What Is a Medical Home?

This idea of a “medical home” — a place where everybody knows your name and your medical records are complete — is nothing new. In fact, that term has been used in medical and government circles for well over a decade.

A medical home combines place, process, and people. It is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. A medical home represents an approach to pediatric health care in which a trusted physician partners with the family to establish regular ongoing care. Through this partnership, the primary health care professional can help the family and patient access and coordinate specialty care, other health care services, educational services, in and out of home care, family support, and other public and private community services that are important to the overall health of the child and family. Providing a medical home means addressing the medical and non-medical needs of the child and family.

A pediatric medical home is defined by the AAP as having the following characteristics:

• The medical care of infants, children, adolescents, and young adults ideally should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.
• It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care.
• The physician should be known to the child and family, and be able to develop a partnership of mutual responsibility and trust.

Children can be cared for at a physician’s office, a hospital outpatient clinic, a community health center, or a school based clinic, as long as it provides the services that constitute comprehensive care. Those services include:

• Partnership: Provision of family-centered care through developing a trusting partnership with families, respecting their diversity and recognizing that they are the constant in a child’s life.
• Clarity: Sharing clear and unbiased information with the family about the child’s medical care and management and about the specialty and community services and organizations they can access.
• Primary care: Provision of primary care, including but not restricted to acute and chronic care and preventive services, including breastfeeding promotion and management, immunizations, growth and developmental assessments, appropriate screenings, health care supervision and patient and parent counseling about health, nutrition, safety, parenting, and psychological issues.
• Secondary care: Assurance that ambulatory and inpatient care for acute illnesses will be continuously available (24 hours a day, 7 days a week, 52 weeks a year).
• Continuity: Provision of care over an extended period of time to ensure continuity. Transitions, including those to other pediatric providers or into the adult health care system, should be planned and organized with the child and family.
• Referrals: Identification of the need for consultation and appropriate referral to pediatric medical subspecialists and surgical specialists. (In instances in which the child enters the medical system through a specialty clinic, identification of the need for primary pediatric consultation and referral is appropriate.) Primary, pediatric medical subspecialty, and surgical specialty care providers should collaborate to establish shared management plans in partnership with the child and family and to formulate a clear articulation of each other’s role.
• Intervention: Interaction with early intervention programs, schools, early childhood education and childcare programs, and other public and private community agencies to be certain that the special needs of the child and family are addressed.
• Coordination: Provision of care coordination services in which the family, the physician, and other service providers work to implement a specific care plan as an organized team.
• Record-keeping: Maintenance of an accessible, comprehensive, central record that contains all pertinent information about the child, preserving confidentiality.
• Assessment: Provision of developmentally appropriate and culturally competent health assessments and counseling to ensure successful transition to adult-oriented health care, work, and independence in a deliberate, coordinated way.

To meet the definition of medical home, a designated physician must ensure that the aforementioned services are provided, regardless of the venue in which the medical care is provided.

Is It OK to Leave Home?

Obviously, the ER does not meet those objectives, nor is it designed to do so. As its name implies, the ER is for emergencies only — when your child experiences a life-threatening illness or injury and can’t wait for a trip to the doctor’s office.

But what about walk-in health care centers, including the new breed of in-store clinics offered by major drugstore chains? Is it ever acceptable to go to a walk-in for relatively minor health complaints like earaches and sore throats?

Certainly, these clinics can be helpful, especially if you are away from home or an illness occurs after hours. But just like the ER, they don’t meet the definition of a medical home, and for the health of your child, you should think twice about using them routinely.

The need for an ongoing source of health care — ideally a medical home — for all children has been identified as a priority for child health policy reform at the national and local level. Over the next decade, with the collaboration of families, insurers, employers, government, medical educators, and other components of the health care system, the quality of life can be improved for all children through the care provided in a medical home.

This article was featured in Healthy Children Magazine. To view the full issue, click here.

Last Updated 8/20/2015

Source Healthy Children Magazine, Winter 2007

The following New Year tips are from the American Academy of Pediatrics (AAP).

Preschoolers
·         I will clean up​ my toys and put them where they belong.
·         I will brush my teeth twice a day, and wash my hands after going to the bathroom and before eating.
·         I won't tease dogs or other pets – even friendly ones. I will avoid being bittenby keeping my fingers and face away from their mouths.
·         I will talk with my parent or a trusted adult when I need help, or are scared.
·         I will be nice to other kids who need a friend or look sad or lonely.

 

Kids, 5 to 12 years old

·         I will drink reduced-fat milk and water every day, and drink soda and fruit drinks only at special times.

·         I will put on sunscreen before I go outdoors on bright, sunny days. I will try to stay in the shade whenever possible and wear a hat and sunglasses, especially when I'm playing sports.

·         I will try to find a sport (like basketball or soccer) or an activity (like playing tag, jumping rope, dancing or riding my bike) that I like and do it at least three times a week!

·         I will always wear a helmet when riding a bike.

·         I will wear my seat belt every time I get in a car. I'll sit in the back seat and use a booster seat until I am tall enough to use a lap/shoulder seat belt.

