A new study out this week shows that many parents are introducing solid foods before the recommended 4 to 6 month window recommended by the American Academy of Pediatrics (AAP).

Many parents are over anxious when it comes to introducing their baby to solid foods. They sometimes view eating as a milestone or accomplishment akin to crawling or walking or talking. Rest assured, early introduction of solid foods will not help your baby ace her SATs or get into Stanford! In fact, there are many reasons to discourage early feeding of solid foods.

To begin with, the nutrient package in breast milk is precisely matched to a young infant’s needs. If solid foods are introduced too early, the infant will get less breast milk and this can actually impede growth and development. Breast feeding also reduces the risk for respiratory and ear infections, diarrhea and sudden infant death syndrome. According to AAP, early introduction of solids increases the risk of some chronic diseases, such as diabetes, obesity, eczema, and celiac disease.

In terms of feeding and nutrition, we know that it is better to wait to introduce solids until an infant is approaching 6 months of age. It’s important to allow an infant’s digestive and immune system to develop as well as wait for physical developments such as the ability to sit up in a high chair and move food from the mouth to the throat. It is a myth that early introduction of solids will facilitate sleeping through the night. Cereal should never be added to bottles and infant feeders are also not recommended.

You can find helpful guidelines for introducing solid foods when the time is right at the AAP Healthy Children site – http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/pages/Switching-To-Solid-Foods.aspx.

Patients of Pediatric Associates of the Northwest are welcome to attend our monthly infant feeding class, which is held the last Tuesday evening of each month at Montgomery Park. Call 503-675-3476 for details and registration.  For more information on our nutrition classes, visit http://www.portlandpediatric.com/patient-information/nutrition/fresh-start-program/.

CDH is an acronym for Congenital Diaphragmatic Hernia.  CDH occurs when a fetus’s diaphragm does not form completely and a hole is left in the muscle between the chest and the abdomen. Since CDH is a rare birth defect and is not widely recognized like many other birth defects, it does not have the funding and research provided like other birth conditions attract.

All of the money raised by the Ladybug Run goes to the Ladybug CDH Foundation, which provides funds to assist families with a child with CDH, as well as supports on-going research about the defect.  In addition to raising funds for families affected by CDH, the Ladybug CDH Foundation hopes the Ladybug Run raises awareness about CDH.  Monetary support plus awareness will hopefully translate to better understanding of the defect, and improve treatment and/or prevention of  CDH.

Why Ladybug?  The inspiration for the Ladybug CDH Foundation is Baby Finley, who was born with CDH, and who spent the first19 days of her life in a section of the NICU called Ladybug.  The care given during her time in the isolette in Ladybug helped her to be among the fortunate 50% who survive CDH.

The next Ladybug Run will be August 10^th, 2013 at Cook Park in Tigard, Oregon.  To learn more about CDH or the Ladybug CDH Foundation, visit www.ladybugcdhfoundation.com.

You’ve been through this a million times: your child has ear pain in the middle of the night. You suspect an ear infection and take them into the doctor’s office. The doctor looks and says, “Yep, it’s an ear infection, let’s treat it.”

Over the past 10 years, we’ve had major changes in how we’ve thought about ear infections. We’ve learned over time that many of the ear infections kids develop are part of a viral syndrome and won’t respond to antibiotics. They just need time. We’ve also learned that, for many kids, ear infections will resolve on their own, even if they are bacterial.

In 2004, the American Academy of Pediatrics (AAP) and American Academy of Family Practice put out guidelines to help doctors understand which patients needed treatment for ear infections right away with antibiotics. The American Academy of Pediatrics just updated those recommendations and broadened them in a new Clinical Practice Guideline. The guideline provides more stringent criteria for diagnosis of ear infections and treatment.

Why all the fuss? Antibiotics are a critical part of medicine and help to treat serious infections. However, when we use them in excess, they start to not work as well. The bacteria that used to be killed or contained by the antibiotic start to adapt to the antibiotic and develop what’s called resistance.

But what about my child- now they have to suffer longer? The new guidelines do emphasize pain control for ear infections and appropriate comfort care. Whenever your child is sick, it’s still important to make sure they get enough liquids, that they rest and that their pain is taken care of. Also, it’s important to remember that if it is a virus causing the infection, treating with antibiotics will not make a difference in pain level or in how long symptoms last.

