News to Use Summer 2015

Pediatric & Adolescent Associates 3050 Harrodsburg Rd 171 N Eagle Creek Dr Lexington, KY 40503 Lexington, KY 40509

Phone 859-277-6102 Fax 859-977-3033

In This Issue: *Trampoline Safety *Who Should I See? *Check-Ups *Allergies in Kids *Safe Sleeping *PAA Fun Facts *Car Safety Restraints *Booster Seats *PAA Physician Matching Game*

Trampoline Safety Trampolines were originally designed in 1945 as specialized training equipment for specific

sports. They have continued to become more popular over the years, being used in sports such as

gymnastics and tumbling and are used as part of the training for other sports like swimming,

diving and figure skating. With this increased popularity in the sports community, the trampoline

was accepted as an Olympic sport in 2000. Not only do these sports use different size, shape and

quality of competitive style trampolines, the appropriate coaching, structured training programs

and safety measures make this very different from trampoline use in a recreational setting such

as homes and trampoline parks.

Recreational use of trampolines has grown tremendously and due to the increasing rates of

trampoline use and injuries, The American Academy of Pediatrics (AAP) has released many

statements over the years (1977, 1981 and 1999) discouraging the use of recreational

trampolines. After the 1999 statement, the trampoline industry began to address the safety

concerns by implementing some safety standards. These standards included adding extra padding

to frames and springs; better quality padding; printed warnings that recommend adult

supervision, avoiding somersaults, restricting multiple users and limiting use to children 6yrs of

age and older. Studies on the efficacy of these safety measures were conducted and although

injury rates have been slowly decreasing since 2004, the potential for severe injury remains

relatively high, therefore the AAP released it’s most current recommendation in 2012, again

discouraging the use of recreational trampolines.

Injuries from recreational trampoline

use are most commonly caused by: Multiple, simultaneous jumpers

colliding with another person

somersaults, flips or attempting stunts

landing wrong while jumping

falling or jumping from the trampoline

falling on springs or frame of the trampoline

Several types of injuries can occur, even with adult

supervision, including: sprains, lacerations and contusions (bruises)

soft tissue injury

fractures (some requiring surgery)

dislocations

head and neck injury (can lead to permanent neurological damage)

spinal cord injuries (can be the most catastrophic)

Not only have home trampolines continued to be popular, there is now the ever growing number

of trampoline parks. While the American Academy of Pediatrics and the physicians of Pediatric

& Adolescent Associates strongly discourage the use of trampolines in the recreational setting,

some parents will choose to allow their children to participate in this activity. Data on the safety

of these parks are insufficient, at this time, and until further information is available, if parents

allow their children to take part, they should apply cautions with any recreational use of a

trampoline – at home or in any setting. Jump parks should inform parents and participants of the

risks involved and that jumpers may be at an increased risk of injury, potentially catastrophic;

homeowners should verify that their insurance polices cover trampoline-related injuries; always

restrict use to single jumpers; somersaults and flips should not be performed; there should always

be active adult supervision which means not only being present, but enforcing the rules and

guidelines.

We all want our children to be active, play with their friends and have fun, but safety

must always be a top priority. Talk to your child about trampoline safety and the possibility of

injuries. As parents, you should be aware when your children may have access to a trampoline at

a friend’s house and your child should understand any rules that you set for them.

Source: American Academy of Pediatrics Policy Statement, October 2012

An Urgent Treatment Center or your Pediatrician: Who should I see?

By: Dr. Katrina Hood, PAA Physician

You are at the local grocery store and your child says, “My ear hurts”. You notice that the store has an Urgent Treatment Center (UTC). So you have a choice of going in to see the practitioner in the UTC or calling your pediatrician for an appointment. When you have this choice, it is important to remember some other issues besides just convenience of the location in the store where you are. This is true of any visit to a UTC while you are within the vicinity of your pediatrician. When out of town, a UTC may be appropriate versus an ER visit.

One primary issue is who is staffing the UTC. Is this person a physician (MD – Medical Doctor or DO – Doctor of Osteopathic Medicine) or another practitioner? These different titles delineate the amount of training the individual has had. A pediatrician has had 3 years of pediatric training and 4 years of medical school. Few other practitioners have anywhere near this amount of training in taking care of children.

