If you have an account balance and are not making regular payments on that balance you can expect to start receiving detailed warning letters from our office soon. Please take these very seriously and follow the instructions so that we may continue to provide health care to your child or children. Failure to pay off the balance or to make satisfactory monthtly payments will result in us asking to take your child elsewhere for health care.
As always, we can set you up with an automated monthly payment plan using your credit card. This is an easy and secure way to make sure that your account stays current and that your child’s health care is not interrupted.
]]>We think it’s important to take home a couple of facts from this that go beyond just recognizing that this is a serious illness. First of all, pertussis is preventable, and the rising cases are due to decreasing immunization rates in California, Washington, and Oregon. The vaccine for whooping cough is part of the regular recommended vaccine schedule and is given starting at two months of age.
Secondly, the most vulnerable patients are the tiny babies who are either too young to have received any pertussis vaccine or are only old enough to have received a couple of doses. That’s the logic behind vaccinating adolescents and adults as well. Tdap vaccine is given as a booster now for tetanus but also stimulates the immune system to ‘remember’ the childhood pertussis vaccine series. We give it starting at about 11 years old, but it is also strongly recommended for any adult who is planning to be around a small baby. So it should be given to new parents, grandparents, child care workers… anyone who will care for our tiniest patients.
Check with your PCP to see if you have had this crucial vaccine and ask for it if the answer is ‘no’ or ‘we’re not sure’. If your PCP doesn’t offer vaccines to adults, most area pharmacies can provide immunizations as well. Protect that new baby — whether that baby is your child, grandchild, or honorary nephew or niece. Don’t end up as the parent on a news story like this one.
]]>National Wildlife Federation’s website has some nice articles on the benefits of kids fooling around in the mud and dirt, as well as practical tips on what they can do to attract and nurture wildlife by their efforts. Local nurseries can also help you get started with child-sized tools and kid-friendly plants and seeds. For garden examples to inspire you and for children, check out the grounds at Deepwood Estate or the Martha Springer Botanical Garden at Willamette University.
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Q: Does my newborn need to get the Vitamin K shot?
A: Yes, absolutely. Babies are born without adequate levels of Vitamin K. Vitamin K is vital to the process of having blood make an effective clot. Our bodies get it from healthy bacteria that live in our intestines and manufacture it for us, but a newborn baby doesn’t have any bacteria yet to do the job. It takes several weeks to get enough bacteria to start making Vitamin K, and in the meantime your baby is unprotected. In the Bad Old Days, this all too often resulted in something called Hemorrhagic Disease of the Newborn. Infants without Vitamin K can have severe bleeding from the tiniest injury, including bleeding into the brain, and this can be fatal. You don’t want to put your newborn at risk for this. You may have heard some people talk about an oral version of Vitamin K instead… but don’t be fooled, it doesn’t work, isn’t approved for this purpose, and we don’t support its use.
Q: When does my baby need to start their his or her immunizations?
A: Right away. The AAP (American Academy of Pediatrics) recommends that the first dose of Hepatitis B vaccine be given in the hospital, right after that baby is born. It’s usually done within the first 12 hours of life. If for some reason this isn’t given in the hospital, we will do it at the baby’s first office visit.
Q: I don’t want to vaccinate my baby. Can I bring my baby to you for care? Are there providers at your office who will agree with my approach?
A: In accordance with AAP policies, we don’t turn parents away from our practice if they don’t immunize their children. That doesn’t mean we agree with your decision. In fact, we think that immunizing your baby, on schedule, according to the recommendations, is the most important health care you can provide to your child. If you have questions or concerns about immunizations we will do our best to answer them and point you toward reliable and scientific sources of information. The Resources section of this website has some great places to start. If you refuse to immunize your baby then you can expect us to remind you of the consequences of your decison at every visit, and you will be asked to sign a special waiver acknowledging the risks of not immunizing. We also reserve the right to restrict non-immunized children from our waiting room by asking them to wait in the car before being seen, to avoid exposing our other patients to potentially devastating illnesses.
