagitis. However, there are safety concerns about the use of PPIs. These include short-term acid rebound after stopping the drug and increased risks for diarrhea, and possibly pneumonia.In addition, a large study found an association between the use of acid-suppressing medications (H2RAs or PPIs) in young infants less than six months old and later development of allergic disease. Moreover, there are theoretical reasons to consider vitamin B12 and iron deficiency in children chronically taking PPIs. Finally, studies in adults have raised theoretical concerns that long-term use of PPIs may be associated with increased risk for osteoporosis.
  1. Histamine 2 receptor antagonists – H2RA’s are medicines that decrease acid production in the stomach by competitively binding a histamine receptor. This includes Axid, Pepcid, Tagamet, and Zantac. H2RAs are a reasonable alternative to PPIs for a short-term trial of acid suppression. They are less effective than PPIs in reducing gastric acidity but more effective than placebo. The safety concerns mentioned above also apply here.
  2. Antacids – Antacids are alkaline drugs that neutralize the acidic pH of the stomach. Antacids are not generally useful in the treatment of GER in infants. Chronic use of antacids in infants can be associated with aluminum toxicity, milk-alkali syndrome, or rickets and should be avoided.
  3. Prokinetic agents – Prokinetic drugs increase the speed at which food leaves the stomach. Prokinetic agents currently have a minimal role in the treatment of GER in infants.  The few prokinetic agents with any established efficacy also have significant safety concerns, including central nervous system side effects for metoclopramide and cardiac arrhythmias for cisapride, which resulted in its removal from the market in the United States and Canada.

Conclusions:

Reflux and vomiting are common occurrences in infants less than one year of age. This is a normal physiologic process that occurs in healthy infants. Most episodes are brief and do not cause symptoms or esophageal injury or result in other complications.

Increased research in the past decade has supported a more supportive approach to refluxing infants with no warning signs. Infants with warning signs may need a more in depth evaluation with radiography, lab studies, and a referral to the appropriate pediatric specialist. Lifestyle changes, avoidance of cow milk and soy proteins in the infant’s diet, thickening of feeds, and positioning after feeds are safe and been shown to offer significant improvement in symptoms.

Studies on pharmacotherapy, (PPI’s and H2RA’s), have identified associated complications and side effects which has led to more vigilant stewardship of their use.

The take home message is if your baby is growing well and reasonably happy, then avoiding medicine is the goal. Ultimately, we are trying to help this baby grow into the strongest, healthiest, smartest, happiest, most successful and independent adult possible with no late effects of medicine that we may not have needed to use. In the practice of medicine, symptoms often require less intervention and I believe this is a good example.

So here’s to smelling like sour milk, wearing baby puke to work like a badge of honor, surviving the mountain of laundry, and knowing that after they turn a year you will be home free… or at least done with the reflux and on to other toddler adventures!!!

What you need to know about RSV – Respiratory Syncytial Virus

Amanda Martin, M.D.

Amanda Martin, M.D.

By Amanda Martin, M.D.

What is RSV?

Respiratory Syncytial Virus (RSV) is a common lower respiratory infection. In infants and toddlers, it causes bronchiolitis, which is swelling and mucous production of the small airways in the lungs, or pneumonia. In infants and toddlers, the most common symptoms are cough, runny nose, difficulty breathing, and fever. In rare cases, it can cause apnea (not breathing for more than 15-20 seconds).

RSV can be particularly dangerous for very young infants or infants and toddlers with underlying medical problems such as chronic lung disease, congenital heart disease, born before 35 weeks, or conditions causing them to have a weakened immune system. It is possible (and likely) to get RSV multiple times during your lifetime; but the good news is, repeat infections are usually not as severe. In healthy older children and adults, RSV often causes cold-like symptoms. RSV most often occurs from October to February.

How is RSV spread?

RSV is spread by bodily secretions (snot, saliva, or coughing) from someone with the virus or objects contaminated with the virus coming into contact with the eyes, nose, or mouth. RSV can survive for several hours on your hands or objects, so hand washing is very important to prevent spread.

Can RSV be tested for?

RSV - Respiratory Syncytial VirusThere is a test available for RSV. However your provider may not recommend that the test be performed, as bronchiolitis is diagnosed by the symptoms your child is having and how their lungs sound during the exam. Since there is no medication to treat RSV, whether your child has bronchiolitis due to RSV or another virus, the test would not change the treatment.

My child was diagnosed with bronchiolitis (caused by RSV or another virus). What now?