·         I'll be friendly to kids who may have a hard time making friends by asking them to join activities such as sports or games.

·         I will never encourage or even watch bullying, and will join with others in telling bullies to stop.

·         I'll never give out private information such as my name, home address, school name or telephone number on the Internet. Also, I'll never send a picture of myself to someone I chat with on the computer without asking my parent if it is okay.

·         I will try to talk with my parent or a trusted adult when I have a problem or feel stressed.

·         I promise to follow our household rules for videogames and internet use.

 

Kids, 13 years old and older

·         I will try to eat two servings of fruit and two servings of vegetables every day, and I will drink sodas only at special times.

·         I will take care of my body through physical activity and eating the right types and amounts of foods.

·         I will choose non-violent television shows and video games, and I will spend only one to two hours each day – at the most – on these activities. I promise to follow our household rules for videogames and internet use.

·         I will help out in my community – through giving some of my time to help others, working with community groups or by joining a group that helps people in need.

·         When I feel angry or stressed out, I will take a break and find helpful ways to deal with the stress, such as exercising, reading, writing in a journal or talking about my problem with a parent or friend.

·         When faced with a difficult decision, I will talk about my choices with an adult whom I can trust.

·         When I notice my friends are struggling, being bullied or making risky choices, I will talk with a trusted adult and attempt to find a way that I can help them.

·         I will be careful about whom I choose to date, and always treat the other person with respect and without forcing them to do something or using violence. I will expect to be treated the same way in return.

·         I will resist peer pressure to try tobacco-cigarettes, drugs, or alcohol.

·         I agree not to use a cell phone or text message while driving and to always use a seat belt.

 

Additional Information: 

·         ​Healthy Children Radio: New Year's Resolutions (Audio) ​

·         How to Shape & Manage Your Young Child's Behavior

·         Chores and Responsibility

·         Creating Opportunities for Children & Teens to Contribute

·         Media Time Family Pledge

·         The Healthy Children Show: Energy Balance for School-Age Kids (Video)​



Published 12/9/2014 12:00 AM http://www.healthychildren.org/English/news/Pages/Healthy-New-Years-Resolutions-for-Kids.aspx

No matter what grade your child is about to enter, there's the yearly back-to-school checklist of to-dos:

·         Shopping for school supplies

·         Filling out permission forms

·         Scheduling your child's yearly pediatric well-child visit

While it may not seem as urgent, a yearly physical exam by your family's pediatrician is an important part of your child's health care. The back-to-school season is a convenient time for putting the exam on your family's schedule.

Your Family-Centered Medical Home

The American Academy of Pediatrics (AAP) advocates that every child and youth receive care through a family-centered medical home. Within the medical home, care is provided continuously over a long period of time so that as a child ages and develops, his or her care is never interrupted.

Adolescence, for example, is a time when vital changes are taking place. It is important to have your child see the pediatrician during the transition years from later childhood to puberty.

The annual pediatric exam also offers the doctor time to provide wellness guidance and advice. In addition to monitoring heart and blood pressure and testing for diabetes, pediatricians can use this annual visit with your child to discuss diet, exercise options, pediatric vision screenings, and testing for cholesterol and anemia.

Building a Medical History

The continuity of regular physical exams is invaluable. Having a long-term history with a child or adolescent gives the doctor the awareness of the child's progress and development over time. This helps the doctor detect emerging problems, as well as being informed by the detail of the patient's history, such as important past illnesses or injuries the child may forget to mention on the sports physical questionnaire.

That detail includes immunization records. A school entry form will generally include a check box asking whether all vaccinations are up-to-date, requiring the parents to remember whether or not they are. The family pediatrician will have accurate records to assist you in filling out these forms.

Examining the Young Athlete

The doctor's annual exam of a young athlete should be similar to one for any other child but most pediatricians will also address some sports-specific issues, including injuries, nutrition, training and exercise programs, and even attitudes in the course of the exam.

The other side of the exercise issue is the student athlete who is already involved in an exercise and training program. Overuse and overtraining injuries continue to be huge problems.

The Need for a Thorough Physical Exam (beyond a sports-specific exam)

Back-to-school check-ups, as they are commonly called, are often the only visit most kids and teenagers have with their pediatrician every year. The annual physical gives the pediatrician a chance to give the child a thorough physical exam and address any emotional, developmental, or social concerns. It is also a good chance to address important questions, especially with teenagers, including adolescent issues of drinking, smoking, drugs, sexual activity, and depression.

Children involved in school athletic programs often receive a sports-specific exam through the school. The timeframe for getting this exam should be at least 6 weeks prior to the start of the sport's season. This allows ample time to work up any new health concerns or rehab any lingering injuries before the season starts, without delaying clearance of the athlete. However, school sports physicals alone tend not to address the child's overall health.

Getting the Balance Right

A healthy childhood and adolescence calls for balancing home life, school, social activities, sports, and extracurricular pursuits. This is not easy, especially during a time when the child is passing through the years of growth, learning, exploration, and emotional and physical development. This is all the more reason to set aside one day during each of those years for your child to see the pediatrician.

