9 MONTH OLDThe Mobile Phase

Proactive in your child’s care.

Empowering families for over 50 years.

Please take the time to read through this material. We provide this information because

we see value in educating our patients.

9 Month Visit: Immunizations

Your child is due to receive the following screening tests at this visit:

Hgb (Hemoglobin Screen)

Lead (Lead Screen)

Your child is due to receive the following immunizations at this visit:

NONE

In addition, we strongly recommend that all patients 6 months of age

and older receive an annual Influenza (flu) vaccine.

Please review the enclosed Vaccine Information Sheets (VISs) prior to

your visit for more information.

For our complete immunization schedule:

wmpeds.com/topic/immunization-schedule

VIDEOS

Let us help you be proactive and educated

in your child’s care!

These following videos are just a few that we may help you and your

child at this age. View these and many more at www.wmpeds.com

9 Months

Croup and Stridor – example of the barky cough and stridor of croup

Coughs: When to Worry – what features of coughs are concerning

Ear Infections –information on the causes and treatment of middle

ear infections

Rashes – information on basic rashes including diaper rash, Fifth’s

Disease, Hand, Foot and Mouth Disease, and hives

Healthy Parents, Healthy Kids

“Example is not just one way to effect change, it is the only way.”

Dr. Albert Schweitzer

Children learn by watching their parents and caregivers. This is how they learn to talk and

how they learn manners, as well as how they learn to eat. The eating “culture” in a baby’s

house has a very strong influence on how that child grows and matures as an eater.

Having a baby who is learning how to eat is a great opportunity for each family member to

evaluate his or her own eating habits and to think about making healthy changes. While it

can be very difficult for us to change our habits, hopefully your baby can help motivate you to

become healthier!

Some of the most important changes many people can make include:

1) making a conscious effort to increase the amount of vegetables and fruits on your

grocery list

- “strive for five” servings of fruits and vegetables daily

- studies show that you have to introduce a new food up to 30 times before a

child will try it; be persistent and patient

- have fruits and vegetables at all meals, even breakfast; think outside of the box

2) reducing the processed foods (hot dogs, pizza, chicken nuggets, etc…) in your home

- processed foods are often a major calorie source for babies by the time they

turn 1 year of age

3) minimizing soft drinks and juice – less is more

- soft drinks and juice are very high in sugar and very low in nutrition

- sugared drinks are bad for your baby’s teeth and are leading causes of obesity

4) paying attention to portions – beware of “Supersizing”

- we have lost our sense of what is a normal sized portion; what was considered

a large portion twenty years ago is now considered a small portion

- use regular size or small plates (and not large plates) to control portion size

For some simple and easy to follow suggestions on how to approach healthy eating, we

strongly recommend the book “Food Rules” by Michael Pollan.

Developmental Poetry by Dr. Hartman

The Junk Food Eater

By around one year,

My pickiness in eating begins,

Giving in makes you feel

Like it’s one of the greatest maternal/paternal sins.

You want me to drink my milk (for calcium),

Every possible treat from you I will try to bilk.

You want me to eat my veggies and meats (for iron),

Sweets I prefer as a main course

Not as treats.

If you think the Arab-Israeli talks are tough,

Culinary negotiations with me can be just as rough.

Remember I may triple my birth weight by the first year,

But after that I only gain five pounds annually,

So don’t fear.

Pickiness is inherent in a toddler’s life,

Just knowing that should reduce your strife.

As a young child I am ruled by my senses,

You’re the adult please set the limits without pretenses.

By: Dr. Hartman

Follow Dr. Hartman on Twitter @DrHartmanWMPEDS

Recommended Book: Let Them Eat Cake: The Case Against Controlling What Your Children

Eat (Ronald Kleinman, MD, Michael Jellinek, MD and Julie Houston)

Developmental Poetry by Dr. Hartman

Croup: The Fears

Is it a dog?

Is it a seal?

No, it’s my feverish child!

It makes my sleepy mind run wild!

Is it pneumonia, asthma, or bronchitis?

I did hear her with a little laryngitis!

Is that wheezing I hear?

Her throat could close up, I fear!

Dr. Hartman

Croup: The Facts

Croup occurs most commonly in children under five years of age. It is caused by a virus thatinflames the windpipe and leads to symptoms including fever and a characteristic barky and

“seal-like” cough. Croup is almost always worse in the middle of the night.

Because croup almost always is worse in the middle of the night, it can be quite frightening.

In spite of this, croup is almost always a mild illness. While about 6% of children younger

than five years of age will contract croup, only about 0.4% of them will require

hospitalization. Croup is a self-resolving illness with the nighttime cough and fever lasting for

one to three days, after which a mild daytime cough may last for up to ten days.

Croup: The Plan

Croup can often be treated at home without medications. If the croupy cough is persistent,croup can be treated with a one day course of Orapred (prednisolone), an oral steroid.

Orapred decreases the swelling in the windpipe and quiets the barky cough of croup.

If your child comes down with croup this season, please refer to our “Nighttime Croup Attack

Plan”. As always, please contact us with any questions!

Nighttime Croup Attack Plan

Please follow this plan in the event that your child awakes in the night with a fever and a

barky cough.

1) If your child is under six months old, call the office. If your child is drooling unusually, is

difficult to wake up, or if his or her lips, hands or feet are blue, call 911 and then follow

steps 2 and 3 below.

2) Take your child into a warm steamy bathroom for 10 minutes.

3) If the cough does not clear, take your child into the cold night air or open a freezer door tobreathe the cold air for 10 minutes.

4) If the cough clears, consider running a humidifier in the room or opening the bedroom

window. If your child sleeps in a bed, you may want to prop him/her up on extra pillows.

5) If your child still has the barky cough or stridor (a wheezy sound made when they breathe in),

give your child a dose of Orapred according to the dosing table (see next page). Continue to

use the steamy bathroom or cold air therapy. The Orapred takes about two hours to work.