Take a deep breath. You will probably get even less sleep than usual, but most infants and children will do fine at home and do not need to be hospitalized. Younger babies breathe through their nose, unless they are crying.

With bronchiolitis, a lot of times there’s a lot of snot in the nose, and suctioning their nose with a bulb suction can help make it easier for them to breath and make them more comfortable. Most of the time when infants are sick, they eat less than usual, and it’s very important to make sure they stay hydrated. This can be achieved by feeding them more frequently. If they are not able to take formula or breast milk, then Pedialyte can be given in its place.

Since bronchiolitis is caused by a virus, there is no medicine that will help. The illness usually will last 7-9 days, with the worst occurring on or about day 5. The cough will often last for 2-3 weeks.

Important signs/symptoms to watch for

How hard your infant/child is working to breathe – When your infant/child is calm (not crying or running around) and the skin under their ribs, between their ribs or above their collar bone is going in and out with their breathing, their nostrils are flaring, or they are breathing more than 60 times a minute, then they are working hard to breath. Try suctioning out their nose and if their labored breathing does not improve, then they need to be seen right away by a health care provider.

Are they hydrated? – Ensure your infant/child has at least 3 wet diapers in 24 hours (about one every 8 hours). Other signs of dehydration include a sunken soft spot, crying without tears, and dry mouth. If there are any signs of dehydration, then they need to be seen by a healthcare provider.

Is their oxygen saturation normal? – When your infant/child is seen in our office, we will check their oxygen saturation. There are devices that can check it at home, but they are often not accurate and unless they are prescribed by a doctor, I would not recommend using them. If you check the oxygen saturation at home and it is less then 92%, then your child needs to be seen right away.

References

Piedra, MD, P. A. & Stark, MD, A. R. (June 12, 2019), Patient education: Bronchiolitis (and RSV) in infants and children (Beyond the Basics).
Retrieved from https://www.uptodate.com/contents/bronchiolitis-and-rsv-in-infants-and-children-beyond-the-basics/print

Barr, MD, F.E. & Graham, MD, PhD, B.S. (August 8, 2019) Respiratory syncytial virus infection: Clinical features and diagnosis.
Retrieved from https://www.uptodate.com/contents/respiratory-syncytial-virus-infection-clinical-features-and-diagnosis

Screen Time vs. Family Time. It’s a problem.

By Dena Pepple, R.N. for Lee’s Summit Physicians Group.

I bought my first smart phone 5 years ago. My first grand-baby was coming, and I wanted to be ready for pictures and FaceTime video that my flip phone did not offer. Shortly after, a niece introduced me to Candy Crush. My husband uses Facebook and has had so many “interesting” posts that I now check his Facebook regularly. (Just to keep up with the world of course!) Since then, I’ve added solitaire and a word search game.

Yes, my name is Dena, and I have a screen time problem.

The average screen time in the USA (including phone and tablet only, not television) is 4 hours and 33 minutes per day. My average was up to 3 and ¾ hours per day.

Lucky for me, this addiction came after my kids were grown, and it doesn’t decrease my productivity as much because my screen time is in the car (riding) or late in the evening. However, it has made me realize what could have been if I were a child or parent of youngsters today with a screen addiction.

When my kids were young we played games, read and took walks. We had family time.

I wonder if I would be different today?

We’re seeing more and more information on the consequences of our technological society and it’s not all good. Below, is a bulletin board I recently presented for a local health fair discussing screen time, family time, and “finding a healthy balance.” (I’m not in the picture, but it was one of my favorites from the event.) This information opened my eyes to what our younger generation is facing.

Health Fair Presentation: Screen Time vs. Family Time

 

Balance is definitely the key and I’m working on it.

My screen time is now below 3 hours per day. Last night I danced with my grand-kids in the kitchen to “Day-O” and “The Locomotion.” I’m on the treadmill more, knitting and doing crossword puzzles. I am working on my balance with screen time, and I hope this helps you as well.

SCREEN TIME

DEFINITION:  Screen time is the amount of time spent using an electronic device with a screen such as a smart phone, computer, television, or video game console. This is a “buzzword” in today’s age of technology and can have both positive and negative effects on our children.

PROS:

1) Enhances daily life (school, work, daily living)
2) Enhances social connections (family, friends)
3) Apps to support healthy lifestyles, charities, etc.
4) Allows peer support (world groups, rare disease, etc.)

