Tamalpais Pediatrics

There are many amazing stories among our Tamalpais Pediatrics patients and their families.  Recently, one of the families in our practice became involved in a cutting-edge study at Stanford in an attempt to cure their children of life threatening nut allergies.  It’s an amazing story – and it isn’t over yet.  Lucky for us, they have chosen to share their story on their blog – click here to read about their journey.  (click here if you want to go to the first post and start at the beginning).

Wikipedia: At or in this place: Stop here for a rest. →

Some families in our practice have received a letter this week about a new policy here at Tamalpais Pediatrics.  Starting this month, we are requiring that all patients in our practice receive the MMR vaccine by age 2, or they will be asked to leave our practice.

This decision was made with much thought and careful consideration, and is based on our knowlege of the safety of vaccines and the danger to our patients and our community of a Measles outbreak.  Our goal is to protect our patients to the best of our ability.  Vaccines, and especially the MMR, are an important part of this effort.

For more details on this policy and the reasons why we felt it was necessary, please click here for a Survivor: Pediatrics post about it.  As always, we welcome your feedback – if you have any questions about this, please bring them up with your doctor.

For the past few months, we have been seeing a version of Hand, Foot and Mouth Disease that looked a little different than usual.  Last week, the San Francisco Chronicle published this story about a new strain of Coxsackievirus that seemed to be causing an usual form of Hand, Foot and Mouth disease in both adults and children.  It is worth noting that we have not seen any cases of toenails or fingernails falling off in our office.  (That part might have been overstated a bit in this article.  But it sells papers, I guess.)

The CDC also published this report, which reports that this particular strain of the Coxsackievirus (CVA6) has an unusual pattern of illness, and has affected all ages (24% of the cases were adults).   They also reported that this virus had previously not been reported in the U.S., but had been reported in outbreaks in Japan, Singapore, Finland and Taiwan.  Another reminder that viruses don’t need a passport – these illnesses are just a plane ride away.

Many of us have struggled to soothe a crying infant; and we all know that when there’s a baby with colic in the family, they’re not the only one crying!  This website, called The Period of Purple Crying, talks about the normal period of crying and fussiness that babies go through, usually from the age of 2-3 weeks to 2-3 months.  Take a look for some tips on what to do and how to get through this challenging time.

Our friends over at Survivor:Pediatrics have been busy, this time we’re linking to a post by Dr. Melissa Arca about pinkeye.  Take a look here to learn about what can cause pinkeye (conjunctivitis) and when it needs to be treated with antibiotic drops.

We spend a lot of time thinking and talking about how much and what kinds of media our children and patients are being exposed to.  Dr. Michael Rich is a pediatrician and former screenwriter who has been nicknamed “The Mediatrician” because he specializes in this area.  Take a look at his website here for some great resources and information about kids and the media.

We have lots of changes to report here at Tamalpais Pediatrics.  Dr. Julie Bokser will be changing her schedule starting next week, April 3.  She will stil be working on Tuesday, Wednesday and in the afternoon on Friday but will be in a different location.  Starting this week, she will be working Tuesdays in Greenbrae and Wednesdays in Novato.

Kathy Morgan, PNP is also changing her schedule.  Kathy will be cutting back her hours here, and will be working on Mondays in Greenbrae and Wednesdays in Novato.  To make space for Kathy’s new day in Novato, Crystal Cox, PA will be moving to Thursdays instead of Wednesdays.  Take a look at the Doctor’s Schedules box here for details.

Kathy will also be working in the Well Baby Nursery at UCSF in addition to continuing with us two days a week.  We are all excited for Kathy and wish her well in her new job (even though we’re sorry she won’t be with us every day anymore).  I guess this is our chance to show our patients how to share!

Sarah Middleton, an infant sleep consultant and parent coach, will be returning to our Novato office on Thursday, April 5th at 12:15PM.  Sarah will be doing a lecture on Sleep from 0 to 12 months, discussing babies’ sleep needs and how best to help your baby learn good sleep habits.  Feel free to join us and bring your questions!

