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Medical Advicefor Parents

A Collection of

By the doctors of

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TABLE OF CONTENTSFeeding Your Child Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Mom’sHealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Back to Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 StoringBreastMilk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 BottleFeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Vitamins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 SolidFoods Newbornto6months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 6to9months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 9to12months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1 to 3 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Baby Hygiene Bathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Diaper Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 UmbilicalCord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 DentalCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Infant and Child Safety SleepingQuarters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 SleepPosition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 FireSafety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Toy Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 SunSafety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 InsectRepellant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 BurnPrecautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 ChildProofing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 AvoidChoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

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Babysitters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 CarSeatGuidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17The Family Fathers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 BrothersandSisters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Telephoning the Doctor When . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 How . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Specific Problems Jaundice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Colds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Crying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Lacerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 PunctureWounds,IncludingAnimalBites . . . . . . . . . . . . . . . . . 23 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 HeadInjuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 MouthInjuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Choking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 FracturesorDislocations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 EyeInjuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 NoseBleeds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Medicine Antibiotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Resources ParentingBooks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 VaccineEducation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Immunizations and Preventive Care Schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 VaccinePolicy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

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FEEDING YOUR CHILDThebestformofnutritionforyournewbabythroughthefirstyearoflifeishumanmilk.Ifyouprefertobottlefeed,youshoulduseiron-fortifiedinfantformula.Anyformofmilkforyourbabyshouldbecarefullydiscussedwithus.

BREASTFEEDINGBenefitsBreastmilkistheeasiestmilkforbabiestodigestandithasjusttherightamountofnutrientstohelpababygrow.Italsocontainssubstancesthathelppreventinfectionsandmaypreventtheearlydevelopmentofallergies.Mom’smilkisalways“readytofeed,”cleanandattherighttemperature.Breastfeedingalsocostslessthanformulafeeding.Breastfeedingbringsamotherandbabytogetheremotionallyaswellasphysically,andmostmothersfinditveryrewarding.

Mom’s HealthBreastfeedingmothersshouldeatawell-balanceddietandcontinuetotakeaprenatalvitamin.Momsofnursingbabiesshouldconsumeatleast2000-2200caloriesperdayandeatadietthatishighinproteinandcalcium.Becausetimeandenergyareinshortsupplyforanewmother,eatingnutritioussnacksthroughoutthedaycanbehelpful.Examplesofsnacksincludebagelswithcreamcheese,celerywithpeanutbutter,cheeseandcrackers,fruit,hard-boiledeggs,andyogurt.Drinkingplentyoffluidsthroughoutthedayisalsoimportantforthebreastfeedingmotherandthebaby.Momshouldgetintothehabitofdrinkingfluidseachtimeshenurses.Water,fruitjuices,vegetablejuices,milk,andsoupareallexamplesoffluidsthataregoodforthemother.Consuminglargeamountsofcaffeineisnotrecommendedbecauseitcancausejitterinessinthebabyandalsodecreasetheironcontentofthebreastmilk.Alcoholshouldbeavoidedbecauseitmayinterferewiththemother’smilklet-downandispotentiallyharmfultothebaby.Occasionaluseofsmallamountsofalcoholneednotbeavoided,butregularuseisdiscouraged.

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Smokingshouldbeavoidedbecauseitinterfereswiththemilklet-downreflexanddecreasesthemother’smilksupply.

Manyofmom’smedicationscanbetransmittedtotheinfantthroughthebreastmilk.Pleaseletusknowifmomistakingorplanningtotakeanymedicationswhilebreastfeedingbecausesomemedicationsmaybeharmfultothebaby.

Itiscommonforbreastfeedingmotherstofindthattheirnipplesaresoreduringthefirstfewdaysofnursingtheirnewborn.Thisusuallydisappearsafterthefirstorsecondweekofnursing.Ensurethatthebabyislatchedonappropriatelytohelppreventsore,crackednipples.Avoidtheuseofsoapandalcoholonthebreastsornipplesandleavethenipplesopentoairasmuchaspossible.Applyinglanolincreamoralittleexpressedbreastmilktothenipplemayhelpwithhealing.Breastsalsomaybecomesoreduetoengorgement.Engorgementcanoccurifmilkisnotadequatelyremovedfromthebreaststhroughnursing.Ifmom’sbreastsbecomeuncomfortablyfull,feedthebabymoreoften(i.e.8-12timesin24hours),soakaclothinwarmwaterandapplytothebreastortakeahotshowerbeforenursing.Massagingthebreasts,usingrelaxationtechniquesbeforeandduringbreastfeedinganddrinkinglotsoffluidsmayalsohelp.Ifthebreastsarepainful,redorhotorifmomhasfeverorbodyaches,thiscanbeasignofabreastinfectioncalledmastitis.Ifmomisexperiencingthesesymptoms,sheshouldcontactherdoctor.

MethodsMakesurethatthebabyisawakebeforeattemptingtonurse.Stimulatetheinfantbychangingthediaper,undressingorunwrappingtheinfant,orwashingtheinfant’sface.Correctpositioningandlatchtechniqueswillhelppreventinjurytothenipples.Threepositionsareusedforeffectivebreastfeeding:thecradleposition,thefootball/clutchposition,andtheside-lyingposition.Foreachposition,useapillowortwotoensurepropertechnique.Tobeginthenursingsession,momshouldsupportthebreastwiththehandina“C”oran“L”positionwiththethumbontopofthebreastandfingersbelowtheareola(the

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darkerportionsurroundingthenipple).Touchingthelipsofthebabywiththenippleorstrokingtheinfant’scheekoftenstimulatestheinfanttoopenitsmouthwidelyandsuck.Keepinmindthatwhenababyiscorrectlypositioned,thenippleandmuchoftheareolaarepulledwellintothebaby’smouth.Thetipofthebaby’snoseshouldbetouchingthebreast.Infantsshouldfeedfrombothbreastsateveryfeeding,alternatingwhichbreastisofferedfirst.Burpthebabybeforeswitchingtotheotherbreastandattheendofthefeeding.Neverpullthenippledirectlyfromthebaby’smouth.Alwaysbreakthesuctionbyplacingacleanfingerinsidethebaby’smouthandgentlypushingdownonthebaby’schin.Donottakethebabyawayuntilyoufeelthesuctionbreak.Foracoupleofdays,feedingsshouldgraduallyincreaseasmom’scomfortandbaby’sdesireallow.Thenursingtimeshouldbegraduallyincreasedasthebaby’sdemandincreasesandmom’snipplesbecomeconditioned.Thelengthoftimeinfantseatisquitevariable.Breast-fedinfantsseemmostsatisfiedwhentheynurse8ormoretimesin24hours.Toensurethatthebabyisgettingenoughbreastmilk,parentsshouldlookfor6to8wetdiapersand3to4yellowseedystoolsperday.Ifyouhavequestionsorfeelthatthebabyislosingtoomuchweight,pleasecall.Weprefertoseeallinfantsintheofficeat4-5daysofage,orsoonerifthereisaproblem.

