Vonnegut Art with Henry Ward Beecher Quote
Dr. Vonnegut Gets His Flu Shot

After The Shots…

What To Do If Your Child Experiences Discomfort

Your child may need extra love and care after getting immunized.  Many of the shots that protect children from serious diseases can also cause discomfort for a while.  Here are answers to questions that many parents have about fussiness, fever, and pain their children may experience after they have been immunized. If you don’t find the answers to your questions, call our office at 617-745-0050.

Call the Office Immediately if You Answer Yes to Any of These Questions:

  • Does your child have a rectal temp of 105 degrees or higher?
  • Is your child pale or limp?
  • Has your child been crying for over 3 hours and just wont quit?
  • Does your child have a strange cry that isn’t normal (a high pitched cry)?
  • Is your child’s body shaking, twitching, or jerking?

Actions to Take to Reduce Fever:

  • Give your child plenty to drink.
  • Clothe your child lightly. Do not cover or wrap your child.
  • Give your child Tylenol or Motrin. DO NOT USE ASPIRIN.
  • Sponge your child in a few inches of lukewarm (not cold) bath water.

FAQs

My child has been fussy since being immunized. What should I do?

After immunization, children may be fussy due to pain and/or fever.  You may want to give your child some Tylenol or Motrin.  DO NOT GIVE ASPIRIN.  If you have questions on dosing please refer to the dosing chart on the on the side of the medication box (according to weight) or see the chart on the other side of this handout, or call the office.  If the fussiness lasts more than 24 hours you should call MVPediatrics.

My child’s arm (or leg) is swollen, hot, and red. What should I do?

A clean, cool washcloth may be applied over the sore area as needed for comfort. If there is increasing redness or tenderness after 24 hours, call the office.

I think my child has a fever, what should I do?

Check your child’s temperature to find out if there is a fever. The most accurate way to do this is by taking a rectal temperature (be sure to use a lubricant such as petroleum jelly when doing so). A fever is anything over 100.4 degree’s try treating the fever with Tylenol or Motrin. If the fever does not go down or was initially over 105 degrees or the child is under 3 months old and the temperature is over 100 degrees call our office. If you take the temperature by mouth (for an older child) or under the arm, these temperatures are generally lower and may be less accurate. Call the office if you are concerned about these temperatures.

My child seems really sick. Should I call the doctor?

If you are at all worried about how your child looks or feels, please call us.

mom and patient in waiting room
"info"
Request a Referral

Many health insurance plans, especially managed plans like HMO’s, require you to receive approval from your pediatrician (PCP) before you take your child to a specialist. You then must obtain a referral number.

Please be aware that insurance companies can deny payment for services even if you have a referral. You must call your insurance company directly about which services may not be covered.

If your insurance is the “managed” type (if you don’t know, call your insurance company), please follow these steps:

Step 1: Verify with your company that you need a referral. Even if your insurance is managed, you may not need a referral for some services. Example: most companies do not require a referral for annual or biannual eye exams or for laboratory tests. Most companies have PPO plans that do not require referrals. Check with your company before you begin the referral process.

Step 2: Speak with your pediatrician or nurse practitioner about the need for a referral and receive medical approval for that referral. Although you no longer need a referral for emergency room visits, it is wise to call first because your pediatrician or nurse practitioner can often expedite your emergency room visit if one is necessary.

Step 3: Make an appointment with the specialist whom your provider has referred you to. When you call the specialist, be sure to ask for the specialist’s provider ID number for the type of insurance that you have and the specialist’s NPI (National Provider Identifier) number. At that time, please confirm that the specialist is a member of your health insurance network; otherwise you may be subject to “out of network” costs.

Step 4: Inform our Referral Coordinator of the information necessary to process your referral paperwork. Please call the office at 617-745-0050 and give us the following information:

  1. Your full name
  2. Your child’s name, date of birth, insurance information, and PCP
  3. Your address and telephone number
  4. Specialist’s name, address, tel. #, and N.P.I. (National Provider Identifier) number if possible
  5. Date of Appointment and Reason for Appointment

Please note: It takes approximately 5 business days to process your referral.