Another excellent post on Survivor: Pediatrics about homework and academics, with some great ideas for how to help your child manage their time, get their homework done and succeed in school.  Remember that not every idea or plan works for every kid, but take a look and choose those things that would work for your child and your family.  Click here.

There is now a dosing chart for Tylenol (Acetaminophen) and Ibuprofen available on the Info page, which includes dosing for the new concentration of Infant Tylenol.  Take a look here – and if you would like to print a copy for home, click the link at the top of the page.

When your child comes in for their checkup, you will notice that we are using a new system to check their eyesight.  The Pediavision  Ocular Photoscreener takes multiple infrared digital pictures of a child’s eyes and does measurements that can tell us if the child is nearsighted, farsighted, has a ‘lazy eye,’ or astigmatism.   We have been using an older version of this equipment in our Novato office for the past year, and have decided to upgrade to the newer system and get one for each office.  Our goal is to make sure that any issues are picked up early, when they are easy to treat.  You will be given information about this test as well as billing and insurance issues when you come in for your visit.

One of the most common questions we are asked is “How much Tylenol do I give?”  This question just got a little more complicated, since  the Infant Tylenol concentration has changed.  Infant’s Tylenol is now the same concentration as Children’s Tylenol, 160mg per 5ml (one teaspoon).  This is because the different concentrations of Tylenol were found to be confusing, and led to errors and overdosing.   The new packaging for Infant Tylenol will not have dosing for children under 2.  We will have dosing information, by weight, available on our website and in the office.   There will be more information at the Tylenol website as the new concentration is rolled out.  You may have both concentrations at home – be sure to check the dosing and concentration before using it.

If you missed our Flu Vaccine Clinics but your child still hasn’t gotten a Flu Vaccine, please call the office to schedule a Nurse Visit for a Flu Vaccine.  We still have plenty of nasal Flu Vaccine for older kids and injectable flu vaccine for those under age 3.  Because the Influenza season here in California is typically later than other parts of the country, we want to keep protecting our patients from Influenza by getting as many vaccinated as possible, right through January, February and beyond.  It isn’t unusual to see Influenza outbreaks in March and April in Northern California.

We also want to make sure everyone can find the Flu Vaccine Information Pages, where you can find information about this year’s flu vaccine and other interesting flu facts.  Click here to view.

The Marin County Office of Public Health notified us recently that there was a case of Mumps diagnosed in a child at Brookside Upper Elementary School in San Anselmo.  So far, we have not heard of any other cases and hopefully there are enough immunized children in our community that we will not see an outbreak of Mumps.

Mumps is a viral illness that causes fever, swelling of the parotid gland (the salivary gland in the cheek) and headache and sore throat.  It can also affect the brain and central nervous system, causing encphalitis and deafness, and in boys it can cause swelling of the testicles and sterility .  In Japan, where children do not routinely get immunized against Mumps, the rate of permanent deafness among children is now 1 in 1000.

Children are vaccinated against Mumps using the MMR vaccine at age 12 to 15 months, and again at age 4 to 6 years.  We routinely give this vaccine at 15 months and 4 years of age in our practice.  If you child has not received an MMR and is over 15 months of age, or if they have not had their booster dose and they are over 4 years of age – please call our office for a visit to get this very important vaccine ASAP.

Another group of children who should get MMR are infants 6 months of age and older who are travelling outside the US.  Check out this CDC Measles Update to learn why.

In case you haven’t heard – California Booster Seat Laws have finally caught up with the recommendations to keep your child in a booster seat until they are tall enough to be protected by a shoulder belt.  The new law, which you can find here, is simple – all children need to be in a Booster Seat until they are 8, OR 4ft 9in in height.  Also remember that all children under age 12 must be in the back seat. Drive safely!

Our colleagues at the Marin County Department of Public Health have a great website with Influenza Information, including information about Influenza activity here in Marin.  Take a look by clicking here.