Additional Information

·         Well-Child Care: A Check-Up for Success

·         A Medical Home Where Everybody Knows Your Name

·         Your Child's Health Story

·         Recommended Immunization Schedules

·         Primary Care Coverage: Information for Parents

·         Understanding Cost Sharing: Deductibles, Copayments & Coinsurance​


http://www.healthychildren.org/English/ages-stages/gradeschool/school/Pages/Back-to-School-Back-to-the-Doctor.aspx

Last Updated 8/11/2014Source Adapted from Healthy Children E-Magazine, Back to School 2012The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

It's good for children and adults to spend time playing and exercising outdoors, and it's important to do so safely.

Simple Rules to Protect your Family from Sunburns

·         Keep babies younger than 6 months out of direct sunlight. Find shade under a tree, an umbrella, or the stroller canopy.

·         When possible, dress yourself and your children in cool, comfortable clothing that covers the body, such as lightweight cotton pants, long-sleeved shirts, and hats.

·         Select clothes made with a tight weave; they protect better than clothes with a looser weave. If you're not sure how tight a fabric's weave is, hold it up to see how much light shines through. The less light, the better. Or you can look for protective clothing labeled with an Ultraviolet Protection Factor (UPF).

·         Wear a hat with an all-around 3-inch brim to shield the face, ears, and back of the neck.

·         Limit your sun exposure between 10:00 am and 4:00 pm when UV rays are strongest.

·         Wear sunglasses with at least 99% UV protection. Look for child-sized sunglasses with UV protection for your child.

·         Use sunscreen.

·         Make sure everyone in your family knows how to protect his or her skin and eyes. Remember to set a good example by practicing sun safety yourself.

 

Sunscreen

Sunscreen can help protect the skin from sunburn and some skin cancers but only if used correctly. Keep in mind that sunscreen should be used for sun protection, not as a reason to stay in the sun longer.

How to Pick Sunscreen

·         Use a sunscreen that says "broad-spectrum" on the label; that means it will screen out both UVB and UVA rays.

·         Use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15 (up to SPF 50). An SPF of 15 or 30 should be fine for most people. More research studies are needed to test if sunscreen with more than SPF 50 offers any extra protection.

·         If possible, avoid the sunscreen ingredient oxybenzone because of concerns about mild hormonal properties. Remember, though, that it's important to take steps to prevent sunburn, so using any sunscreen is better than not using sunscreen at all.

·         For sensitive areas of the body, such as the nose, cheeks, tops of the ears, and shoulders, choose a sunscreen with zinc oxide or titanium dioxide. These products may stay visible on the skin even after you rub them in, and some come in fun colors that children enjoy.

 

How to Apply Sunscreen

·         Use enough sunscreen to cover all exposed areas, especially the face, nose, ears, feet, hands, and even backs of the knees. Rub it in well.

·         Put sunscreen on 15 to 30 minutes before going outdoors. It needs time to absorb into the skin.

·         Use sunscreen any time you or your child spend time outdoors. Remember that you can get sunburn even on cloudy days because up to 80% of the sun's UV rays can get through the clouds. Also, UV rays can bounce back from water, sand, snow, and concrete, so make sure you're protected.

·         Reapply sunscreen every 2 hours and after swimming, sweating, or drying off with a towel. Because most people use too little sunscreen, make sure to apply a generous amount.

 

Sunscreen for Babies

·         For babies younger than 6 months: Use sunscreen on small areas of the body, such as the face, if protective clothing and shade are not available.

·         For babies older than 6 months: Apply to all areas of the body, but be careful around the eyes. If your baby rubs sunscreen into her eyes, wipe her eyes and hands clean with a damp cloth. If the sunscreen irritates her skin, try a different brand or sunscreen with titanium dioxide or zinc oxide. If a rash develops, talk with your child's doctor.

 

Sunburns

When to Call the Doctor

If your baby is younger than 1 year and gets sunburn, call your baby's doctor right away. For older children, call your child's doctor if there is blistering, pain, or fever.

How to Soothe Sunburn

Here are 5 ways to relieve discomfort from mild sunburn:

·         Give your child water or 100% fruit juice to replace lost fluids.

·         Use cool water to help your child's skin feel better.

·         Give your child pain medicine to relieve painful sunburns. (For a baby 6 months or younger, give acetaminophen. For a child older than 6 months, give either acetaminophen or ibuprofen.)

·         Only use medicated lotions if your child's doctor says it is OK.

·         Keep your child out of the sun until the sunburn is fully healed.​

 

Additional Information

·         Baby Sunburn Prevention

·         Teens and Sun: Keeping Them Safe Without Ruining Their Fun

·         Sunburn: Treatment and Prevention

·         Teens & Tanning: Safety Information for Parents

·         Preventing Skin Cancer (Audio)​

·         Ultraviolet Radiation: a Hazard to Children and Adolescents (AAP Policy Statement)

Last Updated 6/5/2014 Source Fun in the Sun: Keep Your Family Safe (Copyright © 2008 American Academy of Pediatrics, Updated 4/2014)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Families may decide to use a retail-based health clinic because they believe it is convenient and less expensive, but according to the American Academy of Pediatrics (AAP), these clinics do not provide children with the high-quality, regular preventive health care children need.