Back to WorkAbreastpumpisamustformomswhoplantoreturntoworkwhilestillbreastfeeding.Itispossibletorentorpurchaseyourownmanualorelectricbreastpump.Afteryourmilkiswellestablishedandthebabyisnursingwell,itisokaytointroduceabottletothebabyataround4to6weeks.Thiswillhelpprepareyourbabyforthetransitiontobottlefeedingduringthedaywhileyouareatwork.Becausetheinfantassociatesfeedingwithmom,thebabywillinitiallytendtoacceptabottlebetterifitisgivenbysomeoneelse.Familiarizeyourselfwiththeprocessofpumpingandhelpbuildyourmilksupply1to2weeksbeforereturningtowork.Itishelpfultotrytousethesamepumpingschedulethatyouwilluseatwork.Infantsleftwithdadorasitterforaneveningcanalsobefedexpressedmilkfromabottle.Manyfathersenjoytheopportunitytobondwithandfeedtheirinfant.

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Storing Breast MilkMilkmanuallyexpressedthroughpumpingshouldbeputinsterilizedordishwashercleansedcontainers.Milkthatwillbeusedwithin24hoursshouldberefrigerated,otherwiseitshouldbefrozen.Frozenbreastmilkcanbestoredforupto3monthsinarefrigeratorfreezerorforupto6monthsinaseparatedeepfreezethatmaintainsatemperatureof0degreesFahrenheit.Storebreastmilkindividuallyinsmallamountssothatonlythebreastmilkthatisneededisdefrostedandused.Anybreastmilkthatisthawedandnotusedwithin24hoursshouldbediscarded.

BOTTLE FEEDINGForsomemothers,breastfeedingwillnotbepossibleordesirable.Inthesecases,thebabyshouldbefedanironfortifiedformula.Ironfortifiedformulascomeinpowder,concentrate,andready-to-feedforms.Therearealsomanydifferentbrandsandtypesofformula.Pleasecallourofficebeforemakinganychangesinyourbaby’sformula.

MethodsForthefirstfewdaysnewborninfantsusuallydrink1-2ouncesateachfeeding,andforthefollowing2monthsmostbabiesdrink2-4ouncesevery3-4hours.Babiesgraduallyincreasetheamountofformulatheywant.However,eachbabyisdifferent,andtheywillnotalwayseatthesameamounteverytime.Ageneralguidelineforatwo-montholdbabyistodrink4-6ounces,andforafour-montholdbabytodrink6-8ouncesateachfeeding.Donotfeedyourbabymorethan8ouncesatafeeding,evenifheorshestillseemshungry.Aninfant’sstomachwon’tcomfortablyholdmorethan8ounces.Also,donotpropthebottleinyourbaby’smouth.Holdingyourbabyduringfeedingsisawonderfulwaytobondwithyourbabyandwillhelppreventearinfectionsandchoking.

VITAMINSBreastfedinfantsandinfantsreceivinglessthan32ouncesofformulaperdayshouldreceiveavitamin(Poly-Vi-Sol®,Tri-Vi-Sol® or

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D-Vi-Sol®)onceadaytopreventvitaminDdeficiency.Thesecanbepurchasedatyourlocalpharmacy.

SOLID FOODSNewborn to 6 months of ageBabieswillbehappyandhealthyonformulaorbreastmilkaloneuntil4monthsofage.Between4and6monthsofagetheymaybegineatingsolidssuchasvegetablesandfruits.Addingcerealtoabottlewillnothelpyourinfantsleeplongerandisnotrecommended.

6 to 9 months of ageAt6monthsyourbabyshouldbeeatingsoftfoodssuchasvegetables,fruits,eggs,meatsandcereals.Avoidfoodsthatmightcauseyourchildtochokesuchasnuts,popcorn,chips,candy,hotdogs,frozenpeas,rawvegetables,grapesandraisins.Donotgiveyourbabyhoney.Smalltastesofpeanutbuttermaybeofferedoritmaybemixedinwithotherfoods.Ifyouarewarmingfoodinamicrowave,alwaysstirthefoodtoprevent“hotspots.”Introduceacuptoyourbabyat6months.Offer4-6ouncesofwaterdaily.

9 to 12 months of ageManybabiesbegintoweanfromthebreastorbottleduringthistimeandthereforebreastmilkorformulashouldbeofferedinacupwitheachmeal.Atthisagechildrenshouldeat3mealsand2-3snacksdaily.Provideregularmealtimesandofferavarietyoftablefoodsbutcontinuetoavoidhoneyandthechokinghazardslistedabove.Yourchildmaybegintoprefertofingerfeedthemselvesatthisageratherthanbefedwithaspoon.Tinypiecesoffish,tenderchickenbites,shavedturkey,finelygroundhamburgerandeggsareexcellentforthisagegroup.Offeratleast5servingsoffruitsandvegetablesdaily.

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1 to 3 years of ageAfterthefirstbirthday,yourbabyshoulddrinkwholemilkorbreastmilkanddiscontinuethebottle.Yourchildshoulddrink3-4servingsofmilkdaily.Continuetooffer3meals,2-3snacks,andatleast5servingsoffruitsandvegetablesdaily.Startingatage2yearsyourchildshouldswitchtoskimor1%milkandmaydrink4ouncesof100%fruitjuiceonceaday.Avoidfoodsthatmightcauseyourchildtochoke.Foodsshouldalwaysbecutintosmallpieces.Hardcandy,nuts,popcorn,hardrawvegetables,grapesandhotdogsarechokinghazardsandarenotrecommended.