Often patients and parents are surprised by the changes that come about in medicine. The paradigm shift in antibiotic prescribing for ear infections is major but has been shifting slowly over the past decade. The new AAP guidelines will help us to more accurately diagnose ear infections in your child and to be even more careful with prescribing antibiotics for this common childhood problem.

Alayna worked in the post operative unit at the clinic in Guatemala, taking care of people who were recovering from surgery.  The medical team performed more than sixty surgeries the week Alayna was there – from routine hernia operations to hysterectomies and exploratory surgeries.  She said many of the people she cared for had travelled many miles to be treated. Some had previously waited weeks or even months to have a condition diagnosed and treated because medical care is so inaccessible in this part of the world.

One particularly memorable patient was a 15-month old little girl who had grabbed a handle of a pan on a stove, accidentally spilling boiling water over more than half of her body.  In the United States, her condition would have warranted a trip to the Emergency Room for treatment of the burns, but her aunt could do nothing more than cover the burns, and travel 12+ hours to seek the clinic’s help.  Alayna said, “Being in Guatemala and meeting these families made me realize how very fortunate we are here in the United State. People do not often die of child birth here, and access to care for such burns would have been immediate here in the U.S., with burn centers dedicated to such patients.”

The Mayan people were incredibly grateful, says Alayna, which made the experience particularly rewarding, but also very humbling.  At the same time, Alayna says the experience was also quite challenging at times. There were not enough supplies, especially sheets, medications, and ice packs, and the way of doing things was simply not as efficient as she’s become accustomed to; for example, the Guatemalan Clinic had little choice but to store medications in shoe racks.

Overall, the trip was life-changing, says Alayna, and she’d like to go again, next time, with her husband.   She knows there are many people in addition to the Mayan population, who are quite underserved medically, and she would love to be part of such an important service again.

After a year of dialysis, Billie received a kidney transplant fifteen years ago, giving her a second chance at living an active, healthy  life.  “So yes. My heart is near and dear to the subject,” she says. “Working with the donor program is how I give back. But  you know,  it’s also just incredibly rewarding. Everyone you meet there is alive because someone else gave the ultimate gift. We were given another day to breathe because of someone else’s sacrifice, or even loss. The stories are phenomenal. But to meet people who are so genuinely thrilled just to be alive – where else can you meet people like that? It’s indescribable.”

Billie volunteers with Donate Life Northwest, formerly known at the Oregon Donor Program.  According www.donatelifenw.org, The goal of all Donate Life Northwest programs is to motivate people to sign up on the donor registry. Studies show that although 90% of Americans support donation, only 40% know how to sign up on their state’s registry.  Billie and other Donate Life Northwest volunteers strive to increase awareness of the need for donor organs, and the ease of registering as a donor, through their many community service programs, and by attending health fairs and county fairs. Donate Life Northwest also helps high school community service participants implement programs in their communities. The organization also participates in fundraising efforts through golf tournaments, special breakfasts, and other events.

Donate Life NW is Billie’s primary place to serve in a volunteer capacity, and her enthusiasm for the organization is contagious.  She says she’d love it if the Donate Life Northwest received more volunteer support as a result of being highlighted at PANW.  Billie says, “It makes a difference. It saves lives.”

Here’s what one donation can do:

• One donor can save up to 8 lives.
• More than 50 people can be helped from one tissue donor.

In 2010, there were 28,663 organ transplants.  If you or anyone you know is looking for a place to support, consider Donate Life Northwest.   They give the gift of hope and life to many.www.donatelifenw.org

As we start another year, I find this is a great time to put my mind to the changes we will face in it. 2013 will be a special year for Pediatric Associates in that we will be making some changes to the general philosophy of how we care for our families. There has been a movement in medicine in America to better serve patients with chronic disease. Historically, individual doctors identified a patient as having a disease and then followed them along by themselves or with the help of more specialized doctors. Nowadays that seems quaint and not very effective. A patient with a chronic disease would be better served by a community of doctors, nurses, medical assistants, care managers, and support groups all coordinated together is some fashion. The catch phrase for this which you will hear many times in our office in the next year is “Care Management”. As a way to serve our patients better, we are going to be seeking out our families with chronic diseases (such as asthma, diabetes, attention deficit disorder, obesity, and cerebral palsy) and enrolling them in our Care Management program (at no extra cost). In doing so we will seek to be in contact more often and offer you services which you might not be aware are available to you (help with referrals, coordination of office visits, transportation to office visits, having your own Care Coordinator, etc.).