CONS:

1) Obesity: Screen time is generally a sedentary activity. It replaces physical activity, encourages mindless snacking, and stimulates food intake due to advertisements.
2) Sleep Problems: Stimulating content and overuse can interrupt sleep time. Screen light mimics daylight, and thus can suppress melatonin that helps us sleep.
3) Addictive Behavior: The instant gratification of screen time can cause a dopamine response which is associated with feelings of pleasure.  These feelings then encourage increased use, and the cycle begins. Internet Gaming Disorder is a real psychological disorder in which most free time is spent online, and little interest is shown in real life relationships.
4) Poor School Performance: Numerous studies show this. Some causes include overuse and attempting to multitask schoolwork with social/entertainment screen time. 80% of brain development occurs in the first three years of life.  Some studies are showing increased screen time under this age affects brain development.
5) Risky Behaviors: Early exposure to alcohol, drugs, and sexual content can lead to earlier interest of these, as well as increased self-injury, eating disorders, and emotional disorders.  Sexting falls under this category. It’s estimated about 12% of youth age 10-19 have used technology to send a sexual photo. Children and teens may not know the full implications of this, but predators do! Beware of seemingly innocent phone apps as many are fronts for secret apps hiding inappropriate photos/videos. Internet Safety 101 Acronyms is also an eye opening resource for parents of texting children.
6) Cyberbullying: Technology/screen time makes on-line bullying easier. This can lead to academic, social, and health issues for both the target and the bully. The risky behaviors listed above and depression listed below often coincide with this.
7) Depression: Increased screen time may lead to decreased actual peer time, isolation, and unrealistic comparison to peers leading to feeling inferior, inadequate, or left out. Teenagers who have >5 hours of screen time per day have a 71% increase in suicidal risk.
8) Attention Deficit Disorder: The fast flow of information can impact the brain’s ability to stay focused on one task for more than a few minutes.

FAMILY TIME

DEFINITION: Family time is the intentional interaction and/or togetherness with other family members during a specific activity, environment, or time frame. It can be as simple as folding clothes or reading a book, to major vacations.

CONS:

1) Family drama
2) Could discourage independence
3) Potential loss of privacy
4) Conflicting interests/time frames

PROS:

1) Family members MATTER! Each person feels important and loved.
2) Fosters Communication: Verbal and non-verbal communication improves as game rules are explained, teamwork is needed, or members just plain “talk” to each other. Very young children learn best with “back and forth” talk.  This is critical for their language development.
3) Strengthens Family Bonds: Family time brings members together emotionally, helping them realize they can count on each other.
4) Improved Academic Performance: Study time can be family time. Parents can ask their children about their school day, help them with homework, be involved with their school activities and show that they value education.
5) Decreased Behavior Problems: Family time teaches interpersonal skills, communication, and how to treat others. Family time allows a safe place to practice these skills.
6) Greater Self-Confidence: Parents who have a positive self-image and value themselves while interacting with their children, will model and foster a healthy self-esteem and positive self-concept in their children as well.
7) Conflict Resolution: Family time can involve some conflict. It also is a great place to work on this invaluable life skill. It is a safe place to express your emotions, communicate, and resolve problems. It gives the child a place to learn/practice/model appropriate behavior.
8) It Is Fun! Family time can lead to a lifetime of great adventures, happy memories, silly stories, quiet moments, and more.

FINDING A HEALTHY BALANCE

ALL CHILDREN/TEENS/YOUNG ADULTS NEED:
  • 8-12 HOURS OF SLEEP PER DAY
  • PHYSICAL ACTIVITY DAILY
  • MEDIA FREE TIME
  • ATTENTION FROM THEIR PARENTS

HOW DO WE BALANCE SCREEN TIME AND FAMILY TIME?

  • Know what your child is doing on-line.
  • Have together screen time: co-view, co-engage, co-play.
  • Set realistic limits and stick to them.
  • Encourage unstructured off-line play.
  • Be a good role model. Children are great mimics.  Parents need to limit their own screen time and teach kindness/manners when they are on-line.
  • Create tech-free zones. Bedrooms and family meals are great examples here.
  • Don’t use technology as a pacifier. If your children are bored or emotional teach them strategies to actually handle these situations.
  • It is okay for teens to be on-line, but also okay for parents to be aware of and involved in what they are doing both on and off-line to guide them in appropriate use and behavior.
  • Teach your children common sense media usage. Not everything online is true, real, or trustworthy.
  • Communicate screen time expectations with others (care givers, grandparents, etc.)
  • Reserve screen time for special occasions such as long car rides, illness, or bad weather.
  • Avoid screen time during meals, grocery store trips, short car rides, etc, as children need to learn patience, tolerate boredom, and learn appropriate interactions with others.
  • Make children/teens earn screen time as this will teach them the importance of working towards a goal.
  • Communicate and socialize in person. Kids need to learn eye contact, manners, and how to talk face to face.
  • FAMILY TIME, FAMILY TIME, FAMILY TIME!