BABY HYGIENEBATHINGWhenbathingyourbaby,useamildsoapsuchasSensitiveSkinDove®,orsmallamountsofbabysoapsuchasJohnson’s® Baby Wash.Spongebathetheinfantuntilthecircumcisionandumbilicalareaarewellhealed.Afterthat,tubbathsmaybegiven.Testthewatertemperatureonthetenderpartofyourarm.Never,foranyreason,leavethebabyunattendedinthebathtub.Shampooyourbaby’shairwitheachbathtohelppreventcradlecap.Theouterearsmaybecleanedwithawashclothbutdonotputanythinginyourbaby’searcanals.Toavoiddryskin,youmayusemoisturizingcreamssuchasVaseline®,Eucerin®orAquaphor® .

DIAPER AREAChangewetordirtydiapersassoonaspossiblebecausefrequentdiaperchangesmayhelppreventdiaperrash.Letyourinfant’sskinairdrybeforeapplyinganewdiaper.Ifyourbabyhasarash,applyVaseline® or Desitin®liberallyafterairdryingtheskin.Donotusebabypowder .

UMBILICAL CORDItisimportanttokeeptheumbilicalcordcleananddry.Keepthediaperedgefoldeddownbelowthecordandgiveyourbabysponge

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bathsinsteadoftubbathsuntilthecordfallsoff.Afterthecordfallsoff,theremaybeasmallamountofbloodydischargefromtheumbilicalareafor1-2weeks.Contacttheofficeifthereisfoul-smellingorpersistentdrainagefromtheumbilicusorrednessoftheskinaroundtheumbilicalcord.

CIRCUMCISIONCircumcisionisanelectiveprocedureandisdoneattheparents’request.Manyboysarenotcircumcisedandhavenoproblemswithmaintaininggoodhygiene.Ifyouchoosetohaveyoursoncircumcised,careofthepeniswilldependonwhichtypeofcircumcisionisperformed.IfaPlastibelldevicewasnotused,applyVaseline®andgauzetotheheadofthepenistopreventitfromstickingtothediaper.IfaPlastibellwasused,noVaseline®orgauzeisneeded.Afterthecircumcisionhashealed,youwillthenneedtopullanyremainingforeskinbackandcleanaroundittopreventitfromstickingtotheheadofthepenis.Ifyouchoosenottohaveyoursoncircumcised,gentletractionontheforeskinshouldbedoneforcleaningpurposes.Donotforciblypulltheforeskinback.Theforeskinwillusuallynotbeabletoberetractedcompletelyuntil4-6yearsofage .

DENTAL CAREAbaby’sfirsttoothwillusuallyeruptbetween4and12monthsofage.Atthistimeyoushouldbeginbrushingwithatinydaboffluoridetoothpasteandasofttoothbrush.Topreventcavities,donotputyourchildtobedwithabottleandalwaysbrushteethafterbreakfastandbeforebedtime.Yourchildshouldstartseeingadentistatoneyearofage .

INFANT AND CHILD SAFETYAccidentsarebyfarthemostcommoncauseofdeathinchildren.Mostofthesedeathscanbeprevented.Herearesometips.

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SLEEPING QUARTERSSleepingwithyourbabyisdangerous.Donotputanythinginthecribwithyourbaby.WerecommendwarmsleepersratherthanblanketsbecauseblanketuseinsmallinfantshasbeenlinkedtoSIDS(SuddenInfantDeathSyndrome).Bumperpadsshouldnotbeused.Infantsshouldsleepincribswhichhavenolooseobjectsorpotentiallydangerousattachments.Cribbarsshouldbenomorethan2-3/8inchesapartandcribrailsshouldbekeptupwhentheinfantisinthebed.Movethemattresstothelowestpositionwhenyourbabycanpushuponhandsandknees.Becarefulnottoplacethecribnearwindows or cords .

SLEEP POSITIONToreduceyourbaby’sriskofdyingfromSIDS(SuddenInfantDeathSyndrome),putyourbabyonhisorherbacktosleep.Donotusesleeppositionersanddonotputyourbabyonhisorhersideforsleep.Despitecommonbeliefs,thereisnoevidencethatchokingismorefrequentamonginfantslyingontheirbackswhencomparedtootherpositions.Weencourageyoutoplaceyourbabyonhisorhertummywhileawaketoreduceflatteningofthebackoftheheadandtostrengthenarmandchestmuscles.

FIRE SAFETYInstallsmokedetectorsoutsideeverybedroom,infurnaceareas,andoneverylevelofyourhome,includingthebasement.Changethebatteriesatleastonceayear.Werecommendahomefireextinguisher,flameretardantinfantclothingandafamilyfireescapeplan.Practicetheescapeplanfrequently.Keepmatchesandflammableliquidsinasafeplace.

SMOKINGExposuretocigarettesmokeisthesinglegreatestcauseofillnessinchildren.ChildrenexposedtocigarettesmokehaveamuchgreaterriskofSuddenInfantDeathSyndrome(SIDS),earinfections,asthmaandrespiratoryinfections.Studiessuggestthatachildwhospends24hourswithsomeonewhosmokesonepackadayisequivalentto

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achildsmokingthreecigarettes.Similarly,achildwhospendsonehourinacarwithsomeonewhosmokeswiththewindowsrolledupisequivalenttothechildsmokingthreecigarettes.Pleasequitsmoking.

TOY SAFETYToysshouldbeageappropriate.Followthemanufacturer’sagerecommendationsandreadtheinstructionscarefully.Ingeneralachild’stoyshouldbelargerthanhisorhermouthandshouldnothaveloosepartsthatcouldcomeoffandcausechoking.

SUN SAFETYUseasunscreenthatis“broadspectrum”andhasanSPFofatleast15.Forchildrenunder6monthsolditisbesttokeepthemoutofdirectsunlightanduseprotectiveclothingsuchasahatandlightweightlongsleevesandpants.However,youmayusesunscreenonhandsandface.Forchildren6monthsandolderyoushouldapplysunscreentoallareasofexposedskin.Sunscreenshouldbeapplied30minutesbeforegoingoutsideandreappliedevery2hours.Encourageyourchildtowearahatandsunglasses.