There have been several news stories recently about outbreaks of E. Coli 0157 infections in children.  The most recent was in the SF Chronicle about five children who became ill after drinking raw milk.  Though there are many claims made about how raw milk is more natural, healthier or better for you, the truth is that pasteurization kills the bacteria that can cause illness in humans.  Those bacteria are a normal bacteria for the cow, so you can never completely guarantee that they will not get into the milk at some point.  Please do not give your children raw milk or products made with raw milk.

Click here for a HealthyChildren.org page on preventing food-borne illness.

There have been news stories circulating about the Facebook group dedicated to finding a way to expose their children to Chicken Pox (not a great idea) and the members who began sending each other infected materials, including lollipops, in the mail (an even worse idea).

Needless to say, this is not something that we think is a good idea.  Our friends at Pedsource have posted an article that very nicely sums up why.  Click here to read it.

For those who are “on the fence” about Varicella (Chicken Pox) vaccine, here are the top three reasons to get the shot rather than take your chances with the disease: 1. Chicken Pox disease is unpredictable.  It’s usually just miserable rather than deadly, but before the vaccine was widespread, 100 or more kids per year would die from Chicken Pox complications in the US.  The vaccine is safe, and 97% effective at preventing severe disease and death. 2. Chicken Pox disease can have serious complications, such as pneumonia, dehydration and skin infection.  That was bad enough in the “old days,” but now with resistant bacteria such as MRSA (Methicillin Resistant Staph Aureus), it is much more dangerous. 3. Shingles is more likely in a child who has had Chicken Pox rather than vaccine.  This has been well studied, and disproves the myth that “natural” Chicken Pox is somehow better than the vaccine.  It just isn’t true.

At Tamalpais Pediatrics, we usually give the Chicken Pox vaccine at 15 months and age 4.  If your child isn’t up to date, call for an appointment….and keep them away from mailboxes until this Chicken Pox Lollipop fad is over.

There are two new posts on Survivor: Pediatrics this weekend by our very own Dr. Branco.  Click here for “In Defense of Cough,” a short article about why cough can be a good thing.  Click here for “Mom and Dad, Did You Ever…” for some thoughts and advice on how to talk to your teen about difficult topics, including drugs and alcohol.

Spend some time looking around – there are many other interesting posts on this site, including Dr. Jenn Gruen’s post called “Fall Colds, What to Do and When to Take Your Child to the Pediatrician,” Dr. Wendy Sue Swanson’s “Baby Proofing Your House” video, and Dr. Joanna Betancourt’s post on “Making Healthy Food Choices for Your Children.“

We’ve posted articles from the Survivor:Pediatrics blog here in the past, and would like to call your attention to a few new articles there that are worth reading.  Click here for Dr. Jesse Hackell’s post on why we do yearly checkups, especially for older kids.  Dr. Jenn Gruen has written a nice post on how to make healthy changes called New Year’s Resolutions in October?, and Dr. Arca has some good advice for parents of The Toddler Who Refuses to Nap.  Take a look at all the articles, including those by Tamalpais Pediatrics’ very own Dr. Branco.

If you haven’t already subscribed for updates by email, click the button above to get signed up.  Whenever we update this News page, you will get an email message about the new item.  This is the best way to stay up to date on what’s going on at our practice (like when Flu Shots come in) and on what we’re seeing in the news that we think is interesting or important for out patients and their families.  Thanks for reading!

Summer weather has finally arrived, and with more kids (and adults) participating in sports and other outdoor activities, we’re sure to see more injuries, aches and pains in our office.   Dr. Jordan Metzl is an athlete and Sports Medicine physician who practices in New York and has an excellent website – www.drjordanmetzl.com – with lots of great videos, links and articles.  If you or your child has a sports-related injury, take a look at  this website – you’re sure to find something that will help you get back up to speed and prevent injuries in the future.

We sometimes get requests to call in medications, or order labs and other treatments over the phone.  This blog post, written by Dr. Suzanne Berman, one of our AAP colleagues, does a good job describing why that’s not such a great idea.  Click here to see it.