6) CALL THE OFFICE IMMEDIATELY IF THIS PLAN DOES NOT WORK.

7) Contact our office in the morning if you use the Orapred.

a. It is important for us to document this in the child’s medical chart.

b. Please contact us by phone or through the patient portal.

8) AS ALWAYS, PLEASE CALL US AT ANY TIME WITH YOUR CONCERNS.

Orapred (prednisolone) dosing table for croup

Child's Weight Dose (teaspoons)

15 pounds ½ teaspoon twice a day for one day

20 pounds ½ teaspoon twice a day for one day

25 pounds ¾ teaspoon twice a day for one day

30 pounds 1 teaspoon twice a day for one day

35 pounds 1 teaspoon twice a day for one day

40 pounds 1 ¼ teaspoons twice a day for one day

45 pounds 1 ¼ teaspoons twice a day for one day

50 pounds 1 ½ teaspoons twice a day for one day

55 pounds 1 ½ teaspoons twice a day for one day

60 pounds 1 ¾ teaspoons twice a day for one day

10

2

3

5

8

9

7

6

4

1 switch to fat-free or low-fat (1%) milk They have the same amount of calcium and other essential nutrients as whole milk, but fewer calories and less saturated fat.

make half your grains whole grains To eat more whole grains, substitute a whole-grain product for a refined product—such as eating whole-wheat bread instead of white bread or brown rice instead of white rice.

foods to eat less often Cut back on foods high in solid fats, added sugars, and salt. They include cakes, cookies, ice cream, candies, sweetened drinks, pizza, and fatty meats like ribs, sausages, bacon, and hot dogs. Use these foods as occasional treats, not everyday foods.

compare sodium in foods Use the Nutrition Facts label to choose lower sodium versions of foods like soup, bread, and frozen meals. Select canned foods labeled“low sodium,” ”reduced sodium,” or “no salt added.”

drink water instead of sugary drinks Cut calories by drinking water or unsweetened beverages. Soda, energy drinks, and sports drinks are a major source of added sugar, and calories, in American diets.

balance calories Find out how many calories YOU need for a day as a first step in managing your weight. Go to www.ChooseMyPlate.gov to find your calorie level. Being physically active also helps you balance calories.

enjoy your food, but eat less Take the time to fully enjoy your food as you eat it. Eating too fast or when your attention is elsewhere may lead to eating toomany calories. Pay attention to hunger and fullness cues before, during, and after meals. Use them to recognize when to eat and when you’ve had enough.

avoid oversized portions Use a smaller plate, bowl, and glass. Portion out foods before you eat. When eating out, choose a smaller size option, share a dish, or take home part of your meal.

foods to eat more often Eat more vegetables, fruits, whole grains, and fat-free or 1% milk and dairy products. These foods have the nutrients you need for health—including potassium, calcium, vitamin D, and fiber. Make them thebasis for meals and snacks.

make half your plate fruits and vegetables Choose red, orange, and dark-green vegetables like tomatoes, sweet potatoes, and broccoli, along with other vegetables for your meals. Add fruit to meals as part of main or side dishes or as dessert.

choose MyPlate10 tips to a great plate

Making food choices for a healthy lifestyle can be as simple as using these 10 Tips. Use the ideas in this list to balance your calories, to choose foods to eat more often, and to cut back on foods to eat less often.

DG TipSheet No. 1 June 2011 Center for Nutrition USDA is an equal opportunity Policy and Promotion provider and employer. Go to www.ChooseMyPlate.gov for more information.

10 tips

Nutrition Education Series

ChooseMyPlThe website featurtips to help Americ

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Enjoy your

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food, but eat less.

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our plate fruits and

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ChooseMyPlate.gov1 includes much of theconsumer and professional informationformerly found on MyPyramid.gov.

Also on the web Sample Menus for a Week

Food Group Based Recipes

Historical Development of FoodGuidance

Nutrition Communicators Network forPartners – Application Forms

All print-ready content

Skin WoundSMake sure the child is up to date for tetanus vaccination. Any open wound may need a tetanus booster even when the child is currently immunized. If the child has an open wound, ask the pediatrician if the child needs a tetanus booster.

Bruises Apply cool compresses. Call the pediatrician if the child has a crush injury, large bruises, continued pain, or swelling. The pediatrician may recommend acetaminophen for pain.

Cuts Rinse small cuts with water until clean. Use direct pressure with a clean cloth to stop bleeding and hold in place for 1 to 2 minutes. If the cut is not deep, apply an antibiotic ointment, then cover the cut with a clean bandage. Call the pediatrician or seek emergency care for large or deep cuts, or if the wound is wide open. For major bleeding, call for help (911 or an emergency num-ber). Continue direct pressure with a clean cloth until help arrives.

Scrapes Rinse with clean, running tap water for at least 5 min-utes to remove dirt and germs. Do not use detergents, alcohol, or peroxide. Apply an antibiotic ointment and a bandage that will not stick to the wound.

Splinters Remove small splinters with tweezers, then wash until clean. If you cannot remove the splinter completely, call the pediatrician.

Puncture Wounds Do not remove large objects (such as a knife or stick) from a wound. Call for help (911 or an emergency number). Such objects must be removed by a doctor. Call the pediatrician for all puncture wounds. The child may need a tetanus booster.

Bleeding� Apply pressure with gauze over the bleeding area for 1 to 2 minutes. If still bleeding, add more gauze and apply pressure for another 5 minutes. You can also wrap an elastic bandage firmly over gauze and apply pressure. If bleeding continues, call for help (911 or an emergency number).

EyE injuriESIf anything is splashed in the eye, flush gently with water for at

least 15 minutes. Call Poison Help (1-800-222-1222) or the pediatrician for further advice. Any injured or

painful eye should be seen by a doctor. Do NOT touch or rub an injured eye. Do NOT apply medi-cine. Do NOT remove objects stuck in the eye.