FAMILY TIME IDEAS

  • PLAY CARDS, GAMES
  • WALK, BIKE RIDE, SPORTS
  • BACKYARD FUN (TAG, SWINGSET, ETC)
  • VOLUNTEER WORK
  • CHURCH/SCHOOL ACTIVITIES
  • HOUSEHOLD CHORES
  • GARDENING
  • VISIT FAMILY/FRIENDS
  • SHARE A MEAL
  • HOBBIES
  • READ TOGETHER
  • TRAVEL
  • PARKS/TRAILS
  • PUZZLES
  • ZOO/FARM
  • MUSIC/CONCERTS/DANCE
  • PICNICS/CAMPING/FISHING
  • SEASONAL ACTIVITIES (SWIMMING, SLEDDING, SNOWMEN)
  • EVERYWHERE GAMES (TELEPHONE, I-SPY, SLUG BUG)
  • STARGAZING/CLOUD SHAPES
  • SCAVENGER HUNTS
  • SURPRISE A FRIEND WITH A VISIT/GIFT
  • COOKING/BAKING
  • CRAFTING
  • EXPLORE NATURE
  • SNUGGLE TIME
  • EXPLORE FARMER’S MARKET, DOWNTOWN
  • GARAGE/ESTATE SALES/ANTIQUING
  • CARNIVALS/FAIRS
  • TRAIN RIDES/WATCHING

To encourage this family time, we had a raffle of a “family fun basket” at the health fair. The basket is full of games, cards, books and more to encourage families to put down their screens and talk, play and be with each other. Pictured below is Mary who won the basket.  She was very excited to go home and share this with her family. Have fun Mary!!

Health Fair Presentation on Screen Time vs. Family Time

Resources:

AMERICAN ACADEMY OF PEDIATRICS, HEALTHYCHILDREN.ORG

What is a Medical Home and how does it relate to my child’s care?

Medical Home - Emergency vs. Urgent Care vs. Pediatrician

By Abbie Engelhardt, R.N. for Lee’s Summit Physicians Group

Some of you are probably thinking, what in the world is a Medical Home? Well, let me explain.

A Medical Home is all about you and your child. It’s a team approach, combined with information technology, to create an accountable “continuity of high quality care”. In other words, to make sure that patients don’t fall through the cracks. At Lee’s Summit Physicians Group, our primary focus is to provide comprehensive, personalized care to our patients and families in a compassionate and welcoming environment.

A Medical Home means that your pediatric team –

  • Knows the health history of your child. (Family, life situation and health goals.)
  • Keeps your child’s complete medical history in one place.
  • Takes care of any short-term illness, long-term chronic illness, and your child’s all-around well-being.
  • Follows up with any other health care providers your child receives care from, when necessary.
  • Works in partnership with you to make sure that the medical and non-medical needs of your child and family are met.
  • Creates a trusting, collaborative relationship with you and your child.
  • Treats your child with compassion and an understanding of his/her strengths.
  • Develops a plan of care with you and your child when needed.
  • Notify you of test results in a timely manner.
  • Respects and honors your culture and traditions.
  • Help make the best decisions for your child’s care.

What is your job as a parent?

  • Know that you are a full partner with us in your children’s care.
  • Come to each visit with any updates on medications, supplements, or remedies you are using, and with any questions you may have.
  • Remember to tell your pediatric team about any care received between visits (emergency room, urgent care clinics, specialists).
  • Keeps scheduled appointments or call to reschedule or cancel as early as possible.
  • Understand your children’s health conditions and what you can do to stay as healthy as possible.
  • Work with us to develop and follow a plan that is best for your children’s health. Let us know of any obstacles to the plan.
  • Give medication as prescribed.
  • Learn about your health insurance coverage.
  • Don’t be afraid to ask questions!

Is it okay to go outside of your primary Medical Home?

Yes, however, you should always start at Home (for example, Lee’s Summit Physicians Group.) When your child is sick or hurt, it can be difficult to tell whether an urgent care or emergency department is the best choice. In making that decision, it’s important to stay calm and recognize the difference between a medical emergency and a medical situation where a different type of care is more appropriate.