In an updated policy statement published in the March 2014 Pediatrics, the AAP emphasizes that retail-based clinics are an inappropriate source of primary care for children because they fragment children’s health care and do not support the medical home.

The policy statement, “AAP Principles Concerning Retail-Based Clinics” released online Feb. 24, updates the Academy’s 2006 policy statement, which expressed strong opposition to the use of retail-based clinics. The AAP acknowledges that the number of retail-based clinics has grown to more than 6,000 as of 2012. Surveys indicate 15 percent of children are likely to use a retail-based clinic in the future, although the majority of patients are adults.

“The AAP recognizes that convenience and access to care will continue to be important drivers of how health care is delivered,” said James Laughlin, MD, FAAP, lead author of the policy statement. “However, the expertise of the pediatrician and the medical home should continue to be recognized as the standard for care of children, and we encourage all AAP members to provide accessible hours and locations as part of a medical home.”

Pediatricians are specifically trained in child health issues. They know each child’s health history, and are best equipped to take care of both simple and complicated problems comprehensively within the medical home. As young patients and their health issues become more complex, the possibility arises that even a simple complaint may be related to a more serious, underlying condition that could be overlooked by someone who is less familiar with the patient, according to the AAP.

While the AAP believes the medical home is the optimal standard of care for pediatric patients, and does not recommend that parents use retail-based health clinics, it is understood that the services of these clinics may be used for acute care outside of the medical home. If parents choose to use a retail-based clinic for their child’s illness, they should ask if the clinic has a formal relationship with their pediatrician, if the clinic will communicate with the pediatrician about the visit, and what the protocol is for following up if the illness does not resolve or the clinic is closed. Parents should consider only using retail-based clinics that have a formal relationship with their child’s pediatrician.

Additional Information:

·                         Retail Based Clinics: Information for Parents

·                         Healthy Children Radio: Retail-Based Clinics (Audio)

·                         Why Choose a Pediatrician?

·                         The Healthy Children Show: Choosing a Pediatrician (Video)

·                         Your Child's Medical Home: What You Need to Know

©http://www.healthychildren.org/English/news/Pages/AAP-Advises-Parents-against-Using-Retail-Based-Clinics.aspx

Published 2/24/2014 12:30 AM

Heredity is clearly an important risk factor for conditions such as heart disease, cancer, and diabetes. However, researchers are steadily gathering strong evidence about how diet influence development of diseases. Experts agree that healthy eating habits from an early age can lower the risk of developing several deadly diseases later on. A diet designed to lower the risk of heart disease, diabetes, and other serious diseases is one that benefits the whole family, adults and children alike.

Risk Factors for Heart Disease

Heart disease is the number one killer of men and women in the United States and most industrialized countries. The chief risk factors are:

·                         Smoking

·                         High blood pressure

·                         Diabetes

·                         High blood level of cholesterol

·                         Physical inactivity

·                         Obesity

·                         Family history of early-onset heart disease

 

Following a Heart-Healthy Diet From an Early Age

American children and adolescents, on average, eat more saturated fat and have higher blood cholesterol levels than young people their age in most other developed countries. The rate of heart disease tends to keep pace with cholesterol levels. One study found early signs of hardening of the arteries (atherosclerosis) in 7% of children between ages 10 and 15 years, and the rate was twice as high between ages 15 and 20.

According to the American Heart Association, a heart-healthy diet from an early age lowers cholesterol and if followed through adolescence and beyond, should reduce the risk of coronary artery disease in adulthood.

All children older than 2 years should follow a heart-healthy diet, including low-fat dairy products. For children between the ages of 12 months and 2 years with a family history of obesity, abnormal blood fats, or cardiovascular disease, reduced-fat milk should be considered.

Is There a Family History?

When you and your children first saw your pediatrician, you were probably asked if there was a history of heart or vascular disease in your family. If your children were young, their grandparents were probably relatively young as well and may not have had a heart attack or stroke (even though they may have been headed for one). If heart disease in the grandparents becomes apparent later on, be sure to bring it to your pediatrician’s attention at the next checkup.

Cholesterol Testing for Adopted Children 

Complete biological family medical histories are not usually available to adopted children and their parents, even for those adopted in open proceedings. To prevent the development of diseases linked to high blood cholesterol levels, adopted children should be screened periodically for blood lipid (fat) levels throughout childhood.

Additional Information 

·                         Healthy Active Living for Families

·                         The 5 Food Groups: Sample Choices

·                         Overcoming Obstacles to Physical Activity

·                         What About Fat and Cholesterol?

·                         Your Family Health History & Genetics 

Last Updated 2/3/2014 Source Nutrition: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2011) The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

It may be cold outside, but it’s just as important for children to get physical activity during the winter as it is during the warmer months. Physical activity should be a healthy part of your family’s routine throughout the year. And safety should always be a central part of your children’s recreational fun.