Cover the painful or injured eye with a paper cup or eye shield until you can get medical help.

FracturES and SprainSIf an injured area is painful, swollen, or deformed, or if motion causes pain, wrap it in a towel or soft cloth and make a splint with cardboard or other firm material to hold the arm or leg in place. Do not try to straighten. Apply ice or a cool compress wrapped in thin cloth for not more than 20 minutes. Call the pediatrician or seek emergency care. If there is a break in the skin near the fracture or if you can see the bone, cover the area with a clean bandage, make a splint as described above, and seek emergency care.

If the foot or hand below the injured part is cold or discolored (blue or pale), seek emergency care right away.

BurnS and ScaldSGeneral Treatment First, stop the burning process by removing the child from contact with hot water or a hot object (for example, hot iron). If clothing is burn-ing, smother flames. Remove clothing unless it is firmly stuck to the skin. Run cool water over burned skin until the pain stops. Do not apply ice, butter, grease, medi-cine, or ointment.

Burns With Blisters Do not break the blisters. Ask the pediatrician how to cover the burn. For burns on the face, hands, feet, or genitals, seek emergency care.

Larg�e or Deep Burns Call 911 or an emergency number. After stopping and cooling the burn, keep the child warm with a clean sheet covered with a blanket until help arrives.

Electrical Burns Disconnect electrical power. If the child is still in contact with an electrical source, do NOT touch the child with bare hands. Pull the child away from the power source with an object that does not conduct electricity (such as a wooden broom handle), only after the power is turned off. ALL electrical burns need to be seen by a doctor.

noSEBlEEdSKeep the child in a sitting position with the head tilted slightly forward. Apply firm, steady pressure to both nostrils by squeez-ing them between your thumb and index finger for 5 minutes. If bleeding continues or is very heavy, call the pediatrician or seek emergency care.

tEEthBaby Teeth If knocked out or broken, apply clean gauze to control bleeding and call the pediatric or family dentist.

Permanent Teeth If knocked out, handle the tooth by the top and not the root (the part that would be in the gum). If dirty, rinse gently without scrubbing or touch-ing the root. Do not use any cleansers. Use cold running water or milk. Place the tooth in clean water or milk and transport the tooth with the child when seeking emergency care. Call and go directly to the pediatric or family dentist or an emergency department. If the tooth is broken, save the pieces in milk and call the pediatric or family dentist right away. Stop bleeding using gauze or a cotton ball in the tooth socket and have the child bite down.

GEnEral■■ Know how to get help.■■ Make sure the area is safe for you and the child.■■ When possible, personal protective equipment (such as gloves)

should be used.■■ Position the child appropriately if her airway needs to be

opened or CPR (cardiopulmonary resuscitation) is needed. (Please see other side.)

■■ DO NOT MOVE A CHILD WHO MAY HAVE A NECK OR BACK INJURY (from a fall, motor vehicle crash, or other injury, or if the child says his neck or back hurts) unless he is in  danger.

■■ Look for anything (such as emergency medical identification jewelry or paperwork) that may give you information about health problems.

StinGS, BitES, and allErGiESSting�ing� Insects Remove the stinger as soon as possible with a scraping motion using a firm item (such as the edge of a credit card). Put a cold compress on the bite to relieve the pain. If trouble breathing; fainting; swelling of lips, face, or throat; or hives over

the entire body occurs, call 911 or an emergency number right away. For hives in a small area, nausea, or vomiting,

call the pediatrician. For spider bites, call the pedia-trician or Poison Help (1-800-222-1222). Have the pediatrician check any bites that become red, warm,

swollen, or painful.

Animal or Human Bites Wash wound well with soap and water. Call the pediatrician. The child may need a tetanus or rabies shot or antibiotics.

Ticks Use tweezers or your fingers to grasp as close as possible to the head of the tick and briskly pull the tick away from where it is attached. Call the pediatrician if the child develops symptoms such as a rash or fever.

Snake Bites Take the child to an emergency department if you are unsure of the type of snake or if you are concerned that the snake may be poisonous. Keep the child at rest. Do not apply ice. Loosely splint the injured area and keep it at rest, positioned at or slightly below the level of the heart. Identify the snake, if you can do so safely. If you are not able to identify the snake but are able to kill it safely, take it with you to the emergency department for identification.

Allerg�y Swelling, problems breathing, and paleness may be signs of severe allergy. Call 911 or an emergency number right away. Some people may have emergency medicine for these times. If possible, ask about emergency medicine they may have and help them administer it if necessary.

FEvErFever in children is usually caused by infection. It also can be caused by chemicals, poisons, medicines, an environ-ment that is too hot, or an extreme level of overactivity.

Take the child’s temperature to see if he has a fever. Most pediatricians consider any thermometer reading above 100.4°F (38°C) as a fever. However, the way the child looks and acts is more important than how high the child’s temperature is.

Call the pediatrician right away if the child has a fever and

■■ Appears very ill, is unusually drowsy, or is very fussy■■ Has other symptoms such as a stiff neck, a severe

headache, severe sore throat, severe ear pain, an unexplained rash, repeated vomiting or diarrhea, or difficulty breathing

■■ Has a condition causing immune suppression (such as sickle cell disease, cancer, or chronic steroid use)

■■ Has had a first seizure but is no longer seizing■■ Is younger than 2 months and has a temperature of 100.4°F

(38°C) or higher■■ Has been in a very hot place, such as an overheated car

To make the child more comfortable, dress him in light clothing, give him cool liquids to drink, and keep him calm. The pediatri-cian may recommend fever medicines. Do NOT use aspirin to treat a child’s fever. Aspirin has been linked with Reye syndrome, a serious disease that affects the liver and brain.