Remember… for non-emergency situations, first call your child’s pediatrician. We have phone nurses available Monday through Friday 8am to 4:30pm. After hours calls are available with a small fee. Many insurance companies provide phone nurses as well. We have urgent care hours 7 days a week.

If you believe the injury or illness is life threatening or may have caused permanent harm, go to the emergency room or call an ambulance. If your child is seriously ill or injured, it is safer for your child to be transported by an ambulance.

Who are we? We are your pediatric Medical Home!

Our pediatric department is open 7 days a week. Lee’s Summit, Raintree and Blue Springs offices all have urgent care hours Monday through Thursday 8am-6pm and Fridays 8am-11pm.  On weekends, only the Lee’s Summit office is open and the hours are 8-11 on Saturday and Sunday.

Medical Home Frequently asked questions:

What does a Medical Home eliminate?
Unnecessary ER visits, missed immunizations/labs, doctor hopping, expensive co-pays, unnecessary costs, duplicate testing (labs, imaging).

My child may need an x-ray, can you do that in your office?
No, but we can evaluate the child and if an x-ray is necessary, we will send an order to Children’s Mercy or Diagnostic Imaging. You don’t need to go to an urgent care that has x-ray services.

Is it okay to go to Children’s Mercy urgent care?
Yes, especially if it is after hours here and can’t wait until the next day during our urgent care hours. If it can wait, you can wait to bring them to their Medical Home.

Does my child really need a Well child check every year even though they don’t need immunizations?
Yes, it is important to monitor their growth and development. Prevention is key to raising a healthy child.

Do you live in a Haunted House? That might not be candy…

By Dena Pepple, R.N. for Lee’s Summit Physicians Group.

We’re not far from Halloween… Are there monsters under your bed or ghosts in your closets? Do you hear creaks and noises in the night? Are you afraid to go to the basement alone? Maybe, you live in a haunted house!

Most of you are laughing or rolling your eyes right about now, but I’m here to tell you that your house may very well be haunted and those dangers are lurking before your very eyes. How do I know this? Unfortunately, it’s all in the numbers.

The National Safety Council says more than a third of child injuries and deaths happen at home. Every year, 3.4 million children are injured unintentionally in the home. About 2,000 of these children (age 14 and under) die as a result. According to the Consumer Product Safety Commission, every 17 minutes an injury from a home furnishing tip-over occurs. The National Safety Council also states that medications are the leading cause of child poisoning.

The causes of these unintentional injuries include burns, suffocation, drowning, firearms, falls and poisoning.

Poison and Candy Look AlikesEvery cause is equally important and must be addressed in every home where children live or visit. The following web sites are overflowing with great information, handouts, education, interactive games, videos, safety checklists, and more:

Poison Look-alikes

One of the causes of unintentional home injuries that I want to discuss in more detail during this Halloween season are poison look-alikes.

I recently received a pamphlet from the Missouri Poison Center (PDF) that had some eye-catching and disturbing pictures of these poison look-alikes. Rat poison pellets look like Nerds candy. Nicotine gum and Dentyne gum come in similar little white squares. Some cleaning solutions and Gatorade have the same purple color. Gummy bears can be candy, vitamins, or even CBD infused. Of course, we all know the old joke of x-lax and chocolates.

Can children tell the difference?

We adults can see or read what the look-alikes really are, but our children may not be able to tell the difference.

In 2017, the Poison Control Centers in the United States received 2.12 million phone calls for human poison exposure. They state peak poison frequency occurs between one and two years of age, and 45% of poison exposures occur in children under the age of 6 years.

So, what can you do?

OUT OF SIGHT, OUT OF REACH, AND LOCKED UP should be your mantra for all medications and other potentially hazardous materials in your home. Keep all medicines and products in their original containers.

Be clear with your children that candy is candy and medicine is medicine.  Do not tell your children medicine is candy so they will be more inclined to swallow. As you are thinking about trick-or-treating and candy bags, look and see what else could be on that look-alike list. Keep the Missouri Poison Center phone number in a prominent place at home and in your cell phone. Most importantly, if you even suspect a poisonous ingestion CALL, CALL, CALL the poison center number!

Missouri Poison Center Phone Number: 1-800-222-1222

Tip-over Injuries

There is another safety issue hidden in plain sight in our homes. Our home furnishings can cause tip-over injuries. 195 deaths were caused by furniture tip-over accidents between 2000 and 2016. Sadly, from 2015 to 2016 the number of tip-over accidents increased by 33%, raising the total number of deaths to 26 per year. ER visits from tip-over accidents are estimated at >30,000 between 2014 and 2016.