Fun in the Winter Sun

It’s true that many safety concerns are the same regardless of season. For example, parents still need to remembersunscreen. Even though it might seem odd, you can getsunburn in the winter. The sunlight reflects off snow and ice.

·      Choose a sunscreen made for children with a sun protection factor (SPF) of at least 15. (Check the label.) Apply the protection 15 to 30 minutes before going out. They need to be reapplied every one and a half to two hours, particularly if your child spends a lot of time outside. Consult the instructions on the bottle. 

·      You should also wear protective eyewear and an SPF lip balm.  

 

Safety in Layers

When thinking about outside activity, think about clothing, too. Layering is a good idea; so are moisture-wicking fabrics and clothing that’s geared to the sport. Keep in mind that regulating body temperature is more difficult in younger children (just as it is during warm weather), so hypothermia can occur more easily. For example, kids can sweat when they’re warm and, as they remove layers, that sweat can chill them quickly when it gets exposed to the cold air. 

Parents have to be really proactive and responsible about dressing children appropriately in layers, covering their heads and necks.

Watch out for fashion trends that could land you in the ER:

·      Long scarves and cords can get caught in sled blades.

·      Hoods can block peripheral vision.


Stay Alert

Injuries can happen anywhere, anytime. Be aware and use caution.

·      Children should always wear helmets while sledding, skiing, snowboarding, and playing ice hockey. 

·      Parents should also make sure that the hill your children are sledding down doesn’t empty onto a pond that might not be frozen solid. 

·      Don’t load up the sled with multiple riders; take turns. "Reckless play," or actively trying to crash into each other or knock people off, is obviously a setup for injury.   


Equipment Check

If you’re planning a skiing or snowboarding trip:

·      Have the equipment fitted by a professional.

·      A child in too-large boots can trip and fall.

·      A child in skis that aren’t the right size can fall, too.

·      Wrist fractures, commonplace in snowboarding, can be prevented by simply using wrist guards.

Safety is key in ice hockey or sports involving equipment. No one wants to buy new skates every year, but it may be necessary as your child grows.

Used equipment is fine, but check it out before you buy it:

·      Look at the laces.

·      Look for broken blades.

·      Make sure the leather on hockey and ice skates isn’t too broken down around the ankles.

·      If you need a mouth guard, wear one.

You have to check all equipment, new and old, to see that it fits. You need to check it to make sure it’s still safe or not broken. If it gets used a lot, it may not hold up. Make sure helmets and boots are sized correctly. Make sure the equipment is in good shape. If you’re concerned, ask a sales person at a ski shop.     

Skills Assessment

If it’s a new activity, work with your child to master the skill first. For example, play it safe by starting with a snowboarding lesson before you all hit the slopes.

It’s recommended, appropriate and safe, to start slow or on a more gentle slope. Practice with your equipment and gradually build up to a steeper slope or faster speed. Be patient and resist pressure to take on more than you’re ready for.

By taking a few precautions, you can make sure that your children get the healthy benefits of winter exercise without taking unnecessary risks.

Additional Resources

·                         Winter Storm Disaster Fact Sheet

·                         Healthy Children Radio: Winter Safety (Audio)

·                         Playing Outside in Cold Weather (Audio)

·                         Avoiding Dry Winter Skin (Audio)

·                         Ice Hockey

·                         Extreme Temperature Exposure

·                         Winter Blues: Seasonal Affective Disorder and Depression

·                         Dry Winter Skin (Audio)

·                         Frostbite Prevention (Audio)

·                         Skiing and Snowboarding 

Last Updated 12/3/2013

Source Adapted from Healthy Children Magazine, Winter 2008

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

​Parents and child care providers can help prevent and slow the spread of the flu. The flu (influenza) is a respiratory illness caused by a virus. Flu infections are highly contagious. They spread easily when children are in a group with other children such as in a child care center or family child care home.

Flu is more dangerous than the common cold for children and can lead to serious health conditions like pneumonia or bacterial infections. Each year many children are hospitalized and some die from the flu.

The following resources provide information on preventing the flu. Materials and tools for child care facilities are also included.

Protecting Children with Chronic Health Conditions

Children and adolescents with a chronic health condition, such asthma, diabetes and disorders of the brain or nervous system are at high risk for flu complications.

·      Flu: A Guide for Parents of Children and Adolescents with Chronic Health Conditions

 

Flu Vaccine Information

The flu vaccine is the best way to protect against getting the flu. All people 6 months and older need a flu vaccine each year. Babies cannot get vaccinated until they are 6 months old. It is critical that people who live with or care for children, especially infants younger than 6 months, get vaccinated. Vaccinating adults who are around an infant to prevent illnesses is often referred to as “cocooning.”

·      Inactivated Influenza (Flu) Vaccine: What You Need to Know

·      Live, Intranasal Influenza Vaccine: What You Need to Know

·      Vaccines Your Child Needs

 

Fighting Germs

A few minutes killing germs can go a long way toward keeping you and those around you healthy. As adults, we know to wash our hands often with soap and water, especially after coughing, sneezing, or wiping noses. It is also important to cover your own mouth and nose when you cough or sneeze. Parents and child care providers can do their part to kill germs and also teach young children how and when to wash their hands.