In addition to calling the office for refills and referrals parents can also use your Patient Portal to request these services.

Medical Home Hub

Patient Centered Medical Home (PCMH) is a team-based health care delivery model which is led by the physician and provides comprehensive and continuous medical care to patients and families. This model may allow better access to health care, increase satisfaction with this care and improve patient health.

Our PCMH Care Coordinator is your in-office representative and primary contact for resource information and assistance with coordination of care.

Direct patient and family benefits from the PCMH model:

  • Increased Information, communication, and education.
  • Patients and families receive timely, complete and accurate information in order to participate in and facilitate decision making.
  • Respect for patient and family values, preferences and expressed needs.
  • Emotional support and alleviation of fear and anxiety.
  • Involvement of patient family and friends.
  • Continuity and transition; smooth information transfer across team of providers and specialists.
  • Coordination and integration of care.
  • Work with our medical team to set self goals, get help managing chronic conditions and get information on self care.
  • An opportunity for ongoing feedback to our practice.
  • Examples of Conditions supported by PCMH:

MV Pediatrics offers resources that target conditions such as:

Asthma http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/
ADD/ADHD http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
Interpersonal communication and social skills Skills For Living
Mood and anxiety support grouphttp://www.nmha.org/go/mood-disorders
Obesity http://www.cdc.gov/healthyyouth/obesity/facts.htm
We also provide reading lists for the families of children with special needs and resources for the deaf and hard of hearing.

Joan Lewis, RN, our Medical Home Care Coordinator, can be reached by calling our main number, 617-745-0050 or by using our secure patient portal.  Joan is in the office Monday through Thursday. Please feel free to call or email with any questions you may have regarding this service.

Additional PCMH references:

  • The American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA), representing approximately 333,000 physicians, have developed the following joint principles to describe the characteristics of the PCMH.

Principles:

  • Personal physician– each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
  • Physician directed medical practice -the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
  • Whole person orientation -the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.
  • Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.

Quality and safety are hallmarks of the medical home:

  • Practices advocate for their patients to support the attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.
  • Evidence-based medicine and clinical decision-support tools guide decision making
  • Physicians in the practice accept accountability for continuous quality improvement through voluntary engagement in performance measurement and improvement.
  • Patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met
  • Information technology is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication.
  • Practices go through a voluntary recognition process by an appropriate non-governmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.
  • Patients and families participate in quality improvement activities at the practice level.

 

Request a Prescription Refill

The most direct way to request a refill for your child is via the secure Patient Portal.  Alternatively, you may also call the office directly and ask to leave a message on the Rx Refill line.  The main number to our office is 617-745-0050.

When calling in a refill please:

  • Speak slowly and clearly.
  • Tell  us the patient name and date of birth.
  • Provide the best phone number to reach you.
  • Provide the prescription name and dosage.
  • Provide the name of your pharmacy or if you will be picking the hard copy up here in the office.
  • The prescription line is checked twice daily.  Messages left after 3pm will be picked-up the following business day. Please allow for 24 hours before contacting your pharmacy.
  • We will call you only if there is a problem with the prescription.
Mother duck and her ducklings

Advice for Common Pediatric Aliments

Asthma

REDUCING ASTHMA TRIGGERS IN YOUR HOME:
There are many things in every home that can cause an asthma attack or make asthma worse. These are called triggers. Below is a list of common triggers. Make changes based on your child’s specific allergies or triggers for asthma attacks