All of our providers are on board with this policy so you won’t get a different answer by shopping around… and in the end, if you are still opposed to immunizations and all of the life-saving science behind them, then you should look elsewhere for a practice. We won’t turn you away but neither will we support your decision to put your child (and others) at harm. We do NOT maintain a list of local providers who do not vaccinate, nor would we recommend any such provider to you.
Q: I want to breast-feed my child, but if I don’t have enough milk, I want to feed the baby goat’s milk. I’ve heard that’s better than formula because it’s all natural.
A: Breast-feeding is best for babies. If you are unable to breast-feed your infant, then a commercially-prepared cows-milk formula is almost always the best choice. There are organic versions available if that is important to you. Goat’s milk is deficient in several important vitamins as well as iron. Infants fed on goat’s milk grow severely anemic and may have other health problems as well. Goat’s milk and goat cheese are fine for older children as part of their balanced diet.
Q: I’ve heard it’s important for a pediatric office to have a ‘sick’ waiting room and a ‘well’ waiting room. Is that true? Do you have your lobby set up that way?
A: We don’t. Studies have shown that divided waiting areas don’t decrease the spread of germs. My favorite analogy to this is the swimming pool story: having a divided waiting room is like having a ‘peeing section’ and a ‘non-peeing section’ of the swimming pool. We believe in preventing illness in our waiting room by keeping it clean and ventilated AND trying to assure that your child doesn’t have to wait very long to be seen. Our staff clean the waiting area and patient restrooms regularly throughout the day.
]]>There’s a sneaky, seductive little idea out there that a lot of parents fall for. It’s the ‘I’ll vaccinate my child, just not all at once’ or ‘just more slowly’ or ‘no more than two vaccines at a time’. Certain celebrity physicians who make a lot of money selling books on this topic like to speak of these strategies as a sort of middle ground, a sort of compromise. It’s an idea that’s attractive to some parents, who struggle to reconcile what they hear from us, the AAP, and the CDC, with all of the misinformation that they get from whack jobs and former Playboy bunnies.
Don’t fall for it.
The vaccine schedule is designed to give every infant and child the best protection from the most deadly illnesses as early as possible. Things like bacterial meningitis from Haemophilus influenza (prevented by the HIB vaccine) and whooping cough (prevented by pertussis vaccine, contained in the DtaP) are true killers of little babies. Every week you delay a vaccine leaves your child with decreased protection for that much longer. And because pediatricians and ED doctors expect that babies are usually getting their shots on time, someone may assume that your child is protected against one of these deadly diseases… when in fact that is exactly what they have.
Input from patients and their families regarding the degree of asthma symptoms is a very important component of our asthma management. In order to help us obtain an accurate assessment of your child’s asthma symptoms, we use something called the Asthma Encounter Form… also known around our office as ‘the blue form’. Typically you will be given this form at check-in, but you may also be given the form by nursing staff or by your child’s provider. It contains a list of standard questions that address both the severity of your child’s asthma as well as the impact of asthma on the life of your child and on the family. The answers that you mark enable us to swiftly get an impression of how well the asthma is controlled, saving you time in our office.
We ask that you answer these questions every time your child or adolescent is being seen for asthma or for an acute illness (such as a bad cough) in which asthma might be playing a major role. In addition, we’ll ask you to fill out this form at least once a year even for those patients who hardly ever have problems with their asthma. So you might get the ‘blue form’ when you are expecting to only talk about a sprained ankle — but we still want to take that opportunity to make sure that your child’s asthma is well controlled and not a problem for him or her.
In general, children and adolescents with intermittent asthma (occasional symptoms, usually with colds or with exercise, no daily medication prescribed) need to be seen for their asthma at least once a year. Children with persistent forms of asthma (ongoing symptoms even when well, nighttime cough, or on a daily preventive medication) need to be seen more frequently, usually every one to three months depending on the severity of the asthma and the degree of control we are able to achieve. If your child has a significant flare-up of his or her asthma that is severe enough to require oral steroids (prednisone, prednisolone, or dexamethasone), we usually want to see them back for a follow-up visit about a month later.
Thanks for partnering with us in improving the care of children and adolescents with asthma, and please feel free to ask us questions about this process at any step along the way.