INSECT REPELLANTInsectrepellantmaybeusedonchildren2monthsandolder.Usearepellantwithnomorethan30%DEET.Using10%DEEToffers2hoursofprotectionand24%DEEToffers5hoursofprotection.Becarefulnottosprayyourchild’sface.Instead,rubtherepellantonyourhandsfirstandthenontoyourchild.

BURN PRECAUTIONSToddlersoftenturnonwaterandareunabletotellhotfromcoldjustbylooking.Becauseofthis,toddlersmayburnthemselvesorothersiblings.Adjustyourhotwaterheatersothewatertemperaturedoesnotexceed120degrees.Itonlytakestwosecondsofexposureto160degreewatertocauseafull-thicknessburn,whileittakestwominutesat120degrees.Watertemperaturecanbecheckedwithameatthermometer.Donotdrinkcoffeeorotherhotbeverageswhileholdingababyanddonotleavehotdrinksunattendediftoddlersarearound.

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Besureallpothandlesareturnedawayfromthefrontofthestove.Donotletchildrenremovehotliquidsfromthemicrowaveoven.Keepchildrenawayfromirons,hairappliancessuchascurlingironsandhairstraighteners,grills,campfires,fireworksandhotmufflers.Donotsmokewhileholdingyourbaby.

CHILD PROOFINGNewborninfantsarecertainlynotmobile,butitdoesn’ttakethemlongtobeginmovingaround.Itisagoodideatostartchildproofingyourhouselongbeforeyouactuallyhavetoworryaboutcuriouschildren.Electricaloutletsshouldbekeptcoveredorfittedwithsafetyplugs.Electricalcordsshouldbetackeddownwheneverpossible,aschildrenlovetopullandchewonloosecords.Medicationsandcleaningproductsorotherpoisonousitemsshouldbeproperlylabeledandkeptinchildproofcabinetsupandoutofachild’sreach.Neverputnonfooditems(likebleachorgasoline)inacupordish.Stairsshouldbeblockedwithgatestopreventfalls.Allfirearmsandammunitionshouldbekeptseparateandinlockedcabinets.CallthePoisonControlCenterat1-800-366-8888foranysuspectedpoisoning .

AVOID CHOKINGHaveabulbsyringeavailableincaseyourinfantspitsupandischoking.Nevertieanystringaroundachild’snecktoattachapacifier.Children,especiallythoselessthanoneyearold,mayeasilybecomestrangled.Donotputjewelrysuchasrings,necklacesorearringsonyourbaby.Childrenlessthanthreeyearsoldshouldneverbegivenitemslikepeanuts,popcorn,gum,grapes,orhardcandywhichareeasytochokeonandmaycompletelycloseoffachild’ssmallairway.Hotdogs,ifgiven,shouldbecutinhalflengthwiseandtheninsmallpieces.Alwayssitwithyourchildrenwhiletheyareeatingsoyoucancloselymonitorforchoking.Allchildrenshouldbeencouragedtochewtheirfoodwell.Donotletyourchildsuckorchewonballoons,asthesemaybreakandlodgeinachild’sairway.

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SUPERVISIONChildrenneedconstantattention.That’showtheyknowyoucare.Apatonthebackwhileyourchildisplayingnicelyiseasytodoandmeansalottoyourchild.Childrenshouldneverbeleftunattendedatanytimeathomeorinacar.Toddlersshouldhaveclosesupervisionaroundinfants,astheymayeasilyhurtthebaby.Petsshouldnotbearoundinfantswithoutsupervision.Neverleaveachildaloneinthebathtub.

BABYSITTERSTakingtimeforeachparent’spersonalneedsisanecessity.Beforeleavingyourchildwithasitter,makesurethesitterknowsyouraddressandphonenumber,thetelephonenumberofouroffice,thenumbertocallincaseoffireorhealthemergency,thenumberofyournextofkin,thetelephonenumberofsomenearbyfriendlyneighborsandthePoisonControlnumber.Ifpossible,leaveanumberwhereyoucanbecontacted.

CAR SEAT GUIDELINESCarseatssavelivesandarerequiredbylaw.CarseatsshouldbeinstalledtightlyusingthevehicleseatbeltorLATCHsystem.Thereshouldbenomorethanoneinchofmovementsidetosideorfronttoback.Alwaysreadthecarseatmanufacturer’sinstructionmanualandyourvehicleowner’smanualforspecificinstallationinstructions.ForcompleteguidelinesfromtheAmericanAcademyofPediatricsvisitwww.healthychildren.organdsearchfor“CarSeats”.

Allchildrenunder2yearsoldshouldriderear-facing.Youmayswitchfromaninfantseattoaconvertiblecarseatbeforeage2yearsaslongasyourchildremainsrear-facingandfitstheheightandweightrequirementsoftheseat.Allchildrenyoungerthan13yearsshouldrideinthebackseat.Acarseatmustbereplacedifithasbeeninamoderateorseverecrash.Considerreplacingseatsthathavebeeninaminorcrash.

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Infants/Toddlers(Birthto2years)Weight/Height Requirements:Makesureyourchildfitswithintheweightandheightlimitsofthecarseat.

Types of Seats:Rear-facingonlyseat,ConvertibleseatSeat Position:Rear-facingInstallation Tips:Harnessstrapsshouldslidethroughtheslotsthat

are atorbelowshoulderlevel.Strapsshouldfitsnuglyagainstyourchild.Makesuretheseatisatthecorrectanglesoyourchild’sheaddoesnotflopforward.

Toddlers/Preschoolers(2and3yearolds)Weight/Height Requirements:Makesureyourchildfitswithintheweightandheightlimitsofthecarseat.

Types of Seats:Convertibleseat,Forward-facingonlyseat,Combinationseatwithharness

Seat Position:Forward-facingInstallation Tips:Harnessstrapsshouldslidethroughtheslotsthat

are at or aboveshoulderlevel.Someseatsrequireusingthetopharnessslotfortheforward-facingposition.Also,youmayhavetoadjusttheangleoftheseat.