COMMON TRIGGERS OF ASTHMA ATTACKS

  • House dust mites: Many people are allergic to dust mites. Dust mites are tiny bugs that you cannot see. They live in cloth and carpet. Follow the guidelines below to help reduce the number of dust mites your child may encounter in your home.
    • Put your child’s mattress, pillow and box springs in plastic or vinyl covers that close with a zipper.
    • Remove stuffed animals or toys from your child’s bed.
    • Wash all blankets and bedding once a week in hot water; wipe off once a week then change bedding.
    • Wipe off furniture and items near your child’s bed once a week with a damp cloth.
    • Do not dust or vacuum while your child is in the room.
    • Remove carpeting if possible, especially from your child’s sleeping area and play area.
  • Tobacco Smoke:
    •  If you smoke, ask your child’s doctor for ways to help you quit. Ask other family members to stop smoking also.
    • If you have to smoke, wear a specific coat or “duster” when outside to smoke. Remove when entering the home.
    • Do not allow smoking in your home, car or around your child.
    • Be sure no one smokes at your child’s day care center.
  • Indoor & Outdoor Pollen and Mold: 
    • Use half-strength bleach or mold-killing solution to clean bathrooms, kitchens and basements.
    • Ensure shower curtains, refrigerator doors, bathtub and window corners are free of mildew or mold growth.
    • Use air conditioning and keep windows closed, if possible.
    • Use a dehumidifier, if available. Empty the pan daily.
    • Do not use vaporizers.
    • Avoid houseplants. If you have them, change the soil frequently.
    • Do not mow grass or rake the leaves around your child.
    • Repair leaky faucets and pipes or other water leaks.
    • Monitor the pollen count and have your child stay indoors mid-day when the pollen count is high.
  • Pets:
    • Remove the pet from the child’s room at all times.
    • Take asthma medications if you cannot avoid visits to family and friends with pets.
    • Wash your pet every week.
    • Choose a pet without fur or feathers.
  • Cockroaches:
    • Keep counters and floors free of food crumbs and keep food and trash in closed containers.
    • Avoid clutter such as piles of papers where cockroaches can hide.
    • Do not use pesticide sprays, foggers or bombs.
    • Use bug spray when your child is out of the house and completely air out the house before he or she returns.
    • Use roach traps in areas that children cannot reach.
  • Strong Odors and Sprays:
    • Avoid burning wood, incense and scented candles.
    • Avoid strong odors such as perfume, hairspray, paints and cleaning products.
  • Exercise, Sports, Work, and Play:
    • Your child should be able to be active without symptoms
    • Ask the doctor about giving your child medicine before exercise to prevent symptoms.
    • Have your child avoid hard work or play outside when pollution or pollen levels are high.
  • Other Triggers:
    • Colds / the flu. Have your child get a flu shot each fall.
    • Food allergies. Avoid foods your child does not tolerate.
    • Cold air. Have your child cover his or her nose and mouth with a scarf on cold or windy days.
    • Other medicines. Tell your child’s doctor about all the medicines your child takes.
    • Emotional / stress. Stressful situations that lead to changes in breathing can make asthma worse.

RESULTS OF REDUCING ASTHMA:
Asthma is better controlled.
Fewer asthma attacks.
Less need for wheezing medications.
Happier, more active children!

 

Diaper Rash
Diaper Rash

Diaper rash is usually caused by irritation of a baby’s skin that is exposed to urine, bowel movements, diaper irritants and infections.
Diaper rash will usually increase between 7 and 9 months when a more varied diet can cause more irritating stools. (This is the period when your baby is trying different foods.) Your baby may also develop a diaper rash after taking antibiotics. This kind of diaper rash may be caused by a yeast infection and will not get better without medicated ointment your child’s doctor can order.

Rarely diaper irritants can cause a rash that may heal if a different brand of diaper is used.