Also, historically the care of a chronic disease was dictated by the medical community. Nowadays, the patient is much more involved, knowledgeable and in control of their own care. As part of Care Management, your provider will work with you to establish specific goals to accomplish for your loved ones. So, if your child has asthma then your provider’s goal might be to make sure he is taking his asthma medications properly but your goal as a parent might be for him/her to play soccer without getting short of breath.

Who coordinates the care of a given patient has been a point of debate for a long time. Insurance providers, medical practitioners, healthcare systems, and patients all have a vested interest. In 2013, there is a growing emphasis on the medical practitioner as the focus of coordination of the care of their patients. The catch phrase for this is “Medical Home”. We are certified by the National Committee for Quality Assurance as a Level 3 Medical Home. In short, this means that we have systems which are well developed to coordinate our patient’s care at a very high level.

Lastly, with the changes of the Affordable Care Act, medical practices such as Pediatric Associates are being asked to show exactly what we are doing to help our patients with chronic disease in a more scientific manner. As I hope you noticed, we have been using electronic medical records (EMR) for many years. Part of our EMR lets us track our patient’s need in a specific manner. So, if your child has asthma, every time you step into the office with an asthma related issue our EMR notes it and tabulates what we are doing to help you. At the end of the year we look at the data to see if we are serving our asthma patients well. If we reach the highest of benchmarks for quality care we feel our system is working. If not, we make new goals for the coming year and adjust our system to make sure this happens. We also show our data to your insurance providers and other regulatory groups so they and you can know we are doing a quality job.

I hope this helps you as you work through the complex medical landscape. Our goal has always been to be the people behind the curtains making the medical world look easy to the people in the audience. We hope we continue to succeed.

Every year during this season we see and hear so much about the flu.  CNN has a story about the flu epidemic sweeping the country.  Someone at work calls in sick with the flu.  Daycare sends a note home saying a child in class was diagnosed with flu.

The problem is the word flu.  People use the term to mean many different illnesses.  In medicine we usually use “flu” as short for the influenza family of viruses.  There are “A” and “B” types that infect humans (but many that infect birds, pigs, horses, etc.).  The typical influenza infection will have an incubation of about 2 days.  The symptoms usually start suddenly and include fever, body aches, sore throat, cough, congestion and runny nose. It is not unusual for the systemic symptoms and fever to last up to 5 days.  This is a respiratory virus and most of the symptoms are related to the nose, throat and lungs.  Some vomiting or diarrhea can occur with influenza but they are not the primary symptoms.  Many people call the vomiting and diarrhea illness stomach “flu” but it isn’t influenza.

The best ways to prevent influenza are keeping your hands clean and sanitized, especially in public places, and to get the annual flu vaccine.  In some circles the vaccine gets a bad reputation for either causing the flu or not preventing the flu.  First of all, it is not possible to get the flu from the flu shot (see previous post).  Secondly the vaccines are not perfect at preventing influenza, but many of the stories of flu after the flu shot are actually just bad colds.  The flu vaccine does not prevent colds, stomach “flu”, or any other disease besides influenza.

Scientists are working on a vaccine that will provide many years of protection, but for now the vaccine needs to be administered every year due to the virus’ slowly changing.

For additional information from NPR see http://www.npr.org/blogs/health/2013/01/17/169516804/bad-flu-season-overshadows-other-winter-miseries

Happy New Year from Pediatric Associates of the Northwest! We know that this month brings with it many a resolution – for some, the pledge to spend less money, or to spend more time with family is renewed. For others, the goal to rekindle old friendships or to learn a new hobby takes priority. Among most Americans, though, New Year’s resolutions center on nutrition and exercise. Everywhere you turn, advertisements promise quick solutions to achieve you goals, whether you’ve vowed to stop eating so much junk food or to get your body slim and trim.

The reality is, a healthy body comes from a consistent commitment to making nutritious food choices and to staying active almost every day. You can make it easier for your kids to do this by developing healthy habits within your entire family – the earlier the better! Along with our registered dietitian, Connie Evers, MS, RD, LD, we’ve developed classes at Pediatric Associates of the Northwest to help set the foundation for a lifetime of health for our patients.

Family Nutrition Classes are offered complimentary to patients of Pediatric Associates and will be held on a rotating schedule from 7 to 8:30 pm at our Montgomery Park location. There are three classes available to families, focused on infant, toddler and whole family nutrition, respectively. Classes include structured instruction with Connie Evers, food demonstrations and opportunities for questions.