Does your community have 911? If not, note the number of your local ambulance service and other

important numbers below.

Be PrePared: Call 911KeeP eMerGeNCY NUMBerS

BY YOUr TelePHONe.

Pediatrician

Pediatric or Family dentist

Poison HelP 1-800-222-1222

ambulance

emergency dePartment

Fire

Police

address oF and directions to tHe location

(For babysitters, caregivers)

FIRST

AIDCall 911 or an emergency number for a severely ill or injured child.Call 1-800-222-1222 (Poison Help) if you have a poison emergency.

The information contained in this publication 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.

HE0418 Copyright © 2011 American Academy of Pediatrics. All rights reserved.

5-65/Rev1210Turn Over for Choking and CPR Instructions.

convulSionS, SEizurESIf the child is breathing, lay her on her side to prevent choking. Call 911 or an emergency number for a prolonged seizure (more than 5 minutes).

Make sure the child is safe from objects that could injure her. Be sure to protect her head. Do not put anything in the child’s mouth. Loosen any tight clothing. Start rescue breathing if the child is blue or not breathing. (Please see other side.)

hEad injuriESDO NOT MOVE A CHILD WHO MAY HAVE A SERIOUS HEAD, NECK, OR BACK INJURY. This may cause further harm.

Call 911 or an emergency number right away if the child

■■ Loses consciousness■■ Has a seizure (convulsion)■■ Experiences clumsiness or inability to move any body part■■ Has oozing of blood or watery fluid from ears or nose■■ Has abnormal speech or behavior

Call the pediatrician for a child with a head injury and any of the following:

■■ Drowsiness■■ Difficulty being awakened■■ Persistent headache or vomiting

For any questions about less serious injuries, call the pediatrician.

poiSonSIf the child has been exposed to or ingested a poison, call Poison Help at 1-800-222-1222. A poison expert is available 24 hours a day, 7 days a week.

Swallowed Poisons Any nonfood substance is a potential poison. Do not give anything by mouth or induce vomiting. Call Poison Help right away. Do not delay calling, but try to have the substance label or name available when you call.

Fumes, Gases, or Smoke Get the child into fresh air and call 911, the fire department, or an emergency number. If the child is not breathing, start CPR and continue until help arrives. (Please see other side.)

Skin Exposure If acids, lye, pesticides, chemicals, poisonous plants, or any potentially poisonous substance comes in contact with a child’s skin, eyes, or hair, brush off any residual material while wearing rubber gloves, if possible. Remove contaminated clothing. Wash skin, eyes, or hair with large amount of water or mild soap and water. Do not scrub. Call Poison Help for further advice.

If a child is unconscious, becoming drowsy, having convulsions, or having trouble breathing, call 911 or an emergency number. Bring the poisonous substance (safely contained) with you to the hospital.

FaintinGCheck the child’s airway and breathing. If necessary, call 911 and begin rescue breathing and CPR. (Please see other side.)

If vomiting has occurred, turn the child onto one side to prevent choking. Elevate the feet above the level of the heart (about 12 inches).

START FIRST AID FOR CHOKING IF

■● The child cannot breathe at all (the chest is not moving up and down).■● The child cannot cough or talk, or looks blue.■● The child is found unconscious/unresponsive. (Go to CPR.)

DO NOT START FIRST AID FOR CHOKING IF

■● The child can breathe, cry, or talk.■● The child can cough, sputter, or move air at all. The child’s normal reflexes are working to clear the airway.

LEARN AND PRACTICE CPR (CARDIOPULMONARY RESUSCITATION).IF ALONE WITH A CHILD WHO IS CHOKING…

1. SHOUT FOR HELP. 2. START RESCUE EFFORTS. 3. CALL 911 OR YOUR LOCAL EMERGENCY NUMBER.

FOR CHILDREN 1 TO 8 YEARS OF AGE

Turn Over for First Aid Treatment.

If at any time an object is coughed up or the infant/child starts to breathe, stop rescue breaths and call 911 or your local emergency number.

Ask your pediatrician for information on choking/CPR instructions for children older than 8 years and for information on an approved first aid or CPR course in your community.

CHOKING/CPR

HE0418 Copyright © 2011 American Academy of Pediatrics. All rights reserved.

5-65/Rev1210

FOR INFANTS YOUNGER THAN 1 YEAR

1. Perform Heimlich maneuver.

■ ● Place hand, made into a fist, and cover with other hand just above the navel. Place well below the bottom tip of the breastbone and rib cage.

■ ● Give each thrust with enough force to produce an artificial cough designed to relieve airway obstruction.

■ ● Perform Heimlich maneuver until the object is expelled or the child becomes unconscious/ unresponsive.

2. If the child becomes UNCONSCIOUS/UNRESPONSIVE, begin CPR.

CHILD CPRTo be used when the child is UNCONSCIOUS/UNRESPONSIVE or when breathing stops.

Place child on flat, hard surface.

CHILD CHOKING (HEIMLICH MANEUVER)

Have someone call 911. If the child is choking and is unable to breathe, cough, cry, or speak,

follow these steps.

2 OPEN AIRWAY.■● Open airway (head

tilt–chin lift).■● If you see a foreign

body, sweep it out with your finger. Do NOT do blind finger sweeps.

3 START RESCUE BREATHING.■● Take a normal breath.■● Pinch the child’s nose closed,

and cover child’s mouth with your mouth.

■● Give 2 breaths, each for 1 second. Each breath should make the chest rise.

4 RESUME CHEST COMPRESSIONS.

■● Continue with cycles of 30 compres-sions to 2 breaths until the object is expelled.

■● After 5 cycles of compressions and breaths (about 2 minutes), if no one has called 911 or your local emergency number, call it yourself.

1 START CHEST COMPRESSIONS.■● Place 2 fingers of 1 hand on

the breastbone just below the nipple line.