Solutions for Diaper Rash:
  • The best way to treat diaper rash is to prevent it, but this isn’t always possible. It is very important to keep the diaper area dry and clean. If the diaper rash continues even after you have tried the following suggestions, call your child’s doctor for advice.
  • To decrease wetness on baby’s skin, change the diaper often when the baby is awake. Babies usually have 6-8 wet diapers every 24 hours.
  • If your baby has a diaper rash, it may be helpful to remove the diaper and allow the bottom to be open to the air. Place your baby on a couple of cloth diapers or receiving blankets over a plastic sheet. If it is cool weather, keep the room as warm as possible. Don’t use ointment on the skin while the diaper is off.
  • Use soap only once a day. Soap can dry and irritate the skin. Be sure to use a gentle soap. If your baby has a very messy stool, it may be better to clean the baby in the tub or sink. Be sure to gently pat the area dry. Rubbing/ lateral friction can make a rash worse.
  • Use baby wipes that are moisturizing. They may contain alcohol which is very drying. If the brand you are using causes a problem, switch to another. Do not use diaper wipes until the rash has cleared, try using water, or mineral oil on a cotton ball.
  • Use a thick, protective layer of ointment (A&D, Desitin, zinc oxide, Balmex, Eucerin or a brand recommended by your child’s doctor) on your baby’s bottom to help protect the skin. Use only medications and ointments that your child’s doctor recommends for your baby.
  • Don’t use talcum powder. It may absorb moisture, but it can be inhaled by your baby and cause irritation to breathing passages. Cornstarch is a safer and more effective substitute.

Call Your Child’s Doctor:
If your baby’s diaper rash does not clear up within 1-2 days, or if blisters or raised areas appear.

Vomiting
Vomiting

Vomiting is common in children. Often vomiting occurs along with diarrhea and is caused by a virus. Other infections, viral infections and even extreme coughing or excitement may also cause vomiting. Gastroesophageal reflux can also cause vomiting.Vomiting can cause dehydration or “drying out,” which can be very serious. Dehydration happens when your child loses too much liquid.

Signs and symptoms of dehydration

Early Signs:
Call your child’s doctor immediately if your child shows any of these signs. Do not wait for the later signs of dehydration.

  • Child has not urinated in 6 hours (babies usually have 6-8 wet diapers in 24 hours).
  • Child is less active than normal or is unusually sleepy.
  • Child’s urine is dark yellow and may smell strong like ammonia.
  • Child’s mouth is dry and sticky.

Later Signs:

  • Child’s eyes are sunken.
  • Child has no energy and is difficult to wake up.
  • Child has a fever.

CALL YOUR CHILD’S DOCTOR IF:

  • Your child shows any signs of dehydration.
  • Your child has green or bloody vomit.
  • Your child experiences severe stomach pain (babies may be very irritable and cry a lot).
  • Vomiting lasts more than 6 hours.

LIQUIDS TO TRY IN SMALL AMOUNTS:
INFANTS:

  • Breast milk
  • Infalyte (do not add water to dilute)
  • Pedialyte (do not add water to dilute)
  • Formula

OLDER CHILDREN:

  • Gatorade (Check with your child’s doctor about other sports drinks. They may not be right for your child.)
  • Caffeine-free tea
  • Popsicles — regular or Pedialyte

HOW TO GIVE LIQUIDS TO YOUR CHILD:

INFANTS:
Breastfeed more often and for a shorter amount of time. For example, breastfeed every half hour for 10 minutes on one breast. After 2 or 3 hours, if this is tolerated well, return to your normal breastfeeding schedule. If you are bottle feeding, start with Pedialyte or Infalyte. Give 1 ounce every half hour for 2 or 3 hours. If the baby takes this well, return to normal feedings with regular strength formula, giving only a tablespoon at a time. If the infant does not have vomiting after 8 hours, you can try to resume his / her normal formula feeding routine.

If vomiting continues, offer 2 or 3 ounces of Pedialyte or Infalyte after each time the baby vomits. Continue feedings with regular formula or breast milk.

OLDER CHILDREN:

Give liquids in small amounts and frequently. For example, give 1 or 2 ounces every half hour. If your child takes this well, increase the amount a little every half hour. If your child vomits, decrease the amount of liquid for the next feeding and then try to slowly increase the amount again with every feeding after that. Slowly advance the diet to a regular diet. Greasy foods and foods high in sugar should be added slowly because they may increase vomiting.