·      Hand Washing: A Powerful Antidote to Illness

·      Germ Prevention Strategies

·      Cleaners, Sanitizers & Disinfectants

 

Preventing the Spread of Illness in Child Care

Young children who have just entered child care are more vulnerable to infectious diseases. This is because it may be the first time they have been exposed to certain germs. In addition, they may be too young to have received enough doses ofrecommended vaccines to have developed immunity.

There are steps that caregivers and teachers can take to prevent the spread of infection in child care.

·      Preventing the Spread of Illness in Child Care or Schools

 

How Sick is Too Sick?

When children are healthy, they can go to child care or school, and parents can go to work. Getting the flu vaccine is the best way to make sure everyone can continue to participate in these important activities. However, when a child feels too sick to participate in activities, or requires care beyond what the caregivers can provide without compromising their ability to care for other children, that child may need to stay home.

·      Treating Your Child’s Cold or Flu (Video)

·      How to Manage Colds and Flu

·      When to Keep Your Child Home From School

 

Additional Resources for Parents & Child Care Providers

·      Managing Infectious Diseases in Child Care and Schools, 3rd Edition - Completely revised and updated, the new 3rd edition of this award-winning quick reference guide provides the latest information on preventing and managing infectious diseases in child care and school settings.  (AAP Bookstore)

·      AAP Putting the Immunization Picture into Focus (AAP.org)

·      AAP Childhood Immunization Support Program (CISP) (AAP.org)

·      Flu.gov (Centers for Disease Control and Prevention)

·      PreventChildhoodInfluenza.org (National Foundation for Infectious Diseases/Childhood Influenza Immunization Coalition)

·      FamiliesFightingFlu.org

Last Updated 10/1/2013

Source American Academy of Pediatrics (Copyright © 2013)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Extreme heat can cause children to become sick in several ways. Make sure to protect your child from the heat as much as possible, watch for symptoms, and call your doctor if you see any develop.

Preventing Effects of Extreme Heat:

There are several steps you can take to protect your child from heat-related illness: 

·      Plan to have a cool, air-conditioned space for your child. If your home does not have air-conditioning, find a nearby building that does. Libraries can be a great place for a cool retreat from the heat. 

·      Make sure your child stays hydrated. Encourage her to drink water regularly, even before she asks for it.

·      Plan for more time to rest than usual; heat can often make children feel tired.

·      When your child is feeling hot, give him a cool bath or water mist to cool down.

·      Don’t forget about the effects of sun exposure.

·      Never leave children in a car or other closed motor vehicle, especially when temperatures are high. The temperature inside the car can become much higher than the outside temperature, and can rise to temperatures that cause death.

 

Potential Health Effects:

Extreme heat can make children sick in many ways, including:

·      Dehydration

·      Heat exhaustion

·      Heat cramps

·      Heat stroke

 

When to Call Your Child’s Doctor:

Call your child’s doctor immediately if he or she develops any of the following symptoms. Your child’s doctor can advise you on the next best course of action and whether an immediate evaluation is needed.  

·      Faintness

·      Extreme tiredness

·      Headache

·      Fever

·      Intense thirst

·      Nausea

·      Vomiting

·      Breathing faster or deeper than normal

·      Skin numbness or tingling

·      Muscle aches

·      Muscle spasms

For more information on how recognize and treat these heat related illnesses, click here.

Psychological Effects:

Don’t forget about your child’s mental health, as well. Children may become anxious or restless from being kept indoors. Plan ahead for entertainment with indoor activities and games, and limit the amount of time spent watching television.

Children may become fearful or stressed from effects of the heat. For example, seeing dead animals or wildlife may be distressing. Reassure your child that many people are working to resolve the situation and keep them safe. Children take their cues from their parents and the environment, so remember to keep calm and answer their questions openly and honestly. Keep in mind not to share more than is appropriate for their age.

Last Updated 5/11/2013

Source American Academy of Pediatrics (Copyright © 2012)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Improving patient care: Smartphones and mobile medical devices

Mobile medical gadgetry is in its infancy, yet these devices can help you motivate pediatric patients and their parents to adopt healthier lifestyles.


Publish date: JUN 01, 2013

By: Andrew J Schuman, MD

The world is a much different place since the iPhone was released this month just 6 years ago in 2007. Because of our smart mobile devices, we talk, text and tweet, shop wisely, travel expediently, and socialize even when alone. Our smartphones and tablets challenge us with games, amuse us with music and books, and entertain us with television shows and movies. As they have become everyone’s constant companion, patients and parents waiting for medical visits use their mobile devices to play games or read e-mail, play music, text a friend, or watch a video. No one is bored while waiting anymore, and empty time is always put to good use.

This universal devotion to mobile devices provides pediatricians with an opportunity to encourage our patients to improve their health and comply with recommendations. In this installment of Pediatrics V2.0 we’ll detail several of the many medical devices that interface with smartphones. It’s truly amazing how many of these affordable gadgets are now available, and how many more are in development and will be released in the near future.

