Johns Creek Pediatrics Blog

April 04, 2019
Category: Uncategorized

    Is there anything more precious than a child’s smile? To me, I really can’t think of anything better. So how do you as a caregiver help protect your child’s adorable smile? Here is some helpful information to guide you:

Why is protecting my child’s teeth important?

    Some parents think their young child’s teeth don’t need to be cared for since their baby teeth are going to fall out eventually. However, poor oral hygiene can not only lead to cavities and gum disease now, but it can lead to more serious problems like permanent damage to adult teeth, dental abscesses (mouth infections), endocarditis (heart infection), and more!

When should I start brushing my child’s teeth?

    As soon as your child’s first tooth starts coming in begin brushing their teeth with a soft toothbrush and a very small amount (the size of a grain of rice) of fluoride containing tooth paste.

What is considered good oral hygiene?

    The goal is to brush your child’s teeth twice a day, morning and night. These are hectic times of day getting everyone out the door and then ready for bed but try to make this a priority!

    Flossing should begin once the teeth have grown close together and a toothbrush can not clean between them. Flossing should be done once a day.

    Children under age three need to use a grain of rice size of toothpaste to brush their teeth.

    Children three years and older need to use a pea size amount of toothpaste to brush their teeth. See picture below for an example.

    Until children are 8 years old it is best to supervise them while they are brushing or flossing to make sure their teeth are cleaned properly. Once children can tie their shoe or are 8 years old, they typically have enough fine motor skills to clean on their own.

What is fluoride?

    Fluoride is a natural mineral that is in many foods and added to many areas water. It helps protect teeth by making the enamel stronger to prevent tooth decay. You may have heard some misinformation from people on social media that fluoride is unsafe but this is not true. Both the American Academy of Pediatrics and American Dental Association recommend using a fluoride toothpaste and drinking fluoridated water. Think of fluoride like your teeth’s vitamin, that helps keep them strong!

When should my child see a dentist?

    Your child should go see a dentist around the age of 1 or once they have had teeth for six months. After their first visit, it is recommended they see the dentist for routine check ups every 6 months. Routine check ups are important so you catch tooth decay early before it becomes a problem!

What other things can I do to keep my child’s teeth healthy?

    NO JUICE! The AAP recommends children only drink milk and water. Juice is high in sugar and can cause tooth decay.

    Limiting SUGARY treats and brushing your child’s teeth after them. Also, avoid having your child constantly snacking throughout the day, instead try to limit them to 3 meals a day and 2 snacks (unless you are told otherwise by your PCP).

    Resist the temptation of letting your child sleep with a BOTTLE or prop a bottle while feeding. Prolonged exposure to milk can cause cavities. Also try to wean your child off of the bottle between the ages of 12-18 months.

    Getting rid of the PACIFIER early. Try and have your child weaned off of the pacifier by age 18 months.

    If you notice any brown or white SPOTS on their teeth make sure to bring them to your child’s dentist early, don’t wait until their routine check up.

If you have any other questions on how to care for your child’s teeth please comment below, call us/come see us at Johns Creek Pediatrics, or ask your child’s dentist.

March 26, 2019
Category: Uncategorized
Tags: Pediatrics  


    There’s no way around it, technology is a big part of our world today.  And it is playing a big role in the lives of our children. Failure to be proactive about our children’s media consumption will result in unwanted consequences and, potentially, long term problems.  Here are some thoughts to consider in developing a proactive plan for your child’s media consumption.

What is screen time?

    This is all television, video, movie, computer, video game, tablet, and social media usage combined.

How much screen time is ok?

    The American Academy of Pediatrics (AAP) recommends no screen time for children under 2 years old.  For children between 2-5 years old only 1 hour per day of high quality educational screen time is recommended.  Beyond 5 years old the recommendation is more complicated because children often use media at school or for homework, but limiting time on electronics beyond school work and encouraging a variety of non-electronic activities is a must.

Have a plan

    We must make, and adhere to, a plan!  The AAP has created a great resource to help you get started.  This can be found at HealthyChildren.org/MediaUsePlan. The resource will guide your family in making a plan (specific to your child’s age) on what types of media can be used, for how long and where, as well as suggesting “media free” zones like the dinner table or bedrooms.

Monitoring usage

    Keeping track of our children’s media usage (type and amount) can be challenging but it is worth the effort.  There are programs available to assist with this like Net Nanny, Screen Time or other parental control software.  Some apps are available that can be set to limit a child’s time on a device. Also, having rules about internet use only in common spaces, like the living room or kitchen, can make it easier to visually monitor children’s usage.

Be educated on media

    The landscape is constantly changing and the more we know the easier it will be to protect our children.  Researching apps or trying them out before allowing kids to use them can be helpful. Information can be gained too from websites like Common Sense Media where movies, video games, YouTube channels, etc. are reviewed and age suggestions are given.