Young Children(4to12yearolds)Weight/Height Requirements:Childrenshouldremaininaboosterseatuntiltheseatbeltfitsproperly,typicallywhentheyare4feet9inchestallandbetween8and12yearsofage.Theyshouldbeabletousejusttheseatbeltwhentheycanridewiththeirkneesbentattheseatedgewithoutslouchingandwiththeirseatbeltlowacrosstheirupperthighsandsnugacrosstheirshoulderandmiddlechest.

Types of Seats:Highbackboosterseat,BacklessboosterseatSeat Position:Forward-facingInstallation Tips:Belt-positioningboosterseatsmustbeusedwithbothlapandshoulderbelts.Makesurethelapbeltfitslowandsnugacrossyourchild’supperthighs.Theshoulderstrapshouldcrossthemid-chestandshoulder.

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DISCIPLINEParentsareteachers.Themaingoalofparentingistoteachchildrenwhattheyshoulddo.Thebest“discipline”istorewardpositivebehaviorswithattentionandencouragement(TIMEIN).TIMEOUTcanthenbeusedwhennegativebehaviorsoccur.Forexample,discipliningachildwhoaccidentallyknockshisglassoverisuseless,whilediscipliningachildwhopurposelydumpshisglassisappropriate.YouwillfindthatthemoreyouutilizetheTIMEIN,thelessyoushouldhavetousetheTIMEOUT.Askusifyouhaveanyquestions.Manygoodbooksareavailableonthissubject.

THE FAMILYFATHERSMothersdonothaveamonopolyoninfantcare.Theonlythingdadscan’tdoisbreastfeed.Feeding,bathing,andchangingthebabywillgofarinestablishingacloserelationshipbetweenfatherandnewborn.Pitchin,dad!Youwillreaprewardsfromallcornersifyoudoyourshare.

BROTHERS AND SISTERSSiblingswillbejealousofanewbaby.Ifthatisacceptedandnotinterpretedas“bad,”itwillpassmorequickly.Itisnotuncommonforsiblingstodevelopoldhabits,suchaswantingabottleorpacifier,whenthenewbabyarrives.Patienceandlotsofattentionwillusuallysuffice.Grandparentsandothervisitorsshouldbeencouragedtotalkwiththeolderkidsfirstbeforepayingattentiontothenewbaby.Makeanyplannedchangesforolderchildren,likemovingtodifferentbedsandrooms,beforethenewbabycomeshome.

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TELEPHONING THE DOCTORWHENIfyourchildhasasuddenonsetofillnessorinjurythatyoufeelisdangerousorcausingsignificantdiscomfort,feelfreetocallusanytime.Callsaboutchronicornon-emergentproblemsshouldbereservedforofficehoursonly.Feveraloneisnotanindicationtocallusafterofficehoursunlessyourchildislessthan2monthsold.Itisimportantforustoknowifyourchildhastroublebreathing,astiffneck,severepain,troublewalking,irritability(extremefussiness)orlethargy(verysleepyornotrespondingappropriately).Vomitinganddiarrhea,exceptinsmallbabies,canusuallywaituntilthenextday(seethesectiononSPECIFICPROBLEMS).

HOWCallourofficeat816-228-4770.Ifyouarecallingafterhours,theansweringservicewillnotifyapediatricnurseoroneofourphysicians.Weareavailable24hoursaday.Beforeyoucall,pleasehaveyouchild’sage,weight,temperatureandpharmacyphonenumberready.Writedownyourquestionsandbereadytowritedowntheinstructions.

SPECIFIC PROBLEMSJAUNDICEJaundiceistheyellowcoloroftheskinandeyesofmanynewborninfants.Itoccurswhenachemicalcalledbilirubinbuildsupinthebaby’sblood.Thisoccursinallbabiestosomeextent.Beforebirth,mom’sliverremovesallthebilirubin,andafterbirthittakesabout5-6daysforthebaby’slivertostartremovingbilirubin.Mostbabieshavelowlevelsofbilirubin(mildjaundice)whichisharmless,butoccasionallythelevelcanbeveryhighandcausebilirubintobuildupinthebrainandotherorgans,causingdamage.Beforeleavingthehospital,abloodtestwillbeperformedtocheckyourbaby’sbilirubinlevel.Lowlevelsofbilirubincanbemonitoredbyinspectionofskin

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colorintheoffice.Middlelevelsmayneedtobefollowedbyrepeatbloodtests,sometimesforseveraldaysinarow,toassurethattheleveldoesnotgotoohigh.Higherlevelsaretreatedeitherathomewithabilirubinblanket,orinthehospitalunderspeciallightsdesignedtohelptheskingetridofthebilirubin.Thesehigherlevelsalsoneedtobefollowedcloselywithbloodtestsonadailybasisuntiltheyfalltoasafelevel.Itisimportanttomakesureyourbabyiseatingwellandhasplentyofwetanddirtydiapers.Callourofficeifyourbabyisnoteatingwell,isdifficulttowakeup,isnothavingwetordirtydiapers,ortheyellowcolorseemstobeworsening.Jaundicecanbeaveryseriousproblemandclosefollowupwithin2-3daysofdischargeisimportant .

FEVERAnychildlessthan2monthsoldwitharectaltemperatureofgreaterthan100.4degreesshouldalwaysbeseenbyaphysician.Inchildren2monthsandolder,feverlessthan106degreesmaymakethechildveryuncomfortable,butisnotharmful.Infact,theAmericanAcademyofPediatricsPolicyStatementonFeverinChildrenstatesthatfeverlessthan107degreesisnotharmful.Feverusuallymeansthebodyisfightinganinfectionanditcanbeavaluablesign.

Treatment for Fever• DoNOTbatheinalcohol.Thisisdangerous.• DoNOTbatheincoldwater.• DoNOTwakeapeacefullysleepingchildtogivefevermedicines.• DoNOTbundleupafeverishchild.• DoNOTfighttogetthetemperaturetonormal,especiallyinachildoverthreeyearsofagewithnohistoryoffebrileseizures.

• DOcoverthebodywithlightclothingonly.• DOspongeyourchildwithalukewarmwetwashcloth.• DObatheyourchildinlukewarmwater.Neverleaveyourchildunattendedinthebathtub.

• DOoffercolddrinks,popsicles,andicechipstochildren9monthsandolder.

• DOgivefever-reducingmedicineifthechildis2monthsorolder.