■● Compress chest at least ¹/3 the depth of the chest, or about 4 cm (1.5 inches).

■● After each compression, allow chest to return to normal position. Compress chest at rate of at least 100 times per minute.

■● Do 30 compressions.

2 OPEN AIRWAY.■● Open airway (head tilt–chin

lift).■● If you see a foreign body,

sweep it out with your finger. Do NOT do blind finger sweeps.

3 START RESCUE BREATHING.■● Take a normal breath.■● Cover infant’s mouth and

nose with your mouth.■● Give 2 breaths, each

for 1 second. Each breath should make the chest rise.

4 RESUME CHEST COMPRESSIONS.■● Continue with cycles of 30 compressions to

2 breaths. ■● After 5 cycles of compressions

and breaths (about 2 minutes), if no one has called 911 or your local emergency number, call it yourself.

1 GIVE 5 BACK BLOWS (SLAPS).

INFANT CHOKINGIf the infant is choking and

is unable to breathe, cough, cry, or speak, follow these steps.

Have someone call 911.

INFANT CPRTo be used when the infant is UNCONSCIOUS/UNRESPONSIVE or when breathing stops.

Place infant on flat, hard surface.

ALTERNATING WITH

Alternate back blows (slaps)

and chest compres-

sions until the object

is dislodged or the infant

becomes unconscious/unresponsive. If the infant

becomes unconscious/unresponsive,

begin CPR.

1 START CHEST COMPRESSIONS.■● Place the heel of 1 or 2 hands over the lower half

of the sternum.■● Compress chest at least ¹/3 the depth of the

chest, or about 5 cm (2 inches).■● After each compression, allow chest to

return to normal position. Compress chest at rate of at least 100 times per minute.

■● Do 30 compressions.

1-hand technique 2-hand technique

2 GIVE 5 CHEST COMPRESSIONS.

Every 8 seconds someoneneeds a poison center…

Could you be next?

Free, Fast,Expert Help.24 hours a day,7 days a week © 2010 American Association of Poison Control Centers

How DoesYour Poison

CenterHelp You?

Poison centers give expert advice fast, over the phone. We can help you and your family with poison emergencies and with questions about poisoning

You can call day or night, 7 days a week, any day of the year. Nurses,

pharmacists, doctors, and other poison experts will answer your call.

We can help you in more than 150 languages or

if you are hearing impaired.

There are many poison centers across our country. You can reach a poison center by

calling 1-800-222-1222 from anywhere in the US.

First Aid for PoisoningIf a person

4 stops breathing 4 collapses, or 4 has a seizure

Call 911 right away.

Poison in the eyes?

Rinse eyes with running water.Call your poison center at 1-800-222-1222.

Poison on the skin?

Take off any clothing that the poisontouched. Rinse skin with running water.Call your poison center at 1-800-222-1222.

Inhaled poison?

Get to fresh air right away.Call your poison center at 1-800-222-1222.

Swallowed poison?

Call your poison center at 1-800-222-1222.

Do not try home remedies or try to make someone throw up. Call your poisoncenter first.

For more information visit www.aapcc.org or call your local poison center.

�•��Put�1-800-222-1222�in�your�cell�phone�and near home phones.

•��Keep�medicines�and�household� products in their original containers and in a different place than food.

•����Always�read�the�label�and�follow� any directions.

•��Keep�household�products�and� medicines locked up. Put them where kids can’t see them or reach them.

•��Buy�products�with�child-resistant� packaging.��But�remember,�nothing� is child-proof!

•��Never�call�medicine�“candy.”�� Poisons may look like food or drink. Teach children to ask an adult before tasting anything.

•��Learn�about�products�and�drugs� that�young�people�use�to�get�“high.”��Talk to your teen or pre-teen about these dangers.

•����Have�a� working carbon monoxide alarm in your home.

Poison Prevention Tips If you think someone has been poisoned, call 1-800-222-1222 right away. Seriouspoisonings don’t always have early signs.

Why Should You Call?Poisonings can happen to anyone and poison centers are for everyone. The call is free and private.

We Help You Save Money and Time:

Seven of ten people who call their poison center get help over the phone. They don’t have to go to a doctor or hospital.

Your Doctor Calls the Poison Center Too:

When doctors and nurses need help treating poisonings, they call their local poison center.

We are the experts.

Do You Know?We often think of children getting poisoned. But�most�people�who�die�from�poisons�are�adults! Poisoning is a danger for all of us.

Almost�anything�can�be� poisonous if it’s used the wrong way, in the wrong amount, or by the wrong person.

Some poisons are:

� •��medicines�(prescription,�over-the-counter, herbal) and street drugs

� •��products�in�your�home�like� shampoo, bleach, bug and weed killers, antifreeze, and lamp oil

� •�chemicals�at�your�job

� •�bites�and�stings

� •�mushrooms�and�plants

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Taking the wrong amount of medicine or someone else’s medicine, accidentally eating dishwasher soap, mixing cleaners, or having too much alcohol to drink could lead to poisoning.

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"IS YOUR HOME

TOTSAFE?"

Create your own

peacemind

of

Your top priority is keeping your

little one safe. It's our mission,

too. Our home childproofing

checklist was designed by our pro-

babyproofers to help you identify

and fix common child safety issues

and help prevent injuries.

Please print and share this article in full with as many parents as you wish. Please contact us if

you wish to copy, quote or duplicate this article for any other usage. Copyrighted material, used

with permission by Kelly A. Smith, author of Mommy Can Do It: A Do-It-Herself Guide to Babyproofing

Brought to you bythe Professional Babyproofers

at

TotSafeEmail: support@totsafe.comToll Free: 1-866-544-5159

Fax: 1-586-203-8252www.totsafe.com

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Home BabyProofing Checklist

Please use our home baby-proofing checklist as a tool to help create a safer home environment for your children. Totsafe recommends that baby proofing be done when your child is around 3-6 months of age, before he/she can crawl, but it’s never too late. It will make it easier if you don’t wait for your child to start opening cabinets or trying to climb the stairs before you childproof your home. Do it as soon as you can, and as thoroughly as possible to help prevent the number one cause of injury to children (unintentional injuries).