 

Computers in disguise

What makes smartphones so “smart” is that they are not just phones; they are powerful portable computers that retrieve or transmit information via telephone or wireless networks. Best of all, smartphones are affordable and integrate seamlessly with other computers and smart devices we possess. This makes smartphones an ideal physician assistant for encouraging patients to follow our recommendations. For example, an overweight teenager may be less than motivated to modify his or her diet and exercise following a conversation with a pediatrician. This may be an entirely different story when the adolescent is informed that “there is an app for that” and a new affordable gadget will help him or her reach specific goals.

The “gamification” of health care is the latest strategy for motivating pediatric patients and their parents to make efforts to adopt a healthier lifestyle. Gamification is driven by data collection and interpretation. Patients use applications and monitoring devices to document compliance with treatment regimens and to visualize progress and goals achieved. As gamification of medical care evolves, we are likely to see patients rewarded for success by insurance companies with cash incentives, reduction in medical care premiums, or other tangible incentives.

 

New opportunity for diabetes care

One of the best examples of smartphone and medical-device integration is the iBGStar glucose monitoring system from Sanofi-Aventis (Bridgewater, New Jersey). This is a 2-inch-long device that plugs into the bottom of the iPhone and integrates with the iBGStar application. A test strip is inserted into the device and a drop of blood is applied. The patient is rewarded with a snazzy animation as the device calculates the blood glucose and the application displays the result. One can review previous readings and use the application to monitor for trends. The application also lets your diabetic patient input carb counts and insulin dosages. The data displayed in the application clearly illustrates the effect these have on the patient’s readings. Best of all, the user can share the log of information with a nutritionist or medical provider by e-mail. The device is very affordable at $99.

Other smartphone-integrated glucose meters are or will soon be available and provide different connectivity options. The Telcare BGM (Telcare; Concord, Massachusetts), the company’s very popular $150 glucose meter, currently features phone network connectivity and uploads all readings inconspicuously to the cloud. Data can be accessed via the MyTelcare.com Web portal and the data syncs with a smartphone application. Via the Web portal, trends can be reviewed and printed, and the device even reminds users when it’s time to order supplies.

LifeScan Inc (Milpitas, California), which markets a full line of sophisticated glucometers, recently received US Food and Drug Administration clearance to market its OneTouch VerioSync Blood Glucose Monitoring System that will connect to smartphones and tablets via Bluetooth. It is likely to be available by the time you read this.

 

Getting fit

Over one-third of children in the United States are either overweight or obese, and pediatricians try to encourage overweight children to modify their lifestyle via adoption of healthy eating habits and regular exercise. Mobile technologies have made it possible to gamify fitness and motivate children who welcome competition with friends and interaction with computers.

A very popular kid-oriented mobile fitness device is the Zamzee Activity Meter (Zamzee Co; Redwood City, California). Parents can purchase the mobile device for $30 and “skin” it with appealing designs and colors. The device is clipped to a belt or shoelaces. At intervals, the meter is plugged into a computer via the USB port and the uploaded data is reviewed via a child-friendly Zamzee portal. Children earn points and badges based on goals and can level up when milestones are achieved. Motivation can also be augmented with rewards parents can purchase for children. These can be redeemed at the Zamzee online reward store or can be exchanged for gift cards to Amazon, iTunes, GameStop, and many others. According to the Web site, the effectiveness of the Zamzee device has been studied in more than 448 children over a 6-month period and its use is associated with an average activity increase of 60% compared with non-Zamzee users.

Teenaged patients really like stylish “kicks” (aka sneakers or shoes) and those who are interested in getting fit might be interested in Nike’s full line of smartphone-connectible activity-monitoring products. These include a wireless sensor that fits in a special pouch in the heel of the Nike+ line of sports shoes and communicates wirelessly with an iPad Nano (via a special receiver) or smartphone; a GPS/activity-monitoring watch that plugs into a computer’s USB port; and the new FuelBand system that connects to smartphones via Bluetooth. Prices range from $30 for the sports kits that include a sensor and receiver for an iPod Nano, to $150 for the FuelBand system, to $169 for the Nike+ SportsWatch GPS. All data can be viewed via an application on a smartphone or via the Nike+ Web portal.

In addition to the activity monitors just described, dozens of other fitness-monitoring systems are available. These keep track of distances traveled, calories burned, and many also track other important fitness parameters such as heart rate while exercising and duration and quality of sleep. Time will tell if these ultimately will prove worthwhile for patients who wish to lose weight or improve their level of fitness.

Another interesting device that could potentially facilitate weight loss is the Hapifork, soon to be available from Hong Kong-based Hapilabs Ltd. The device teaches patients to eat at a slower pace. If food is consumed too rapidly, the device vibrates and flashes to warn the user to slow the pace of eating. The device connects to a smartphone via Bluetooth or uploads data to your computer via USB, then syncs with the Hapilabs Online Dashboard, a Web portal that keeps track of how long a meal takes as well as the number of fork servings per meal and the interval between bites. The device comes in a number of appealing colors and can be cleaned in a dishwasher. Many are optimistic that this simple device will make a profound difference in assisting our obese patients to pace themselves during mealtime, so satiety is achieved before overeating occurs. As of this writing, the price of the Hapifork has not been set.