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Forchildren2monthsandolder,acetaminophenmaybegiveneveryfourhoursasneededforfever.Ifyourbabyislessthan2monthsofage,donotgiveacetaminophen.Callyourdoctorimmediately.Ibuprofenmaybegiventochildren6monthsandolder.Pleaseaskusifyouhavequestionsaboutthecorrectdoseofmedication.Yourgoalshouldbetogetthetemperaturelessthan102degreesrectally.

VOMITINGDonotofferanyfluidsforaboutonehouraftervomitingstarts.Thenofferonlyelectrolyte-basedsolutionssuchasPedialyte®.Gatorade®,particularlythe“G2”variety,maybegivenifthechildwon’ttakePedialyte®.Feedthechildsmallquantitiesoften.Startbyhavingthechildtakesmallsipsandthenincreaseto1⁄2to1ounceevery30minutes.Strivetogive2or3ouncesoffluidperpoundofbodyweightper24hours.Whenvomitingdecreasesandthechildistoleratingclearliquids,youmayoffersmallamountsofregularfoodastolerated.Advancethedietastolerated.

Forinfantsnotyetonsolidfoods,offersmallamountsofformulaoncethePedialyte®isstayingdown.Breast-fedinfantsshouldberestartedonthebreastassoonaspossible.Forolderinfantsandchildren,milkorformulamaybegivenoncethechildistakingclearliquidswithoutdifficulty.

DIARRHEADiarrheainchildrenmaylastuptoaweekormore.Thechildmayappearveryillorplayhappilyandseemquitenormal.Donotbeconcernedifthechild’sstoolsarenotofnormalconsistency(andthechildseemsfine,otherwise),asthismaybethecaseforuptotwoweeks.Ifnovomitingispresent,feedthechildanormaldiet.Insomecases,milkandjuicesmayaggravatethediarrhea.Yogurtwithactivecultures,however,mayhelpdiarrheaimprove.Ifyourchildcontinuestohaveaproblemwithdiarrheaafterafewdays,youshouldcontactthedoctor.

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When to See the Doctor• Ifyouryoungbabyhasvomitingorhasfeveranddiarrhea.• Ifyourchildhasbloodorpusinhisorherstool.• Ifyourchilddoesnotwet(urinate)for12hoursduringtheday.• Ifyourchildhasadrymouthortongue.• Ifyourchildseemsunusuallysleepy,cranky,orirritable.

Be Prepared to Answer These Questions• Howmanytimeshasyourchildvomitedinthepast24hours?• Canyourchildkeepdownclearliquids?• Howmanytimeshasyourchildurinatedinthepast24hours?• Howmanystoolshasyourchildhadinthepast24hours?•Hasyourchildingestedanypoisonsormedicine?•Doesyourchildhaveabdominalpain?•Doesyourchildhaveafever?•Howsickdoesyourchildlookbetweenspells?

COLDS(UpperRespiratoryInfections)Coldsarecommoninchildren,anditisnormaltohaveseveralcoldsperyear.Acoldconsistsofcough(usuallyworseatnight),runnynoseandsneezing.Childrensleeppoorlyandmaybeirritablewhentheyhaveacold.Fevermaybepresent.Acoldmaylastfromseveraldaystotwoorthreeweeks.Childrenwho“always”haveacoldprobablyhavesomethingelsesuchasanallergy.Newbabiesfrequentlysneezeandcoughwithoutbeingill.

What to do for a ColdUsearubberbulbsyringetocleanoutayoungbaby’snose.Salineorsalt-waternosedropsmaybeusedtomoistensecretionssotheycanberemovedeasily.Tomakeyourown,use1/4teaspoonofsaltto1cupoflukewarmwater.Youmayalsopurchasesalinenosedrops.Twotothreedropspernostrilfollowedbysuctioningwithabulbsyringewillbeespeciallyhelpfultorelievecongestionbeforefeedingand bedtime .

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MedicinesOver-the-countercoughandcoldmedicinesarenotrecommendedforchildrenunder4yearsofagebecausetheycancauseserioussideeffects.Afterage4yearstheymaybeusedifrecommendedbythedoctor.Acetaminophenmaybeusefulforachesorfeverinchildren2monthsandolder.Ibuprofenmaybeusedforachesorfeverinchildren6monthsandolder.

Call the doctor when your child has a cold if he or she has:• Fevergreaterthan100.4degreesininfantslessthan2monthsold• Fevergreaterthan104degreesinchildren2monthsandolder•Wheezingortroublebreathing• Rapidbreathing• Persistentcryingorwhining,especiallyatnight• Pusintheear• Failuretodrink• Continualdrowsiness• Extremeirritability• Coldlastingmorethanthreeweeks

CRYINGNewborninfantswillcryabouttwohourseachdaynomatterwhatyoudo.Newbornssleepuptotwentyhoursaday,whichmeansthathalftheirwakingtimeisspentcrying.Theircryingtimeincreasesuntilthebabyissixtoeightweeksold,peakingoutataboutthreehourseachday.Afterthat,thetimespentcryinggraduallydecreases.Forunknownreasons,infantsusuallycrymoreintheeveningsthanduringtheday.Youwillprobablybeabletoidentifyatimethatyourbabygetsfussymosteveryday.Whenthebabycries,makesurethebabyisnothungryorinneedofadiaperchange.Ifthebabyseemsfine,exceptforthecrying,trynottoworry.Cryingistheonlyexercisenewbabiesget!Infantswhoarecryingandunabletobeconsoledorhaveothersymptomslikefeverorvomitingshouldbeseenbythedoctor .

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CONSTIPATIONBabiesnormallygruntandstraintohavebowelmovements.Ifstoolsareformed,butnothard,andoccurthreeorfourtimesperweek,thebabyisprobablynotconstipated.Ifconstipationispresent,youmaytryadding1teaspoonofMolassespertwoouncesofformulainoneormorebottlesperdayuntilsoftstoolsoccur.Thismaycausediarrheasodon’toverdo!Letusknowatthewellbabyexamifthisisachronicproblem.