Another point to consider is access to your child’s records. At your pediatrician’s office, the doctor will be able to check the chart for allergies, frequency of infections, last medication, complications of prior medicines and other specifics related to your child.

Overall, your child will have more complete care at the pediatrician’s office. Even though convenience is a reason to consider, keep in mind what you will receive with the visit with your Pediatrician.

Check Up Season is Here! By:

Dr Katrina Hood, PAA Physician

It is check-up season for pediatricians across America! Summer is filled with few illnesses for us to see, but plenty of school and

sport physicals to be done. You may ask why we like to see kids for check-ups on a yearly basis. Primarily we like to see children

yearly to watch for trends of unhealthy behaviors. With 40% of kids being overweight, seeing them yearly allows us to track their progress and begin to make changes before a child’s

weight is hard to manage. We can also counsel parents and children about healthy habits. When we complete a sports physical we also perform a general check-up. This general check-

up allows us to discuss your child’s health in depth; such as diet, school performance, social activities, sports, etc. School systems require yearly sports physicals to make sure we screen

for changes in family history and problems a child may have during his/her sport. Our goal is to do our best to find preventable issues regarding your child’s heart, respiratory system and their

overall health. Please call and schedule your check-up today.

Health Requirements for School School Physicals: All students entering public school for the first time,

as well as kindergarten and sixth-grade students, are required to get

physicals and immunizations prior to starting classes. Children entering

childcare/daycare may also require these check-ups.

Sports Physicals: Middle and High School Students who wish to

participate on school athletic teams must have a valid Sports Physical

Certificate on file at their school. For more information on sports

physicals, visit the Kentucky High School Athletic Association website, www.khsaa.org .

*** Physicals are valid up to 1 year before the beginning of school or grade entry ***

Reminder about Physical Forms

If you have forms (school, camp, college, etc.) that need to be completed, please bring them with you to your check-up appointment. If you should lose the form and it needs to be completed again, there will be a $10 charge

for this. If you call for a form to be completed, you need to allow 2-3 days for this to be

done. Thank you.

You can find some of these forms on our website, www.paalex.com. If you complete your portion of the forms prior to your appointment, it may save you some time.

Allergies in Kids: What to Do? By:

Dr. Charles Ison, PAA Physician

Allergic rhinitis, sometimes called "hay fever," affects 15-25% of American

children and is probably the most common chronic disease in childhood.

Although it’s called "hay fever," allergic rhinitis is not caused by hay, nor is it

associated with a fever. Instead, it is an overreaction of the immune system to

substances (allergens) that are harmless to most people. The symptoms of

allergic rhinitis can be triggered by pollen (especially tree, grass and ragweed),

mold spores, dust mites, pet dander and cockroaches.

Symptoms include a clear runny nose, nasal

congestion, itchiness of the nose, postnasal

drip, sneezing and coughing. The eyes may be

red, itchy and have clear drainage.

Complications of allergic rhinitis include mouth

breathing – this can lead to long-term dental

and facial bone abnormal growth. Restless

sleep can lead to daytime fatigue. The ears can

be affected, which can lead to retained fluid in

the middle ears, raising the potential for ear

infections, hearing problems, and then

problems with speech in children.

The tendency to have allergies is often inherited. What a child is allergic to,

though, is usually not. Allergic rhinitis is diagnosed by history, physical exam and

sometimes by allergy skin testing. Specific allergies may be tested for in children

5 and older by putting diluted samples of suspected allergens on the skin that

has been scratched or pricked. Sometimes the allergen samples are injected into

the skin. A red, hive-like reaction is usually a positive sign for that particular

allergen.

Treatment consists of avoidance, medications and sometimes immunotherapy.

During the season, it is recommended to avoid the peak pollen and mold spore

time of 5-10 a.m. Staying indoors, using air conditioning and mattress covers,

and removing rugs and carpeting may help. Antihistamines by mouth or as nasal

sprays, or eye drops in children as young as 6 months may be used. Steroid nasal

sprays and oral leukotriene inhibitors can also be effective. If avoidance and

medications provide no relief, immunotherapy may be tried. Diluted mixtures of a

child’s offending allergens are injected into the skin in slowly increasing

concentrations over years. This trains the immune system to eventually become

tolerant of (and not react to) these allergens.