]]>Today’s children and teens face a variety of challenges: media/technology bombardment, obesity risks, bullying at school, mental health problems, overwork/exhaustion. These are all issues that we, as pediatricians, want to help you identify in order to help your children. We also know now that many children deal with subtle developmental issues that can be better helped if detected earlier. And with budget cuts to schools, a visit to the doctor’s office is often your child’s only opportunity to have their vision and hearing screened.
The American Academy of Pediatrics recommends frequent well child exams in the first two years of life and yearly thereafter. If you have an infant or toddler, we should be seeing that little one at two weeks of age, two months, four months, six months, nine months, twelve months, eighteen months, and two years of age. Some higher-risk toddlers will need a visit at 15 months and/or 30 months. Then we should see your preschooler at age three years, four years, and five years.
We perform formal developmental screening with the Ages and Stages tool at nine months and three years, and any other time it seems warranted. We also use the M-CHAT tool to screen for autism at 18 months and at two years. Your four- and five-year-olds can expect us to test their hearing and vision, and we start monitoring BMI (body mass index) at age two.
After age five, we should see your child every one to two years for preventive care. Some insurances still only pay for checkups every two years in that age group, but we encourage you to get feisty with your insurance over this and ask to have it changed! The AAP recommends that children over the age of five continue to be seen yearly, and we would like to see them. In the elementary-school-aged child, we perform vision screening (and hearing if needed or not done previously) as well as any catch-up immunizations.
In middle school, we also begin to screen for problems such as mood disorders, substance use, and school issues. High school youth can expect a detailed questionnaire covering issues such as safety, substance use, risky sexual behaviors, and mental health issues… in addition to some immunizations that come due in the teenage years! Of course, if your youth is participating in a school sport, he or she will be required by the school to have a physical every two years anyway.
To provide the best care for your child or adolescent, it’s important that we have these opportunities for preventive care. We can’t in good conscience just serve as an urgent care or shot clinic for your child. We’ll take every opportunity to remind you of this need when you call or come in for other reasons. So study the schedule above, and if you’ve got a little one (or a not-so-little one) who is in need of a checkup, give us a call! Or better yet, use your Secure Patient Portal Account and request an appointment online, without even having to pick up the phone.
]]>Q: Will you see my baby in the hospital, and when?
A: Yes! As long as you are delivering at Salem Hospital, we will see and examine your normal newborn in the first 24 hours. All of our physicians have newborn privileges at Salem Hospital. We do not take care of patients at Silverton Hospital or other hospitals in the Mid-Valley, nor in the Portland area.
Q: Do I need to notify your office, or preregister the baby?
A: Usually, no. If you deliver at Salem Hospital and specify to the hospital staff that we will be the baby’s health care provider, your baby will usually be automatically registered by our billing staff once they appear on our hospital census. Then when you call to make the follow-up appointment, you will complete the process by giving us the rest of the details — such as baby’s brand new full name! If you deliver somewhere else, you will need to call us and register the baby after he or she is born. Our Billing department does this for you. If your OB provider is expecting the baby to have special health care needs, a call to us in advance will help to coordinate care.
Q: How long will mom and baby stay in the hospital?
A: We are only providers for the baby, not the mom … but some general rules apply. Normal healthy newborns usually stay about 48 hours, sometimes a bit less. Anything less than 48 hours is considered an ‘early discharge’, and not all babies qualify. Any baby who is a bit early, is having feeding problems, or just isn’t behaving needs to stay 48 hours (and longer if needed for your baby’s health). There are a number of screening tests that will be performed on your baby between 24 and 48 hours of age, so on no account should your baby go home before 24 hours of age.
Q: When does my baby need to come to the office?
A: We see most babies one or two days after discharge. To facilitate this, we have weekend hours. If your baby’s doctor tells you to come in for a Sunday appointment, he or she isn’t kidding…. we will be here to see your baby.
Q: We are expecting a boy. When can we have him circumcised?
A: We no longer perform infant circumcisions, either at the hospital or in the office. You may contact Willamette Urology at 503-561-7100 if you would like to have that surgery performed.
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