Educate your children on media

    Children often do not think about the dangers of their media usage.  Explaining to kids privacy concerns and why they should not post their address or identifiers like school name is important.  Also, enabling privacy settings offers some protection. Children are the target of advertising much of the time. Making them aware of this and the ways companies try to influence them can help them think more critically when using media.  Having conversations about topics like “sexting” and cyberbullying are important as well.

Health risks

    There are some specific health risks associated with media consumption.  Research has showed an association between the more hours watched of tv and obesity, so encourage children to turn it off and get moving.  We also know from research that tv and other electronics disrupt sleep. “Putting devices to bed” outside of the bedroom and not having televisions in bedrooms can help prevent this.  Gaming addictions are a real problem that pose their own set of health risks. There are educational/learning concerns that occur as well, especially when media is introduced at a young age or is very fast paced.

Be the example

    We must practice what we preach.  If we want our children to limit media usage we must do the same.  If being a responsible “internet citizen” is the goal then we have to show them how we do that.  The area of electronic media is like all other areas of parenting. Our responsibility is to protect our children while leading and guiding them so they can eventually be independent responsible users.

 

                                                         

March 19, 2019
Category: Uncategorized
Tags: Allergies  

Have you seen it, that yellow film on your freshly washed car? The dreaded spring pollen has arrived! Even if you haven’t SEEN it yet, the Georgia pollen counts are extremely high. Spring time allergies are almost exclusively caused by tree pollen. Georgia’s top contributors are Oak, Pine, Sweet Gum, Juniper and Cottonwood.  Not sure if you have an allergy to these trees? Let’s talk about it

Allergic Rhinitis or Hay Fever, as it is commonly called, can cause a myriad of symptoms for about 30% of the population, including children. Most children need to be exposed to 1-2 seasons of pollen before they develop any type of immune response. If your child is under 2 years old, their symptoms are unlikely to be secondary to seasonal allergies. Signs of these seasonal allergies include clear runny nose, sneezing, itchy, watery eyes and nose, cough, congestion, and scratchy/tickle throat. These symptoms are not accompanied by fever or significant fatigue. For most children, these symptoms are mild and easily managed.  We can usually tell in the office with history and examination if your child is suffering from seasonal allergies or an upper respiratory infection, so if you’re unsure, we would be happy to see them!

So, we decided that maybe your child does have allergy symptoms, what can we do about it? How do we treat these bothersome symptoms? We can easily treat them with some lifestyle modifications and some over-the-counter allergy medications (in most cases). We recommend making sure at the end of the day, after being outside, you shower before bedtime and have clean sheets and pillows, to avoid carrying the pollen into the home and extending the exposure.  We also recommend second generation antihistamines such as Zyrtec, Claritin, or Allegra. These over the counter anti-histamines are non-drowsy and provide daily relief of some allergy symptoms. One of the most effective treatments includes glucocorticoid nasal sprays (such as Flonase, Nasacort, Rhinocort, etc.).  Most of these nasal sprays are safe in kids over the age of 2, but please check product labeling for specific ages and instructions. If your eyes are the most bothersome symptom, sometimes eye drops can be more helpful than the antihistamines and nasal sprays. Look for allergy eye drops that contain ketotifin (Zaditor, Alaway, Children’s Alaway, etc.) and follow the label’s instructions.

If you’ve tried these lifestyle modifications and over the counter medications and your child is still suffering from bothersome symptoms, we recommend a visit to our office! Some children have more complex allergies and require more interventions to relieve their symptoms.  

Some great resources:

https://www.healthychildren.org/English/tips-tools/symptom-checker/Pages/symptomviewer.aspx?symptom=Nose%20Allergy%20(Hay%20Fever)

http://www.atlantaallergy.com/pollen_counts

                                                                        

Suicide prevention, cyberbullying and the toxic society in which we are raising our kids

On Easter Sunday, April 8, 2012, my dear childhood friend’s daughter committed suicide at the age of 15.  This was a beautiful girl in a loving, faith-filled family who had a bright future ahead of her.  If it can happen to Grace, it can happen to anyone.   

Her story is not uncommon.   She was cyberbullied by a fellow classmate and friend who raped her and then bragged about it on social media.  She was ostracized by peers and the bullying was relentless. Attempts to bring the situation to justice were stonewalled by law officials and school administrators.  Her family got her psychiatric help, but the high school peer pressure was overwhelming.  Tragically, her only escape was to take her own life. 

Her parents have successfully lobbied for anti cyber bullying laws in Maryland where they live. They have established a foundation, G.R.A.C.E. in her honor.  Giving Respect and Compassion to Everyone.  Hopefully this law and similar laws in other states will allow such situations to be brought to justice.  Hopefully this program will bring attention to the toxic environment in which we are raising our children.  But none of this will bring Grace back.  And there is a giant hole in the hearts of her family, friends and community.