The fix here is the use of furniture straps on every potential tip-over furnishing.

Dressers, televisions, bookcases, and any other tip prone furniture should be securely attached to the wall. These straps can be found online at many stores (Home Depot, Target, Walmart, Lowes, and more).

Charlie’s House

Charlie's House LogoYou can also get these straps for free at Charlie’s House.

Charlie’s House is a non-profit organization started here in Kansas City, in memory of a beautiful little boy named Charlie. Charlie died in his home in a dresser tip-over accident. They educate on home safety and are in the process of building a real safety house to better educate parents about these safety issues, and ultimately save lives.    They also offer other home safety devices such as cord covers, drawer latches, outlet covers, and more.

Thirty-two years ago I child proofed my home for the first time.

We read about home safety advice, put up gates, attached drawer locks, had poison control numbers ready, and used a “real” car seat to bring our baby home. We were ready to keep our kiddo safe… or so we thought.

That baby (my daughter) is now having her own babies and childproofing her own home. She makes me look like a rookie. She has multiple gates, doorknob grips everywhere, soft furniture corner covers, a locked medicine box, furniture straps, cabinet locks, and more. I teased her that her house was almost grandma proof! But she did it right and knows that it’s an ongoing, evolving and everyday process. I am proud of her and her vigilance to protect her children.

As our family fun month of October continues, enjoy the cooler weather, school activities, pumpkin spice everything, and of course Halloween candy and parties. Have fun with your scary costumes and haunted houses. But don’t forget the scares in your own “Haunted House”.  Be prepared, stay alert, use the resources listed, and protect your little goblins.

Let’s keep the haunted houses in Halloween where they belong!

Taking Care of our Own: Sabrina’s Story

By Rhonda Pfaffly, Referral Coordinator for Lee’s Summit Physicians Group.

It seems like the news and social media are focused on sensational, negative things most of the time. It’s draining. Wouldn’t it be nice to hear some good news for a change? Well, I’ve got a story for you. Here at Lee’s Summit Physicians Group, we’re family… not a collection of employee numbers or bodies filling chairs. I’ve gotten to watch this story play out over the past few months.

Sabrina

SabrinaSabrina works at the front desk at our Rain Tree office. She’s been with LSPG for several years, working full time and going to school to be a radiologist technician.

Unfortunately, a couple of months ago, she was involved in a grease fire and sustained 1st, 2nd and 3rd degree burns to her face, arms, legs, chest, abdomen and back. She was in the Research Burn Unit for the past several months.

Since the day of her accident, she’s gone through several surgeries and skin grafts. And last week, she finally got to come home. She still has a long road ahead of her involving physical therapy and more surgeries. In spite of that, she has a great spirit and keeps us posted on her recovery through Facebook and emails.

Taking Care of our Own

The minute we heard about Sabrina’s accident, the front desk employees didn’t bat an eye. They started figuring out how they were going to cover her shifts. Rachel in our billing office made ribbons for us to wear to show we support her. They were a great reminder around the office. Purple is Sabrina’s favorite color, so we made purple bracelets inscribed with her favorite saying, “Don’t Worry, Be Happy”. We sold them for $2 each and raised $700 to help with Sabrina’s expenses.

We also held Sabrina Spirit Week by dressing up every day:

  • Monday – Purple Monday
  • Tuesday – Tie Dye Tuesday
  • Wednesday – Wacky Wednesday (Mismatched clothing day.)
  • Thursday – Twinning Thursday (Find a coworker and be their twin… or triplet… or quadruplet!)
  • Friday – Royals day

Supporting SabrinaWe donated $1 each day to be able to participate. All told, we raised $1,620 for Sabrina to help with her expenses.

She continues to amaze us with her “Don’t Worry Be Happy” attitude and we know she will pull through this. Her boyfriend, Toby, says, “She’s a warrior!!!”

We will continue to be here for Sabrina and her family while she is recovering. That’s why I couldn’t be more proud of our team. I get to spend my days with my second family here at LSPG. I’ve experienced this support personally when I lost my husband in January. My friends and coworkers took care of me and continue to show their support. I hope you never have to face this situation, but it really helps to know people are in your corner and you can count on them to understand if something terrible happens.

The moral of this story is… I hope you work in a place where you’re treated like family. Not just the easy stuff… but the times when it really matters and you need to show up!