The following is a list of common toddler safety risks in the home. Check off items once

they are secured.

• Stairways: Secure the top and bottom of stairways with baby safety gates. Please see our "GUIDE

TO BABY SAFETY GATES" to help you choose which gates are right for your space. PRESSURE MOUNTED BABY GATES ARE NOT RECOMMENDED FOR THE TOP OF THE STAIRS.

Special Circumstances (molding/baseboards, uneven or hollow walls, wrought iron railings, balusters,

etc.) may require the use of gate installation kits to create a mountable surface.

• Windows: Windows (including first floor windows and higher) pose a falling hazard to

children. Children should not have access to open windows; windows that can be opened more

than 4" are hazardous. Use childproofing window guards or wedges on all windows.

• Window Blinds: Cords from window blinds should be kept out of children's reach at all

times. They are a strangulation risk to children and can easily be secured out of reach. NEVER

PLACE A CHILD'S CRIB OR BED NEAR THE WINDOW OR WINDOW BLINDS.

•Electrical Outlets: Create a barrier between children and electrical currents with appropriate

childproofing measures. Determine whether your outlets are Standard or Decorator* and:

•If you have outlets constantly in use (i.e. lamp plugged in all the time): We suggest outlet

covers.

•For outlets that are frequently used (i.e. outlet used to plug in vacuum, then remove it): Try

sliding outlet plates, which replace your existing outlet plate and have a 'door' that slides

closed to cover the outlet as soon as an item is unplugged.

•Outlets that are rarely used (usually left unused): Outlet plugs fit snugly inside outlets to

prevent access.

* Decorator Outlets have 2 screws, one at top, one at bottom. Standard outlets have one

screw, in the middle. For more information regarding electrical outlet safety, please read

"Outlet Safety In Your Home" a guide to selecting electrical safety products for your home.

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• Medicines, Cleaners, Cosmetics, etc.: These items should to be kept out of the reach of

children. Medicines, cosmetics, cleaners and other household products should be kept in their original containers with labels, and up in cupboards or on shelves where children can not have access

to them. Use cabinet locks and latches on cupboards or drawers where these items are stored.

• Balcony, Loft, Landing, etc. with banisters: Use banister shields to close off gaps between

balusters and newel posts, particularly where the space is more than 4". Remove items from around

banisters, half walls, etc. that children may use to climb. This includes toys, chairs, tables, and other

products that curious children may use to step up on.

• Kitchens: Kitchens can be one of the most hazardous rooms in your home. If it is possible, use a

baby safety gate to block off access to the kitchen, especially during cooking or baking.

•Always use the back burners when cooking; make sure that pan and pot handles are pointing

toward the back of the stove.

•Never hold your child while working in the kitchen. Children may try to grab hot foods or

sharp items that could injure them. If a child does grab a sharp item such as a knife, do not

try to pull it out of the child's hand. Instead, firmly squeeze the child's wrist until they let go of the object.

•Use Stove Knob Covers or Locks to prevent access to burner knobs.

•Use adhesive locks on the refrigerator/freezer to prevent little ones from getting into food

& drinks they should not have.

•Keep knives and other sharp objects stored in locked drawers.

•Store plastic bags away from children.

• Electrical Appliances: There is a huge array of electrical appliances that are hazardous to

children. Kitchen stoves, refrigerators, ovens, microwaves, and dishwashers can all lead to burns and

other injuries. They should be secured with guards, latches, and straps to prevent access, and guard

against injury. Unplug electrical appliances when not in use.

•Heavy or Unstable Furniture (including dressers, armoires, entertainment centers, book

cases and changing tables, etc.): Every year thousands of children are injured due to tipping furniture. Children pull out dresser drawers and use them as steps to climb up furniture. Heavy

and/or unstable furniture should be removed or secured with special furniture straps to studs in the

walls to prevent them from tipping onto a child. Keep the tops of furniture clear of knick-knacks,

toys, flowers, etc. to help deter climbing.

•Toilets: Children are particularly curious about water, even water in the toilet. Just a couple of

inches of water, such as that in the toilet, bucket, or pet dish can pose a drowning risk. Use toilet

locks to prevent access to water in the toilet, and never keep water in buckets, tubs, etc. Pets’ water dishes should be kept out of the reach of babies and toddlers as well.

•Water sources (faucet, bathtub, shower): Children should not have access to water for many reasons. In addition to the drowning risk associated with water, it can also put children at risk for

being scalded if it is too hot. Water heaters in your home should be set to no more than 120 degrees

to help prevent this. Keep bathroom doors closed or gated off and use a Safety Tap Guard to

prevent access to water.

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•Cabinets/Drawers: Cabinets and drawers hold many items that can be dangerous to children

including cleansers, medicines, cosmetics and sharp objects like knives and scissors. Cabinets and

drawers should be secured with locks or latches to prevent access. Individuals who prefer not to

install hardware mounted cabinet & drawer latches can try Adhesive Mount Cabinet Latches.

• Garbage Cans: Children should not have access to garbage cans or their contents. Garbage cans

should be placed where children cannot reach them, and locked closed with a locking strap.

•Sharp-edged tables, fireplace hearths, and window sills: Use corner and table edge cushions to

pad sharp edges of tables, hearths, computer desks, counters, etc.

•Cords in reach: Electrical cords should be kept out of reach of children to minimize pulling on

items, and gaining access to electrical outlets. Computers, entertainment centers, and lamps are a few of the items that have cords that should be secured out of reach. Cord control kits or outlet covers

with cord shorteners can be used for this purpose.