In 2016, suicide was the second leading cause of death among both 10-14 years old (436) and 15-24 years old (5,723) according to the Center for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control.

We have an epidemic of anxiety and depression in our youth.  I wish we had a vaccination for it!  I see more troubled teens today than ear infections and this is a dramatic change during my career.  There are many factors, but I believe these are the most common, based on talking to these kids.  All of these kids are amazing, talented, gifted, bright with so much to offer the world, yet they don’t see their worth.  Why?

  • Our society is fixated on achievement and loses sight of the importance of what we do with our gifts and talents.  Only one person can be #1.  Does that make everyone else a failure.  Of course not, but that is the message our kids are getting.
  • Our society is fixated on perfection.  If this is our aim, we fail every day.  Mistakes, imperfections, changes in direction – this is how we learn and grow.  It is ok.
  • I’m calling out parents, here (myself included).  We try to shelter our kids from disappointment.  In doing so we deprive them of the ability to solve their own problems and realize that life goes on.  We send them a message that they can’t handle the bumps in life and so they don’t. 
  • Another thing we do is fail to “own” our own imperfections.  Point them out to your kids.  Let them see you as less than perfect, but willing to pick yourself up, dust yourself off and start all over again.
  • The fixation on achievement (see above) leads to terrible self care, sacrificing nutrition, exercise, sleep and peace in the pursuit of heaven knows what.  More items on the resume.
  • Social media and media in general add a facet that we as parents didn’t have to deal with growing up.  There is no refuge.  Social media follows you into your bedroom.  It used to be when you got home you were safe from all that.  Kids are so vulnerable to feeling left out when others post on social media and they aren’t included.  They don’t understand that people only post the best stuff, not the mundane, ordinary stuff of day to day life or their struggles.  Sometimes it’s hard to see this as an adult.  Imagine your 16 year old self navigating this minefield.

What can we do as parents, friends, teachers, a community?

Remember:

  • Depression is treatable. Don’t let your teen’s depression or anxiety snowball. Talk with your teen about his or her feelings and contact your pediatrician to find solutions.
  • It's important for parents to learn about the factors that can put a teen at risk for suicide. The more you know, the better you'll be prepared for understanding what can put your child at risk. 
    • Major loss (i.e., break up or death)
    • Substance use
    • Peer or social pressure
    • Access to weapons
    • Public humiliation
    • Severe chronic pain
    • Chronic medical condition
    • Impulsiveness/aggressiveness
    • Family history of suicide

If your instinct tells you that a teenager might be a danger to himself, heed your instincts and don't allow him to be left alone. In this situation, it is better to overreact than to underreact. See How to Communicate With and Listen to Your Teen.  

Never shrug off threats of suicide as typical teenage melodrama.

Any written or verbal statement of "I want to die" or "I don't care anymore" should be treated seriously. Often, children who attempt suicide had been telling their parents repeatedly that they intended to kill themselves. Most research supports that people who openly threaten suicide don't really intend to take their own lives; and that the threat is a desperate plea for help. While that is true much of the time, what mother or father would want to risk being wrong?

Any of these other red flags warrants your immediate attention and action by seeking professional help right away:

  • "Nothing matters."
  • "I wonder how many people would come to my funeral?"
  • "Sometimes I wish I could just go to sleep and never wake up."
  • "Everyone would be better off without me."
  • "You won't have to worry about me much longer."

When a teenager starts dropping comments like the ones above or comes right out and admits to feeling suicidal, try not to react with shock ("What are you, crazy?!") or scorn ("That's a ridiculous thing to say!"). Above all, don't tell him or her, "You don't mean that!." Be willing to listen nonjudgmentally to what he or she is really saying, which is: "I need your love and attention because I'm in tremendous pain, and I can't seem to stop it on my own."

To see your child so troubled is hard for any parent. Nevertheless, the immediate focus has to be on consoling; you'll tend to your feelings later. In a calm voice, you might say,"I see. You must really, really be hurting inside."‚Äč

Seek professional help right away.

If your teenager's behavior has you concerned, don't wait to contact your pediatrician. Contact a local mental health provider who works with children to have your child or youth evaluated as soon as possible so that your son or daughter can start therapy or counseling if he or she is not in danger of self-harm.  However, call your local mental health crisis support team or go to your local emergency room if you think your child is actively suicidal and in danger of self-harm.

Share your feelings.

Let your teen know he or she is not alone and that everyone feels sad or depressed or anxious now and then, including moms and dads. Without minimizing his anguish, be reassuring that these bad times won't last forever. Things truly will get better and you will help get your child through counseling and other treatment to help make things better for him or her..