Lastly, Withings.com markets a full line of affordable smartphone-integrated products to help parents monitor the health and well-being of their children. The company sells a full-featured baby monitor that transmits high-resolution video and sound over a wireless network, phone network, or Bluetooth so parents can view their baby on a smartphone anywhere and anytime. Parents can talk with their baby, play a lullaby, and be alerted when the baby cries or fusses. The baby monitor sells for $250. Withings also markets a baby scale that syncs via a wireless network or Bluetooth with computers and smart devices. The app keeps track of feedings and plots the child’s weight gain on gender-specific growth charts. The baby scale is $180, and converts to a child scale simply by removing the cradle.

Withings also sells a $150 fitness scale that monitors weight, body mass index, and heart rate, as well as a smartphone-connected sphygmomanometer. The $129 sphygmomanometer helps patients monitor their blood pressure readings and the effect that medication, diet, and exercise have on improving blood pressure. Data can be shared with providers via e-mail or via a secure patient portal.

 

Breathing easier

Several mobile devices can assist parents in the home monitoring of children with respiratory problems. For many children, peak flow meters are used to monitor respiratory status, and many smartphone applications such as Asthma Buddy, Asthma MD, and asthmaTrack can be used to track peak flow reading scores, medication use, and exacerbations. Pulse oximeters have come down in price significantly and several are now being sold in pharmacies for as little as $40. These can determine whether an asthma exacerbation is associated with a falling pulse oximeter reading and thus warrants an expedited medical evaluation. The iSpO2 from Masimo (Irvine, California) is the first iPhone-connectible pulse oximeter. It has a special application that displays the pulse oximeter reading along with the pulse and the perfusion index and keeps a log of readings so these can be reviewed with physicians to guide therapy. The device sells for $250.

Asthmapolis (Madison, Wisconsin) is releasing an innovative sensor that fits atop standard controller and rescue inhalers and syncs with a mobile app via Bluetooth. By using the Asthmapolis sensor, patients will be able to provide their physicians with information that documents compliance with controller meds as well as the frequency and location (via GPS) of rescue medication usage. Previously, physicians had to depend on patient and parent reports regarding compliance and exacerbations. The use of the new device and its ability to present objective data may facilitate creation of new personalized strategies for improving asthma management.

Lastly, iSonea Ltd (Melbourne, Australia) manufactures a handheld acoustic monitor called the Wheezometer for documenting asthma symptoms in patients. The device analyzes a 30-second record of a child’s respiratory noises and produces a measurement called the WheezeRATE. The device is being promoted as an adjunct to oximetry, peak flows, and asthma scoring as a means to document the presence of asthma symptoms and response to therapy, both long-term and during acute exacerbations. The company has also announced that it anticipates the production of a new smartphone-connected AirSonea system before the end of this year. The system will link a new version of its respiratory acoustic monitor to a smartphone application that displays the device’s readings.

 

In the office

Patients are intrigued by all the medical gadgets and gizmos we use in the medical office, and they may be even more interested if you integrate mobile devices into your own practice. The advantage of doing so is that the mobile applications excel at showing patients the significance of measurements. If we show patients that we feel mobile devices are accurate and reliable enough for office use, we encourage patients and parents to consider using mobile health technology at home when indicated.

Of the devices mentioned above, smartphone- or iPod touch-connected glucose meters, pulse oximeters, blood pressure cuffs, and wireless scales and baby scales provide affordable alternatives to our standard office devices. In addition to these, you might also be interested in purchasing a few others that either are presently available or will soon be available.

AliveCor (San Francisco, California) offers a $200 heart monitor that snaps on an iPhone and enables the smartphone to function as a single-lead electrocardiogram (ECG) recorder. The device is either held by the fingers of both hands or placed on a patient’s chest, and the device displays the ECG along with the heart rate. The device can display a continuous ECG and record up to 30 seconds of a rhythm strip that can be captured and electronically transferred via the cloud. Although not a substitute for a Holter monitor, the device is capable of capturing abnormal rhythms in patients you suspect may have a dysrhythmia on auscultation or via a pulse check.

Another device that may be available by the time you read this article is the Remotoscope from CellScope Inc (San Francisco, California), now in development. An attachment to a typical smartphone gives the user the ability to visualize and photograph the tympanic membrane in high resolution. If the optics are as good as I expect, I see the Remotoscope being a useful tool in educating parents about the diagnosis and treatment of otitis media or otitis externa.

 

Where do we go from here?

Clearly a new age of mobile medical gadgetry is in its infancy and evolving rapidly. We now have the ability to encourage patients to use smartphone-connected devices to lose weight, exercise regularly, and adhere to our recommendations for management of obesity, diabetes, asthma, and hypertension. These devices also provide your practice with the opportunity to gamify some aspects of health care, improving the likelihood that children may adopt a healthier lifestyle.

DR SCHUMAN is adjunct associate professor of pediatrics at the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and an editorial board member for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with or financial interests in any organization that may have an interest in any part of this article.

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