•Nightlights: Some nightlights have small parts and hot bulbs that can injure children. They also

may be pulled out, exposing children to outlets.

•Nightlight with Outlet Cover is an alternative to standard nightlights, and offers protection

from outlets.

• Fireplaces, Wood Burning Stoves, Barbecue Grills: Children should not be allowed near

fireplaces, grills or wood burning stoves. It is good practice not to allow children near them even

when they are not in use. Protect children from burns from fireplaces and stoves with fireplace

gates. Use edge and corner cushions on hearths to protect from bumps and bruises.

• Plants: Several household plants can be fatal to children if eaten, and the fertilizer in soil can be

harmful, as well. Plants should be moved out of children's reach. If that is not an option, pot should be covered with mesh or plastic so that child does not have access to the soil. Your local hardware

store should be able to help you find an appropriate gauge of mesh so that children can't reach in,

but allow plants to 'breathe.‘

• TV/VCR/DVD/Stereo: Children are often fascinated with buttons and doors, such as those

found on TVs, VCRs, etc. Clear plastic shields can be used to guard against having a child insert

inappropriate items into the VCR, push buttons, etc. Attach appliance straps to items to help

prevent them from tipping onto children.

• Computer and Entertainment Centers: Areas around the computer and entertainment centers

can have several hazards to children. Generally, these areas have a large amount of cords, adapters, and heavy equipment like a monitor or television set. Browse our website for power strip safety

covers, outlet & adapter covers, cord control kits, and safety locking straps to help prevent injuries.

• Carbon Monoxide & Smoke Detectors: It is recommended that carbon monoxide detectors be

placed in every separate sleeping area of the home, on the ceiling at least 15 feet away from fuel-

burning appliances. There should be at least one smoke detector on every floor of the home.

Carbon monoxide is a colorless, odorless gas, which is a particular hazard to children because they have faster metabolic rates and gas accumulates faster in their bodies than adults.

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Other Home Childproofing Tips:

• Use childproofing products correctly all of the time. Train older children, babysitters and visitors

(including Grandma & Grandpa) on how to properly use child safety items in your home to help

ensure correct use, and continued protection of your child. It only takes one time for a cabinet to be

left open, or a toilet to be left unlocked for an accident to happen.

• Prevent access to scalding water using anti-scald devices, and/or setting your water heater to a

maximum temperature of 120 degrees.

• Make sure cleaners, cosmetics, plants, and other poisonous substances are correctly labeled with

name and ingredients so that if your baby ingests the item you can give accurate information to a poison control center or emergency medical team.

• Make sure windows cannot be opened more than 4” and/or are blocked with Window Guards.

• Always supervise your child in the bath.

• Remove two-piece doorstops, which have small parts that can be choking hazards, replace with

one-piece doorstops.

• Make sure to keep older children's toys away from younger children.

• Keep cigarettes, lighters, matches, and lit candles out of children's reach.

• Check floors for small objects that could pose a choking hazard, move breakable items like

figurines, ceramics, vases, etc. to higher locations where children cannot reach them, and remove

tablecloths and coverings that toddlers may try to pull themselves up on.

• Consider childproofing to be an ongoing process.

This baby proofing checklist was created to be as thorough as possible, however, please remember that this checklist is just for reference, and may not cover all of the child safety issues in your home.

As every child is unique, baby proofing must be done based on your unique child’s needs. What

works for one parent or child may not be the best solution for you and your child.

Baby proofing products are meant to be deterrents; they are not meant to substitute for

proper adult supervision. Never leave a child unattended.

Tuberculosis Screening Form

Routine tuberculosis skin testing is no longer part of well child check-ups. Instead, the

current recommendations from the American Thoracic Society and the Centers for DiseaseControl is for skin testing to be limited to people in contact with individuals who are

potentially at higher risk of having tuberculosis. In the United States, people who tend to be

at higher risk of having tuberculosis include:

• IV drug users

• Homeless people

• Institutionalized people (nursing homes, prisons, psychiatric hospitals)

• Migrant farm workers

• Immigrants from high risk areas such as Asia (except Japan), Africa, the Middle East,

South/Central America, Caribbean

• Socio-economically deprived individuals

• Children from households with tuberculosis patients

If your child has been in contact with people in any of these high risk groups, please inform

your physician so that routine tuberculosis skin testing will be included as part of your child’s

visit today.

Please sign this form stating that you have read the above risk factors and that your child

does not fit into any of the above risk groups. If your child does fit into one of these categories

please discuss this with your provider.

To be reviewed at:

New Patient: _____________________________ Date: _______________________

9 Month: _____________________________ Date: _______________________

5 Years: _____________________________ Date: _______________________

Other: _____________________________ Date: _______________________

_____________________________________ __________________________

Patient Name Date of Birth

Postpartum Therapists

We strongly suggest you speak with your obstetrician if you feel you might be experiencing signs of

postpartum depression.

Therapists

JoAnn Feldstein, Ed.D.

93 Union St, Suite 401

Newton Center, MA 02459www.drjoannfeldstein.com/

617-332-9887

Debra Greenberg, LICSW

15 Cottage St

Norwood, MA 02492

dgreenberglicsw@comcast.net

781-329-6696

Eda Spielman, Psy.D

6 Fairfield St

Newtonville, MA 02360

http://www.jfcsboston.org/

617-969-4117

Kathleen O’Meara, APRN

27 Mica Ln

Wellesley, MA 02481

781-431-0207

Ellis Waingrow, MSW, LICSW

24 Lincoln St

Newton Highlands, MA 02461

http://www.selfleadership.org/

617-244-8132

Wendy Hrubec, LICSW

275 Turnpike St, Suite 108

Canton, MA 02021

http://www.selfleadership.org/

781-821-2063

Janet Leibowitz, PsyD

345 Neponset St, Suite 6

Canton, MA 02021

http://www.janetleibowitz.com/781-258-3587

Christine Gardosik, LICSW21 Cohasset St, Suite 3

Foxborough, MA 02035

978-808-1635

Needham Psychotherapy Associates, LLC

992 Great Plain Ave

Needham, MA 02492

http://npaonline.com/

781-449-7522

Psychiatrist

Ann Briley, MD

18 Wareland Rd

Wellesley, MA 02481

781-237-7896

Allison Phillips, MD

27 Mica Ln

Wellesley, MA 02481

781-431-0207

U.S. Department of Health and Human Services Centers for Disease Control and Prevention