**This article can be found in the Lexington Family Magazine**

Safe Sleeping

Starting in 1992, infant supine sleep (lying on their back) has been the recommended sleep position to help with the prevention of SIDS (Sudden Infant Death Syndrome) and since that time, the incidence of SIDS has decreased by about 50%. While the cause of SIDS still remains unknown, many studies over the years have found other causes for infant sleep-related deaths such as suffocation, asphyxiation, and entrapment have increased in incidence since 2005. Therefore, new recommendations have been added to the existing ones, which primarily focused on “back to sleep”, to include more ways to provide an overall safe sleeping environment for all infants under 1year old.

The current safe sleeping recommendations include:

Breastfeed if possible

Infants should be immunized

The baby should sleep in the same room as the parents, but not in the same bed

Supine position (flat on their back) o No side positioning – this is an unstable position and the infant could easily

roll to the prone position (their stomach) o No elevated supine positioning, even if a baby has reflux or congestion and

neither wedges nor positioners should be used. This position has not been proven to help reflux or congestion and it can result in the baby sliding down the crib into a position that may compromise respiration

Make sure baby’s head and face are not covered

Use of a firm sleep surface– car seats and other sitting devices such as swings and infant seats are not recommended for sleep.

Avoid soft bedding – no bumper pads, stuffed animals, pillows or comforter-type blankets in the crib with the infant

Avoid overheating – infant should sleep in a cool, well ventilated room

Consider pacifier use

Avoid exposure to tobacco products

Separate sleep areas for twins and multiples. Avoid co-bedding.

Supervised, awake, tummy time is recommended daily to help with the development of head and neck strength and to minimize the occurrence of positional plagiocephaly (flat spot on head)

Once a baby is able to roll form supine to prone position (back to stomach), they can remain sleeping in that position and do not need to be moved back to the supine position, but the parent should always initially place them in the crib on their back.

Source: PEDIATRICS October 2011 (American Academy of Pediatrics)

About PAA PAA was established in December 1959 and has been caring for infants, children

and adolescents in Central Kentucky for 55 years. Some of the current patients

are 3rd generation PAA patients in their family!

All of our physicians are Board Certified in Pediatrics and have more than

250 years of combined experience in pediatric medicine. All of our

physicians are Fellows of the American Academy of Pediatrics (FAAP).

We offer lab and x-ray services at our main office and have highly trained

Registered Nurses, Licensed Practical Nurses, Medical Assistants and other

staff to care for your children.

We offer two convenient locations and easy parking in addition to accessible

office hours. We are open 364 days per year because having your

pediatrician available is important to every parent. Our philosophy is to do

our best to see all children, who are sick and need to be seen, on the day

you call. During busy time, we may

see your child after normal office

hours, if needed.

While we refrain from “walk-in” or

“drop-in” appointments, we answer

our telephones from 7:30am to

5pm each weekday and 7:30am to

noon on Saturdays. If you feel your

child is seriously ill and cannot wait

for your appointment, please ask to

speak to one of our nurses so they

can assess your situation.

PAA participates with most major insurance plans.

Registered Nurses are available during the day to handle phone calls about

your sick child or routine health questions. When you call our office, ask to

leave a message for a nurse and we will call you back as quickly as possible.

If your call is urgent, please tell the receptionist.

Our website, www.paalex.com, contains downloadable forms, handouts,

health information, useful website links and commonly asked health

questions. It’s an excellent resource for parents.

Our physicians feel very strongly that each child should have a medical

home; one practice to meet the primary care needs of that child. Going to

other offices, urgent treatment facilities, or emergency rooms for well visits

or routine illnesses (colds, ear infections, etc) does not offer the best

continuity of care, and as a result, your child’s records are often not updated

with the latest medical information.

Car Child Safety Restraints Infants / Toddlers:

Rear-facing only seats and rear-facing convertible seats. All infants and toddlers should ride in a Rear-Facing Car Seat until they are at least 2 years of age, preferably longer. It is NORMAL for toddlers’ legs to touch the seat in front of them when rear-facing – toddlers are very flexible, and it doesn’t bother them to sit with their legs bent. Rear-facing is safer! When your baby exceeds either the weight or the height for your infant carrier seat, it will be time to transition to a convertible seat. A convertible seat can be used rear-facing or, eventually, forward-facing.