FOODS TO START WITH:

Rice
Plain crackers
Chicken
Noodles
Potatoes
Bananas
Applesauce
Foods to Avoid Until the Vomiting Ends
Fruit juice
Kool-Aid
Dairy products
Fried food

Do not use any medication for your baby or child unless your child’s doctor tells you to give it. Medications that are good for adults or older children can be dangerous for babies or small children.

Lice!
Frequently Asked Questions About Head Lice

What is Pediculosis?
Pediculosis or head lice are tiny, wingless bugs about the size of a sesame seed or smaller. They have six legs with tiny claws and live only on human scalps. Head lice can range in color from light brown to gray. While annoying, head lice are not life threatening.

How widespread are head lice?
It is difficult to track head lice cases because head lice are not considered a disease and therefore public health departments and the Centers For Disease Control do not routinely track the number of head lice cases. However, schools and manufacturers of lice products estimate head lice cases at 12- 25 million infestations a year in the United States alone. Most of those infested are children under the age of twelve.

Head lice have been infesting humans since the cave days.

How do you get head lice?
Head lice do not hop, jump or fly. They migrate through direct contact with an infested person and their belongings. Pets do not transmit head lice, and poor personal hygiene does not cause an infestation. In fact, head lice prefer clean, healthy heads. Head lice do not live in, nor spontaneously generate from, the dirt, trees or the air. They live on the human head!

What are the symptoms of head lice?
The most common symptom of a head lice infestation is persistent itching, particularly around the ears, back of the neck and crown, but some people never itch at all. Repeat infestations can cause some individuals to become super-sensitive to bites. Secondary bacterial infections can occur with excessive scratching. See a doctor if this occurs.

Diagnosis of head lice is usually made by finding nits (lice eggs). Nits are tiny, whitish, oval eggs firmly attached to one side of the hair shaft at an angle. Viable nits are usually, but not always, found within a half-inch of the scalp.

Hint – if you can blow or flick it off, or if it crumbles in your fingers, it is not a nit.

How do you treat for head lice?
Getting rid of head lice is a three-step process. You must kill all the live lice, check for and remove all the nits by combing and manual nit picking, and do a reasonable job of cleaning the infested person’s belongings and home environment.

Please make sure you have head lice before treatment. Many people misdiagnose head lice and treat themselves or their children with chemicals unnecessarily.

What are Pediculicides?
Pediculicides are the pesticides used to eliminate head lice. Familiar over-the-counter brand names include: Rid, Nix, Pronto and Clear. These products contain insecticides (pyrethrin or permethrin) and should always be used with caution. Check with your pharmacist or doctor to determine which product is safe for your family. Never use these products if you are pregnant or nursing, or on infants under 6 months of age. Follow the directions exactly when using them.

Misuse of these products i.e., leaving them on longer than the directions state or applying more treatments than specified by the manufacturer, puts children at risk for overexposure to chemical pesticides. Also, children with allergies may be at more risk for allergic reactions to pesticides.

A prescription medication called Kwell should never be used. Kwell contains Lindane, a powerful neurotoxin and possibly carcinogenic pesticide, which can cause serious side effects including seizures and even death. Consumer Reports has petitioned the Food and Drug Administration to remove this pesticide from the market. Children and the elderly are particularly vulnerable to Lindane toxicity.

Are head lice becoming drug-resistant?
People should also be aware that according to entomologists, any insect over time can develop resistance to pesticides. It is not surprising therefore, that many consumers, health professionals and entomologists report that head lice have become resistant to pediculicides. However, failure to follow directions, non-compliance and failure to pick nits manually can also result in a persistent head lice infestation. Predictably, consumers are frustrated and confused as to how to proceed.

What should I do if I have used pediculicides and still have head lice?
If you have used a pediculicide correctly and still have live lice or new nits, you probably have a persistent case of head lice. According to the Palm Beach County Head Lice Task Force and the Head Lice Treatment and Prevention Project at Florida Atlantic University College of Nursing, persistent head lice is defined as three incidents of live lice found over a 6-week period.

If you have head lice that have resisted treatment, do not continue to use additional chemical treatments in the hopes that they will work. They will not, and such chemical treatments were never meant to be used repeatedly.