VACCINE INFORMATION STATEMENT

Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis

Hojas de información sobre vacunas están disponibles en español y en muchos otros idiomas. Visite www.immunize.org/vis

Influenza (Flu) Vaccine (Inactivated or Recombinant): What you need to know

1 Why get vaccinated?

Influenza (“flu”) is a contagious disease that spreads around the United States every year, usually between October and May.

Flu is caused by influenza viruses, and is spread mainly by coughing, sneezing, and close contact.

Anyone can get flu. Flu strikes suddenly and can last several days. Symptoms vary by age, but can include:• fever/chills• sore throat• muscle aches• fatigue• cough• headache• runny or stuffy nose

Flu can also lead to pneumonia and blood infections, and cause diarrhea and seizures in children. If you have a medical condition, such as heart or lung disease, flu can make it worse.

Flu is more dangerous for some people. Infants and young children, people 65 years of age and older, pregnant women, and people with

certain health conditions or a weakened immune system are at greatest risk.

Each year thousands of people in the United States die from flu, and many more are hospitalized.

Flu vaccine can:• keep you from getting flu,• make flu less severe if you do get

it, and• keep you from spreading flu to

your family and other people.

2 Inactivated and

recombinant flu vaccines

A dose of flu vaccine is recommended every flu season. Children 6 months through 8 years of age may need two doses during the same flu season. Everyone else needs only one dose each flu season.

Some inactivated flu vaccines contain a very small amount of a mercury-based preservative called thimerosal. Studies have not shown

thimerosal in vaccines to be harmful, but flu vaccines that do not contain thimerosal are available.

There is no live flu virus in flu shots. They cannot cause the flu.

There are many flu viruses, and they are always changing. Each year a new flu vaccine is made to protect against three or four viruses that are likely to cause disease in the upcoming flu season. But even when the vaccine doesn’t exactly match these viruses, it may still provide some protection.

Flu vaccine cannot prevent:• flu that is caused by a virus not

covered by the vaccine, or• illnesses that look like flu but are

not.

It takes about 2 weeks for protection to develop after vaccination, and protection lasts through the flu season.

3 Some people should

not get this vaccine

Tell the person who is giving you the vaccine:• If you have any severe, life-

threatening allergies. If you ever had a life-threatening allergic reaction after a dose of flu vaccine, or have a severe allergy to

any part of this vaccine, you may be advised not to get vaccinated. Most, but not all, types of flu vaccine contain a small amount of egg protein.

• If you ever had Guillain-Barré Syndrome (also called GBS).Some people with a history of GBS should not get this vaccine. This should be discussed with your doctor.

• If you are not feeling well. It is usually okay to get flu vaccine when you have a mild illness, but you might be asked to come back when you feel better.

4 Risks of a vaccine reaction

With any medicine, including vaccines, there is a chance of reactions. These are usually mild and go away on their own, but serious reactions are also possible.

Most people who get a flu shot do not have any problems with it.

Minor problems following a flu shot include:• soreness, redness, or swelling

where the shot was given • hoarseness• sore, red or itchy eyes• cough• fever• aches• headache• itching• fatigue

If these problems occur, they usually begin soon after the shot and last 1 or 2 days.

More serious problems following a flu shot can include the following:• There may be a small increased

risk of Guillain-Barré Syndrome (GBS) after inactivated flu vaccine. This risk has been estimated at 1 or 2 additional cases per million people vaccinated. This is much lower than the risk of severe complications from flu, which can be prevented by flu vaccine.

• Young children who get the flu shot along with pneumococcal vaccine (PCV13) and/or DTaP vaccine at the same time might be slightly more likely to have a seizure caused by fever. Ask your doctor for more information. Tell your

doctor if a child who is getting flu vaccine has ever had a seizure.

Problems that could happen after any injected vaccine:• People sometimes faint after a

medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision changes or ringing in the ears.

• Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This happens very rarely.

• Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination.

As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

The safety of vaccines is always being monitored. For more information, visit: www.cdc.gov/vaccinesafety/

5 What if there is a serious reaction?

What should I look for?• Look for anything that concerns

you, such as signs of a severe allergic reaction, very high fever, or unusual behavior.Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should I do?• If you think it is a severe allergic

reaction or other emergency that can’t wait, call 9-1-1 and get the person to the nearest hospital. Otherwise, call your doctor.

• Reactions should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor should file this report, or you can do it yourself through the VAERS web site at www.vaers.hhs.gov, or by calling 1-800-822-7967.

VAERS does not give medical advice.

6 The National Vaccine

Injury Compensation Program

The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines.

Persons who believe they may have been injured by a vaccine can learn about the program and about filing a claim by calling 1-800-338-2382 or visiting the VICP website at www.hrsa.gov/vaccinecompensation. There is a time limit to file a claim for compensation.

7 How can I learn more?

• Ask your healthcare provider. He or she can give you the vaccine package insert or suggest other sources of information.

• Call your local or state health department.

• Contact the Centers for Disease Control and Prevention (CDC):- Call 1-800-232-4636

(1-800-CDC-INFO) or- Visit CDC’s website at

www.cdc.gov/flu

Vaccine Information StatementInactivated Influenza Vaccine 42 U.S.C. § 300aa-26

08/07/2015 Office Use Only