LACERATIONSIndeep,dirtywounds,allowbleedingtocontinueforafewsecondstocleansethewound.Stopprofusebleedingbyapplyingfirmpressuredirectlyonthewound.Donotuseatourniquetinanysituation.Useacleanhandkerchief,cloth,orhandtoapplypressure.Ifbleedingisnotsevere,washthewoundwithalargeamountoftapwaterandmildsoap.Applyabandageandcalladoctor.Ifthebleedingisundercontrol,mostlacerationsarenotemergencies.Suturingmaybedoneassoonaspracticalwithinasixhourperiod,eitherintheofficeortheemergency room .

PUNCTURE WOUNDS, INCLUDING ANIMAL BITESPuncturewoundsshouldbewashedimmediatelywithlargeamountsoftapwaterandsoap.Letthewoundbleedfreelyforamoment.Leavethewounduncoveredwhenbleedinghasstopped.Woundsshouldbesoakedinwarmsoapywaterfourtimesadayuntilwellhealed.Seethedoctoriftheareaseemsveryred,warmoranypusispresent.Ifyourchildhasnothadatetanusshotwithintheprecedingfiveyears,oneshouldbeobtainedwithin48hoursaftertheinjury.Incaseofanimalbites,notifythelocalpolicedepartment.

SEIZURESSeizuresmaybeoneofthemostfrighteningemergencies,buttheyareusuallynotasseriousastheyappear.Staycalm.Sincethechildwillbeunconscious,placehimorherinasafeplaceonthefloor,withheadturnedtoonesideincasevomitingoccurs.Thechildwill

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appearsomewhatblue,andrespirationswillbeshallow.Ifthechildisnotbreathing,call911.Alwaysseeadoctorafterthefirstseizure,andalwayscallthedoctornomatterhowmanyseizuresthechildmayhavehadpreviously.Seizuresusuallylastnomorethanfivetotenminutes.Feverisacommoncauseofseizuresinchildren.

HEAD INJURIESIfyourchildisunconscious,evenbriefly,duetoaheadinjury,thechildmustbeevaluatedbyadoctor.Ifthereisnolossofconsciousness,thechildmayormaynothavetobeseen,dependingontheseverityoftheblow.Thechildshouldbeawakenedduringthenighteverytwohours,andshouldseemtorecognizetheparentsandrespondnormally.Thepupilsshouldbeequalinsize,andbothshouldbecomesmall(constricted)whenalightisdirectedintothem.Oneepisodeofvomitingcommonlyfollowsheadinjuriesinchildren.Thevomitingisusuallyduetonauseaandisnotserious.Ifachildvomitsmorethanonceorseemsunusuallysleepy,heorsheshouldseethedoctor.

MOUTH INJURIESMouthinjuriesarecommoninchildrenandordinarilynotnearlyasseriousastheyfirstappeartobe.Itisrarelynecessarytoplacestitchesinthemouthortongue.Theoralcavityishighlyvascularand,therefore,bleedsprofusely,butitlikewisehealsquicklywithverylittlescarring.Thetreatmentinvolvesapplyingpressuredirectlyonthepointofbleedingfor5minutes.Mouthinjuriesshouldbecheckedforlooseorbrokenteeth.Injurytobabyteethshouldhavedentalattentionsoon.Injurytopermanentteethismoreseriousand,ingeneral,adentistshouldbecalledassoonaspossible,particularlyifatoothhasbeenloosened.Frontteeththatarealmostoutcanoftenbesavedbyearlydentalcare.

CHOKINGManytimeswhenachildputsaforeignobjectinthemouth,itisswallowedeasilywithnochokinganditusuallypassesthroughtheintestineswithoutcomplication.Ifanobjectbecomeslodgedinthewindpipeortracheaandthechildisunabletobreatheorcough,strike

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thechild’sbackfirmlybetweentheshoulderbladestofacilitateacough.Ifchokingcontinues,call911.Tomakeyoufeelmoreconfidentinhowtohandlechokingepisodes,considertakingaCPRcourselikethosesponsoredbytheAmericanRedCross.

FRACTURES OR DISLOCATIONSIfafractureordislocationissuspected,donotmovetheinjuredpart,butimmobilizeitwithaslingorsplintuntilthedoctorchecksit.Ifthereisapossiblebackorneckinjury,call911.Donotattempttomovethechildwithoutexpertadvice.Keepthechildwarmandcomfortable.Iftheinjuredareaisnotobviouslycrookedandibuprofenoracetaminophenrelievesthepain,theinjurycanbehandledduringofficehours.Callusbeforegoingtotheemergencyroom.

EYE INJURIESIfachemical,suchasanacid,getsintotheeye,havethechildliedownandpourmanyglassesfullofwaterontheeye,washingitwell.Callthedoctor.Ifanobjectsuchasasmallrockorwoodchipgetsintotheeye,itmayfrequentlybewashedoutinthismanner.Ifthereismuchpain,closetheeyewithabandagetoeliminateeyelidirritation.Anychildthatcomplainsofeyepainorblurredvisionafterwashingtheeyeshouldbeseenbythedoctor.

NOSE BLEEDSHavethepatientsitup.Pinchthesoftpartofnosebetweenthumbandforefinger,keepingsteadypressurefor10minutes.Graduallyreleasethepressure.Keepthepatientquiet.Tellhimtospitouttheblood,nottoswallow.Bloodisrichinsaltandwillcausenauseaandvomitingifmuchisswallowed.Ifrepeatednosebleedsoccur,applyasmallamountofVaseline®intothebleedingnostriltwicedailyfor1-2weeksinordertokeepthescabsoft.

BURNSIfyourchildisburned,soaktheaffectedareaincoolwaterandthenlightlycoveritwithgauzeoracleancloth.Donotapplyanycreams,ointments,greaseorlotionstothearea.Callusforanappointment.

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MEDICINEThebodyofanormalchildshouldbeabletofightdiseaseandrecoverfrommostillnessesalone.Medicinescanhelpthebodydothisjob.Medicines,suchasthoseforpain,fever,colds,orvomiting,aresimplytorelievedistressingsymptomsandwillnot“cure”thedisease.Becausemanydrugsareunnecessary,oftenhavesignificantsideeffects,andarefoundinstudieslaterontobeharmful,weareveryconservativeaboutprescribingthem.Pleasecalltheofficeifyouhavequestionsaboutanyover-the-counterorprescriptionmedicines.Topreventdisasters,alldrugs,includingvitamins,mustbekeptinchild-proofcabinetsandcontainersandoutofreachofchildren.