Toddlers / Preschoolers: Convertible seats and forward-facing seats with harnesses. Any child who has outgrown the rear-facing weight or height limit for his convertible car seat should use a Forward-Facing Car Seat with a harness for as long as possible. When your child is at least 4 years old AND at least 40 pounds, he or she can transition to a booster seat. Although the back on the booster is optional, a high-back booster that includes five-point harnessing offer s the best protection.

School-Aged Children: All children should continue to ride in a booster seat until they are 57 inches in height. Over 50% of 10 year olds still need boosters!

Older Children: When children are old enough and large enough for the vehicle seat belt to fit them correctly, they should always use Lap and Shoulder Seat Belts for optimal protection. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Important Things to Remember:

Keep in mind that each step “up” in car seats (rear-facing to forward-facing, convertible seat to booster seat, etc) provides LESS protection for your child. Don’t be too eager to advance!

Make sure your child’s weight and height are always within the limits of whatever seat you are using. Check the sticker on the side of the seat after your child is measured at each check-up to be sure.

Car seats have an expiration date. Check the bottom of the seat. If you are unable to find an expiration date, assume the seat expires 5 years after purchase.

References: American Academy of Pediatrics; Thecarseatlady.com

_______________________________________________________________________________________________Physician Matching Game (Last Page) Answers: Bennett – 13, Gillispie – 10, Hood – 14, Hosinski – 9, Ison – 22,

Lewis – 39, Menkus – 23, Nelson – 3, Revelette – 18, Riley – 36, Straub – 41, Wilson - 8

Booster Seats: Things to Know By:

Dr. Michelle Bennett, PAA Physician

Are you confused about whether your child needs a booster seat? If so, you're not alone -- and your child is probably not helping by trying to convince you that every other child his age is already out of the booster! Here's the information you need to know to keep your not-so-little-one safe:

1. Children can transition to a booster when they are at least 4 years of age AND at least 40 pounds.

3. Booster seats come in two forms: high-back and backless (combination seats can transition between the two). High-back boosters offer several added elements of protection. They keep sleeping children more safely positioned and more comfortable. They provide an extra layer of protection at the child's back and neck. And in one study, they offered 50% better protection in side impacts.

4. High-back boosters that include five-point harnessing offer the best protection. Watch this video (http://www.youtube.com/watch?v=V2kO8AxKbrM) to see the difference in a crash test.

5. Don't forget that car seats and booster seats have expiration dates. Just like anything plastic, they can lose some of their strength with time. Look for the sticker on the seat to see if an expiration date is printed. If not, assume that the seat should be replaced 5 years after purchase.

6. Children should remain in boosters until they are 57 inches tall and can meet all five of these requirements when buckled in using the regular lap and shoulder belt:

-- Does the child sit all the way back against the auto seat?

-- Do the child's knees bend comfortably at the edge of the auto seat?

-- Does the belt cross the shoulder between the neck and arm?

-- Is the lap belt as low as possible, touching the thighs?

-- Can the child stay seated like this for the whole trip?

Over 50% of 10-year-olds still need booster seats!

7. Once a child is ready to be out of the booster, she should still sit in the backseat of the car until at least age 13. (This is a recommendation based on musculoskeletal development, not size.)

9. Is your child complaining about being in a booster? Blame it on us, parents! We're happy to take the fall for you on this one!

Want more information? The Car Seat Lady's website is an awesome resource: www.thecarseatlady.com. Safe Kids is another great site: www. safekids.org.

Drive safely, everyone!

Draw a line to match the physician’s

name with the number of years they

have been at PAA.

Dr. Bennett 14 years

Dr. Gillispie 23 years

Dr. Hood 8 years

Dr. Hosinski 13 years

Dr. Ison 9 years

Dr. Lewis 3 years

Dr. Menkus 41 years

Dr. Nelson 36 years

Dr. Revelette 22 years

Dr. Riley 39 years

Dr. Straub 10 years

Dr. Wilson 18 years

That is a total of 236 years

of service at

Pediatric & Adolescent Associates!