Encourage your teen not isolate himself or herself from family and friends.

It's usually better to be around other people than to be alone. But don't push if he says no.

Recommend prayer and support from your faith family.

If your faith life is important to you and your child, this is an amazing gift.  You can remind your child that no matter the circumstance, God is in control.  God can bring meaning out of any circumstance and is always merciful and forgiving.  Encourage your son or daughter to dive deeper into his or her faith life to fill the holes that can never be achieved by the pursuit of worldly success.

Recommend exercise.

Physical activity as simple as walking or as vigorous as pumping iron can put the brakes on mild to moderate depression.

Urge your teen not to demand too much of himself or herself.

Until therapy begins to take effect, this is probably not the time to assume responsibilities that could prove overwhelming. Suggest that he or she divide large tasks into smaller, more manageable ones whenever possible and participate in favorite, low-stress activities. The goal is to rebuild confidence and self-esteem.

Remind your teen who is undergoing treatment not to expect immediate results.

Talk therapy and/or medication usually take time to improve mood. Your child shouldn't become discouraged if he or she doesn't feel better right away.

If you keep guns at home, store them safely or move all firearms elsewhere until the crisis has passed.

  • Fact: Suicide by firearm among American youth topped a 12-year high in 2013, with most of the deaths involving a gun belonging to a family member, according to a report from the Brady Center to Prevent Gun Violence. Any of these deaths may have been prevented if a gun wasn't available.

If you suspect your child might be suicidal, it is extremely important to keep all firearms, alcohol, and medications under lock and key.

 

We are here to help.  Please contact us if you have concerns about your child’s mental health.  We screen for depression at your annual well check, but that is only once a year.  The dialogue must be ongoing.

I want to prevent tragedies such as what happened to my friend and her beautiful daughter, Grace.


Additional Information:

 

Where to Take Your Child for Medical Care

Life is busy and having a sick or injured child on top of everything else can be really overwhelming. Many parents aren’t exactly sure where to take their little one for medical care. It can be really confusing with all the different options available these days. Well, we are here to help! Here are some tips to help you decide.

When should I take my child to the PEDIATRICIAN?

One of our friendly providers at Johns Creek Pediatrics would love to see your child for their well checks and medical conditions that are not emergencies. So, what are medical conditions that aren’t considered emergencies you ask... well here are a few examples: coughs, colds, ear aches, foreign objects in ears and noses, pink eye, and sore throats. Click here to see all the services we provide.  If there is something else and you are not sure if it is something we will treat, just call us and we will let you know! We want you to think of us first, we are your medical home! We are open 7:30 am to 6 pm Monday- Thursday, 7:30 to 5 pm on Fridays, and 9 am to 11:30 am on Saturdays. Did you know we offer walk in visits, same day appointments, and telemedicine?

When should I take my child to an URGENT CARE CENTER?

We recommend going to an urgent care center if we are not open and your child has a non-emergency medical condition that you think may worsen if they are not seen before our office will be open next. If it is something that can wait, we prefer you come in to our office because we know your child best!

If you decide to go to an urgent care center, we recommend going to one of the local Children’s Healthcare of Atlanta urgent care centers. Children’s has a helpful app you can download that shows all of its locations and provides wait times- here is a link to download the app for iOS or android.

When should I take my child to the EMERGENCY DEPARTMENT?

Your child should go to the ER if they are experiencing an emergency. Some examples of emergencies include: difficulty breathing, fever of >100.4 F in a child younger than 2 months old, loss of consciousness, seizure, or severe bone fracture.

Just thinking about having to take your child to an ER can be scary. But one thing that can help you breathe a little easier is to remember that luckily there are 3 pediatric ERs in Atlanta designed just for kids. We recommend your child go to one of the Children’s Healthcare of Atlanta Emergency Departments where there are health care providers who are specifically trained to treat pediatric patients.

When should I call 911?

Hopefully you will never have to call 911 for your child but just in case…we recommend you call 911 any time you believe a child needs immediate medical treatment. A list of some examples include: severe difficulty breathing, skin or lips that look blue, seizure, unresponsiveness, or a severe stiff neck accompanied by headache and fever.

If you aren’t sure if it is an emergency or not please call us at 770-814-1160, even if we aren’t open. We always have someone on call you can speak with to help you determine if you need to call 911, go the emergency department, urgent care, or come in to your friends at Johns Creek Pediatrics.

 

American Academy of Pediatrics. (2017, April 24). Is It A Medical Emergency or Not? Retrieved from https://www.healthychildren.org/English/family-life/health-management/Pages/Is-It-a-Medical-Emergency-or-Not.aspx

First Aid for Families. (2018, May 2). When to Call Emergency Medical Services (EMS). Retrieved from https://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/When-to-Call-Emergency-Medical-Services-EMS.aspx

 





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