Instead try a treatment program called Head Lice to Dead Lice . This pesticide-free treatment has proved extremely successful in eliminating persistent head lice infestations. The Five-Step Battle Pan outlined in both the video and book incorporates the use of olive oil as a smothering agent. The smothering program is non-toxic and has a high success rate when followed as directed.

Lice breathe through holes in their sides. When you cover these holes with olive oil, the lice will die. However, it takes awhile for them to die, because head lice can shut down their systems for hours. That’s why you need to know exactly how and when to use a smothering program.

Why is manual nitpicking so important?
Every successful lice removal program must include manual nit picking. Even if you treat with chemicals and/or olive oil you must also incorporate manual nit picking into your treatment program because nothing has proved successful in killing nits.

Lice lay their eggs close to the scalp. It used to be thought that eggs further than 1/2 inch from the scalp were not viable. However, new research indicates that this is not true, especially during warm weather. Therefore, removing all the nits is the only sure way to get an infestation under control.

Getting rid of head lice requires perseverance.

What are DEC plugs?
Skin can become irritated after using a pediculicide. This can result in the formation of desquamated epithelial cell plugs (DEC) which people often mistake for nits. This causes many caregivers to overtreat with chemicals thus continuing the cycle. If you are not sure if you are seeing nits, take a suspected nit on a hair shaft to your doctor and have him confirm the diagnosis by looking at the suspected nit under a microscope.

What if you can’t see the nits to pick them out?
Check for and remove nits in bright light – daylight is best. Sit near a window and shine a bright light on the infested person’s head. If you have poor eyesight, get someone to help you or purchase a blue vision visor which magnifies nits 2 1/2 times at a distance of 8″.

Can you use mayonnaise, butter or vaseline to smother head lice?
Like olive oil, mayonnaise, butter and vaseline are smothering agents. However, unlike olive oil, these substances are difficult to get out of the hair, particularly in the case of vaseline. Children are often repelled by the smell of butter and mayonnaise and both these substances can turn rancid, and cause problems if children suck on their hair.

Mineral oil (including baby oil) is not recommended because it can be harmful to mucous membranes.

Olive Oil is the best smothering agent. It has been lab-tested and found to be effective in killing head lice. Olive oil has few, if any, allergic properties and is relatively inexpensive. The least expensive grade – pumace or restaurant grade – is best. And olive oil can be purchased with food stamps. Smothering head lice is a safe and effective treatment option, but it can be somewhat complicated. To smother successfully, you have to be persistent and know when and how to apply the smothering agent.

How do you clean the home environment?
Some entomologists believe that you do not have to clean the home environment at all because head lice die very quickly once they are off the human head (36-48 hours), are very slow moving off the head, and nits need a human blood meal within 45 minutes of hatching to survive. That said, most people are not comfortable unless they do some cleaning of the home environment. The PVP cleaning program (personal items first, vacuuming, etc.) outlined in Head Lice to Dead Lice is a simple and reasonable cleaning program that should eliminate any lice in the home. If you find yourself obsessing about housecleaning, you need to take a deep breath and refocus your energies back to the infested person’s head.

When is it safe to send a child back to school?
Most schools have a no-nit policy to control head lice outbreaks. Generally, when you have completed one pediculicidal treatment & one olive oil treatment (or two olive oil treatments) and a thorough nit combing and manually removed all nits, you can send your child back to school. At this point, there should be nothing left on the head that is capable of moving onto another head.

However, this does not mean your child is lice free. You must continue to check for lice, do the olive oil on specified days and manually remove nits.

Remember, the olive oil treatment program is a twenty-one day program based on the life cycle of the louse. As long as you continue to treat with olive oil on the designated treatment days, your child should not infest anyone else.

If you choose to use only pediculicides, be aware that these treatments are not 100% effective and head lice have developed resistance to many current treatments.

Can you get head lice from a swimming pool ?
Extremely unlikely because head lice shut down in water.