1. Starting our Right with Baby
This session covers the basics of infant growth and development and offers guidelines for feeding baby during the first year of life. Self-care for busy moms is also a focus of this class.
Upcoming Classes: January 22nd, February 26th, March 26th or April 23rd

2. Growing Up: Feeding Development and Behavior
As your baby turns into a toddler, eating habits may become unpredictable. Learn how to best nourish your toddler and develop a healthy feeding relationship.
Upcoming Classes: January 28th, February 25th, March 25th, or April 22nd

3. Creating a Healthy Family Food Environment
It’s not always easy to eat well given the availability of unhealthy food and beverage choices. The focus of this session is on how young families can create a healthy and balanced approach to eating and nutrition.
Upcoming Classes: January 29th or April 29th

For those interested in individualized nutrition counseling, appointments are available in both Pediatric Associates offices (please call for fees and availability of individual appointments).

Dr. Bruce Birk, who’s been part of the Sunday Parkways event for six years,  says, “It’s a wonderful way to promote healthy lifestyles, neighborhoods, and bicycling.  I enjoy the families who bring their children to our practice coming by and chatting. I also enjoy seeing all the children out there on their bicycles, ruling the streets, without a car in sight. These events endorse the message of good health through regular fitness, but more importantly a healthy lifestyle.”

Bikers enjoying the hydration station

Most of us know that while automobiles are great, they are by no means the best way to get around.  Dr Birk adds, “We encourage walking, biking, and mass transit over automobiles whenever possible. “  Participating in Sunday Parkways is just one of the ways PANW hopes to reinforce the importance of an active  lifestyle – and one which gives back to the community as well.

It’s about that time across America. Malls are packed with frantic shoppers. Stacks of Holiday catalogues are piled on the kitchen counter. Everywhere we go, no matter which holiday we celebrate, the retail machine is sending a message loud and clear: time to buy!!

It’s not solely the fault of Corporate America. Holiday shopping is fun and makes us feel like we’re really “getting into the spirit of the season.” We’re drawn to it. Our kids pick up on the frenzy as well.

It’s also not that Holiday buying and receiving is necessarily bad. It’s just that, for many, the holidays are only a flurry of pretty packages. That Holiday magic melts away once the wrapping has been torn off all the gifts.

Here are a few ways to help kids experience the Holidays in a way that’s a little more meaningful and memorable:

1. Build a season that’s centered on giving: Volunteer at a homeless shelter with your teens, plant a tree with your younger child, join a book drive. Check out www.handsonportland.org for monthly calendars with volunteer opportunities for families. They even have a special Holiday Volunteering page for those only able to give a few hours.

2. Give gifts that will help your child learn, not just entertain: Melissa Taylor at Parenting.com has compiled a top ten list for fun gifts that are also educational: http://www.parenting.com/blogs/mom-congress/melissa-taylor/years-hottest-learning-gifts-kids

3. Consider gifts that focus on others: Heifer International (www.heifer.org ) provides developing-world families in need with livestock or educational opportunities to build self-sufficiency. Justgive.org (www.redefine.justgive.org) lists local, national and international options for donating – from local school foundations to national children’s rights organizations.

4. Celebrate family traditions: What fun traditions can you create that are not gift-focused? Maybe it’s attending a special Holiday service, cutting down a Christmas tree together or making food together. Your kids will remember the special moments you create for years. Red Tricycle (www.redtri.com) has innovative ideas for counting down to Chanukah, touring neighborhoods decked out in holiday lights and finding local Holiday events.

5. Think about making gifts versus buying: Spending time together picking out a craft or food item to create, listening to Holiday music as you work and enjoying each other’s company can be much more meaningful than waiting 30 minutes in a crowded parking lot to edge your way into a parking spot.

6. Employ the “Less Is More” Rule: The Holidays are definitely a time to lavish love on your children but sometimes we get caught up in the number of gifts we’re giving (and get stressed out in the process of purchasing and wrapping all of them). Even if we buy a bunch of gifts, the law of diminishing returns kicks in after a few of those shiny packages are unwrapped. Gifts can get less and less exciting if there are more and more (and more) of them. Maybe just one or two really special gifts are enough at Christmas, or one bigger gift for the first day of Chanukah, with smaller gifts for the rest of the holiday. It’s a change of focus, but you might find that your children appreciate each gift they have much more as a result.

The Holidays can be a time of renewed inspiration and memorable family traditions. Being intentional about the ways we celebrate the season can help our children realize its true joy. Happy Holidays from Pediatric Associates of the Northwest!