ANTIBIOTICSAntibioticsareveryimportantmedicinesbecausetheyhelpthebodykillbacteria.Pneumococcal(akindofbacteria)pneumonia,streptococcal(anotherkindofbacteria)sorethroats,abscesses,kidneyinfectionsandmeningitisareinfectionswhicharealmostimpossibleforthebodytofightalone.Becauseofthis,whenweprescribeantibiotics,theyshouldbegivenexactlyasordered.Ifanymedicineisleftover,itshouldbethrownout.

Bacterialresistancetoantibioticsisanemerging,veryseriousproblem.Frequentuseofantibioticsisthoughttobetheprimarycause.Notfinishingacourseofantibioticsasprescribedisanothercause.

Therearestillnogoodmedicinestofightviruses,whicharethecauseofmostcolds,sorethroats,stomachflu,andmononucleosis.Becauseofthis,onlymedicinesthatrelievesymptomsarehelpful.

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RESOURCESPARENTING BOOKSManyexcellentchildcarebooksareavailable.Thisisalistofafewofourfavorites.

Caring for Your Baby and Young Child: Birth to Age 5BytheAmericanAcademyofPediatrics,StevenP.Shelov,M.D.Editor-in-Chief

Discipline without Shouting or SpankingByJerryL.Wyckoff,Ph.D.andBarbaraC.Unell(Thisbookisoutofprint,butmaybeobtainedonlineatBarnes&NobleandAmazon.com.)

Don’t Take it Out On Your KidsByKatharineC.Kersey,Ed.D.(AvailableonlineatBarnes&NobleandAmazon.com.)

Parenting with Love and LogicByFosterW.Cline,M.D.andJimFay

Solve Your Child’s Sleep ProblemsByRichardFerber,M.D.

VACCINE EDUCATIONForadditionalsourcesofinformationregardingyourchild’simmunizationscontacttheCentersforDiseaseControlandPrevention(CDC)at1-800-CDC-INFOor1-800-232-4636orgotheirwebsiteatwww.cdc.gov/vaccines.

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Age Procedure Results & Date4 – 5 Days Physical Exam

Hep B (if not given at birth)

2 Weeks Physical Exam

1 Month Physical ExamHep B

2 Months Physical ExamDTaP, Hib, IPV, PCV, Rotavirus

4 Months Physical ExamDTaP, Hib, IPV, PCV, Rotavirus

6 Months Physical ExamDTaP, Hib, PCV, Rotavirus, Hep B

9 Months Physical ExamIPV

12 Months Physical ExamLead, Hematocrit, MMR, Varivax, Hep A

15 Months Physical ExamDTaP, Hib, PCV

18 Months Physical ExamHep A

2 Years Physical ExamLead, Hematocrit, May need catch-up dose of Hep A

30 Months Physical Exam

3 Years Physical ExamLead, Hematocrit

4 - 5 Years Physical ExamLead, Hematocrit, Urine, DTaP, IPV, MMR, Varivax

6 - 8 Years Yearly Physical Exam

9 - 10 Years Yearly Physical ExamCholesterol, HPV

11 - 15 Years Physical ExamHematocrit, Urine, Tdap, Meningococcal May need catch-up doses of HPV Cholesterol screening at 11 years if not previously obtained at 9-10 years

16 - 18 Years Yearly Physical ExamHematocrit for females, Meningococcal, Cholesterol screening at 17-18 years if not previously obtained

IMMUNIZATION AND PREVENTATIVE CARE SCHEDULE

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Immunization KeyCholesterol=abloodtesttoscreenforhighcholesterolDTaP=Diphtheria,TetanusandacellularPertussisVaccineHematocrit = a test for anemiaHep A=HepatitisAVaccineHep B=HepatitisBVaccineHib=HaemophilusinfluenzaeTypebVaccine,ananti-meningitis

vaccineHPV=HumanPapillomavirusVaccine,avaccinetopreventgenitalwartsandcervicalandanalcancers

IPV=InactivatedPolioVaccineLead=atestforleadpoisoningMeningococcal=MeningococcalVaccine,ananti-meningitisvaccineMMR=Measles,Mumps,RubellaVaccinePCV=PneumococcalVaccine,ananti-pneumoniaandanti-meningitis

vaccineRotavirus=RotavirusVaccine,topreventrotavirusstomachfluTdap=Tetanus,diphtheria,acellularpertussisVaccineUrine=aurinetestVarivax=ChickenpoxVaccine

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VACCINE POLICY

Vaccinesareeffectiveinpreventingseriousillnessandinsavinglives.

Vaccines are safe .

AllchildrenandyoungadultsshouldreceivealloftherecommendedvaccinesaccordingtotheschedulepublishedbytheCentersforDiseaseControlandtheAmericanAcademyofPediatrics.

Basedonallcurrentscientificevidence,vaccinesdonotcauseautismorotherdevelopmentaldisabilities.Thimerosal,apreservativethatwasinvaccinesfordecades,doesnotcauseautismorotherdevelopmentaldisabilities.

Vaccinatingchildrenandyoungadultsisthesinglemostimportanthealth-promotinginterventionweperformashealthcareproviders,andthatyoucanperformasparentsandcaregivers.Therecommendedvaccinesandtheirschedulearetheresultsofyearsandyearsofscientificstudyanddata-gatheringonmillionsofchildrenbythousandsofourbrightestscientistsandphysicians.

Asthepercentageofunvaccinatedchildrenrisestheriskoftheseterriblediseasestoallchildren,eventhevaccinatedones,alsorises.

Foralloftheseveryimportantreasonsitisanabsoluterequirementforongoingcareinourpracticethatyourchildrenbevaccinatedontherecommendedschedule.

The Physicians and Nurse Practitioners ofCockerell and McIntosh Pediatrics

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NOTES

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Blue Springs office205NWR.D.MizeRoad,Ste304

BlueSprings,MO64014

Independence office11200 Winner Road

Independence,MO64052

Higginsville office1717 Main

Higginsville,MO64037

Phone816-228-4770

Fax 816-228-1156

www.cmpeds.com