Can heat kill lice?
Yes, lice hate dry heat. You can put clothes, hats, towels, etc in a hot dryer for twenty minutes which should kill lice and their eggs.
Copyright © 2000 Headliceinfo.com

traveling with children
Rolling Suitcase

Travel With Children

Traveling with an Ear Infection
By Mark Vonnegut, M.D.

Is it safe to travel with a baby or child who has an ear infection?

Absolutely! The pain from a middle ear infection is as bad as it’s going to be right at the outset, which is why kids often wake up screaming. The middle ear is a very small space, mostly surrounded by bone and drained by the Eustachian tube. As long as the Eustachian tube is open, secretions are drained and pressure with the outside world is equalized and there is no pain.

Small people have small Eustachian tubes. It doesn’t take much to stuff them up and turn that small space into a small closed space. A few otherwise harmless bacteria multiplying in that closed space cause irritation and inflammation, setting off an immune response that makes for more pressure and inflammation that further compromises the Eustachian tube. The exquisitely sensitive tympanic membrane is the only way out. A screaming child with a bulging red tympanic membrane makes my job easy and can be a welcome change from all the times babies and children are up at night without such a clear excuse.

You don’t have to change your travel plans just because your child has an ear infection. You can take or not take antibiotics anywhere and recover from an ear infection. Children, with their small Eustachian tubes, are more likely to be uncomfortable with elevators or taking off and landing in an airplane (landing is worse), but there’s nothing about having an ear infection that would make it any more painful. Children are actually more likely to complain about the middle ear popping in the uninfected ear.

Many pediatricians believe that treating ear infections with antibiotics has at least as many disadvantages as advantages. As the eardrum stretches out, the pain is often already getting better by the time you see the doctor. Antibiotics take at least 12 hours to kick in and rarely affect the acute discomfort. Ibuprofen, acetaminophen, warm olive oil and distraction are all much more effective treatments for the acute pain than antibiotics.

But what about the fever, cough, hearing and generally feeling lousy? What about recurrent or chronic ear infections? What if the eardrum ruptures?

The fever, cough and feeling lousy are either coming from the viral infection that blocked up the Eustachian tube in the first place or the pressure in the middle ear, neither of which are going to be changed by antibiotics. The eardrum rupturing relieves the pressure in the middle ear and makes the child feel much better and much faster than anything else and 99/100 times ruptured eardrums fix themselves once the acute infection has burned itself out.

If you are traveling and your child comes down with an ear infection, call your pediatrician back home. It costs a lot less than an ER visit and an ER visit will usually get you a “one size fits all” antibiotic treatment. Your own doctor can advise comfort measures, keep you out of the ER and check your child’s ears when you get back home. It takes about 10 seconds to diagnose an ear infection and treat it with antibiotics. Explaining why you don’t think antibiotics are necessary takes much longer. It’s unlikely an ER doctor you’re never going to see again has the time or inclination to make that kind of effort.

This article can also be found at:
The Boston Parents Paper

Traveling with Children by Air
  • Allow yourself and your family extra time to get through security, especially when traveling with younger children.
  • Talk to your children before coming to the airport about the security screening process. Let them know that their bags (backpack, dolls, etc.) will be put in the X-ray machine and will come out the other end and be returned to them.
  • Discuss the fact that it’s against the law to make threats such as; “I have a bomb in my bag.”  Threats made jokingly (even by a child) can result in the entire family being delayed and could result in fines.
  • Similar to travel in motor vehicles, a child is best protected on an airplane when properly restrained in a care safety seat appropriate for the age, weight and height of the child, meeting standards for aircraft until the child weighs more than 40 lbs. and can use the aircraft seat belt. You can also consider using a restraint made only for use on airplanes and approved by the FAA. Belt positioning booster seats cannot be used on airplanes, but they can be checked as luggage so you have them for use in rental cars and taxis.
  • Although the FAA allows children under age 2 to be held on an adult’s lap, the American Academy of Pediatrics (AAP) recommends that families explore options to ensure that each child has his own seat. Discounted fares may be available. If it is not feasible for you to purchase a ticket for a small child, try to select a flight that is likely to have empty seats.
  • Pack a bag of toys and snacks to keep your child occupied during the flight.
  • In order to decrease ear pain during descent, encourage your infant to nurse or suck on a bottle. Older children can try chewing gum, drinking water or juice through a straw, or filling up a glass of water and blowing bubbles through a straw (4 years of age or older).
  • Consult your pediatrician before flying with a newborn or infant who has chronic heart or lung problems or with upper or lower respiratory symptoms.
  • Consult your pediatrician if flying within two weeks of an episode of an ear infection or ear surgery.
  • We offer immunizations and travel consultations.
Traveling with Children by Car
  • Always use a car safety seat for infants and young children. A rear-facing car safety seat should be used until your child has reached the highest weight and/or height allowed by his car safety seat, but at a minimum until your child is at least one year of age AND weighs at least 20 pounds. It is best to ride rear-facing as long as possible. Once your child has outgrown the rear-facing height or weight limit, he can ride in a forward-facing car safety seat.
  • A child who has outgrown her care safety seat with a harness (she has reached the top weight or height allowed for her seat, her shoulders are above the top harness slots, or her ears have reached the top of the seat) should ride in a belt-positioned booster seat until the vehicle’s seat belt fits properly (usually when the child reaches about 4’9″ in height and is between 8 to 12 years of age).
  • All children under 13 years of age should ride in the rear seat of vehicles.
  • Never place a child in a rear-facing care safety seat in the front seat of a vehicle that has an airbag.
  • Set a good example by always wearing seatbelts.
  • Children can easily become restless or irritable when on a long road trip. Try to keep them occupied by pointing out interesting sights along the way and by bringing soft, lightweight toys and favorite CDs for a sing-along.
  • Plan to stop driving and give yourself and your child a break about every two hours.
  • Never leave your child alone in a car, even for a minute. Temperatures inside the car can reach deadly levels in minutes, and the child can die of heat stroke.
  • In addition to a traveler’s health kit, parents should carry safe water and snacks, child-safe hand wipes, diaper rash ointment, and water and insect-proof ground sheet for safe play outside.
International Travel with Children
International Travel
  • If traveling internationally, make sure your child is up to date on her vaccinations and check with your doctor to see if she might need additional vaccines.
  • In order to avoid jet lag, adjust your child’s sleep schedule 2-3 days before departure. After arrival, children should be encouraged to be active outside or in brightly lit areas during daylight hours to promote adjustment.
  • Conditions at hotels and other lodging may not be as safe as those in the United States. Carefully inspect for exposed wiring, pest poisons, paint chips or inadequate stairway or balcony railings.
  • When traveling, be aware that cribs or play yards provided by hotels may not meet all current safety standards. If you have any doubt about the safety of the crib or play yard, ask for a replacement or consider other options.
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Classes and Ongoing Events

Expectant Parents' Night

Our Next Expectant Parents’ Night is scheduled for Wednesday, March 8th from 5:30PM to 7PM

Light refreshments will be served. Please R.S.V.P. by completing the on-line registration form or calling 617-745-0050 to let us know you are coming.

Register Here!

What we cover during the class:

  • What to expect from the hospital
  • Breastfeeding is worth a try
  • Circumscision is optional
  • Our practice philosophies
  • Introduction to our providers
  • How the practice works
Sign Language for Your Baby

Beginning March 7th from 2-3pm, Sign Language Classes will be offered every other Tuesday for infants 6 months and older.

Please call 617-745-0050 to register for these free classes!

Behavioral Health Groups & Classes

Please call the office and ask to speak to someone from Behavioral Health regarding upcoming classes.

Art Room

Our art room is available for all children during our open hours. Parental supervision is required.  Come on in an make something!

Drop in For Art (Supervised Sessions)

Supervised “Drop in for Art” has concluded for Summer 2016. Check back with us over school vacation weeks for new sessions.

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