The American Academy of Pediatrics has released an updated list of available, recommended car seats and booster seats (with current pricing!) for 2021. Check out the updated link by visiting:
All infants and toddlers should ride in a rear-facing seat until they reach the highest weight or height allowed by their car safety seat manufacturer – usually, until 2 years. Most convertible seats have limits that will allow children to ride rear facing for 2 years or more. Make sure the straps are tight -- there shouldn't be any slack-- and that the upper harness fastener is positioned on the chest. Remove thick coats or sweaters before strapping your child in, as the bulk may cause the straps to seem tighter than they actually are.
Children who have outgrown the rear-facing weight or height limit for their convertible seat should use a forward-facing seat with a harness for as long as possible, up to the highest weight or height allowed by their car safety seat manufacturer. Many seats can accommodate children up to 65 pounds or more. All children whose weight or height exceeds the forward-facing limit for their car safety seat should use a belt-positioning booster seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are 8 to 12 years of age. All children younger than 13 years should ride in the back seat.
Ask your pediatrician if you are unsure if your child meets the requirements to graduate from a booster seat.
At Carolina Kids Pediatrics in Raleigh, NC, all our pediatricians can provide you with updated guidance on vehicle safety for kids of all ages. However, there are also a number of locations around the Triangle where experts will inspect the installation of your child’s car seat for free. To find a location near you, check out: https://www.buckleupnc.org/locations/
Please feel free to contact Carolina Kids Pediatrics in Raleigh, NC, at 919-881-9009 or send us a message on the patient portal if you have any questions or concerns about car seat safety.
Carolina Kids Pediatrics
The first CoVID-19 vaccine has received emergency use authorization, and a second vaccine may follow later this week. However, it is likely that children and adolescents will not receive immunizations against CoVID-19 in the near future.
Neither Pfizer nor Moderna have completed Phase 3 clinical trials in children. Pfizer began studying CoVID children’s immunizations in October when it first enrolled participants aged 12-16, and Moderna announced last week that it will begin administering children’s immunizations to older kids and teens (also aged 12-17) soon. Neither company has vaccinated kids under 12 in its research trials yet.
I suspect that CoVID-19 vaccine trials in adolescents might be complete by mid to late spring. If they are confirmed both safe and effective, adolescents might be immunized beginning in the summer or fall. Vaccines for younger children might become available after this time.
I would not expect that Carolina Kids Pediatrics or other Raleigh, NC, pediatricians would administer CoVID vaccines to children and adolescents until rigorous Phase 3 trials in each age group have been completed, had been reviewed and endorsed by the FDA, by the CDC’s Advisory Committee on Immunization Practices, and the American Academy of Pediatrics.
So, how do CoVID vaccines work?
The first two vaccines to come to the U.S. market are mRNA vaccines. These vaccines use a small piece of genetic material from the virus which will then create the CoVID spike proteins in the body – this is the protein that must be neutralized by antibodies in order to develop immunity to CoVID-19. These vaccines do not contain a living virus and therefore cannot cause infection in the person who is getting immunized. They also do not alter the genetic code of the person getting the vaccine.
According to Pfizer and Moderna, each vaccine is about 95% effective in preventing symptomatic CoVID infection, although it’s unclear how long this protection will last. A booster dose is necessary several weeks after a person is initially vaccinated.
The first CoVID vaccines in Raleigh, NC, and elsewhere in the country, will go to high-risk health care workers and the elderly – residents of nursing homes and chronic care facilities will likely be among the first to be vaccinated. So, your children may be later in the line for CoVID vaccines, but your children’s doctors and nurses may be immunized by spring – although we believe that health care workers who work in ICUs and hospital CoVID units will and should be immunized first.
Am I confident rolling up my own sleeve to be vaccinated? Absolutely. I am satisfied that these vaccines are receiving an appropriate level of evaluation and scrutiny, and I look forward to the day when widespread CoVID immunizations will begin to interrupt the cycle of transmission which has paralyzed so much of the country and the world.
I believe that the vaccine which was authorized this week is safe and highly effective in preventing CoVID-19 in adults. As a pediatrician, I do have one additional comment about the authorization of the Pfizer vaccine. The vaccine was authorized for individuals age 16 and higher – but the number of patients in Pfizer’s Phase 3 clinical trial between 16 and 18 years old was much smaller than the tens of thousands of adults over 18 who were enrolled. Although the vaccine appeared to be safe and effective in the 16-18-year-olds in the trial, I would be interested in seeing a Pfizer trial with larger numbers of adolescents, which is in progress. Regardless, the priority in these early days is not – and should not be – the vaccination of healthy teenagers.
For all the kids out there, I am also pleased to announce that the CDC has declared Santa an essential worker, and he is now fully immunized against CoVID-19 – so don’t worry about him coming to your house in a couple of weeks. The reindeer appear to have natural immunity.
If you have other questions about children’s immunizations, please reach out to our Raleigh, NC, team of pediatricians at (919) 881-9009.
Carolina Kids Pediatrics
We have now posted an updated schedule of 14 prenatal education classes at Carolina Kids Pediatrics in Raleigh, NC from December 2020 to June 2021. The class dates are:
Tuesday, December 15, 2020, at 5:45 pm
Wednesday, January 6, 2021, at 5:45 pm*
Tuesday, January 19, 2021, at 5:45 pm
Wednesday, February 3, 2021, at 5:45 pm*
Tuesday, February 16, 2021, at 5:45 pm
Wednesday, March 3, 2021, at 5:45 pm*
Tuesday, March 16, 2021, at 5:45 pm
Wednesday, March 31, 2021, at 5:45 pm*
Tuesday, April 13, 2021, at 5:30 pm
Wednesday, April 28, 2021, at 5:30 pm*
Tuesday, May 11, 2021, at 5:30 pm
Wednesday, May 26, 2021, at 5:30 pm*
Tuesday, June 8, 2021, at 5:30 pm
Wednesday, June 23, 2021, at 5:30 pm*
Due to the CoVID-19 pandemic, all prenatal education classes are limited to 10 participants or fewer, and all participants must be healthy and wear masks. Prenatal education classes are always led by one of our pediatricians right in our office in Raleigh, NC. If you are more comfortable meeting with one of our pediatricians remotely, we also offer free telemedicine prenatal orientations.
During our prenatal education classes, we will cover the basics of caring for your newborn, including what to expect after delivery, and how to prepare yourself and your home for the new addition to your family. Prenatal education classes marked with an asterisk (*) will also include a brief presentation and a question and answer session with our lactation consultant. If you live in the Raleigh, NC, area please call Carolina Kids Pediatrics at (919) 881-9009 to sign up, or just sign up right on our website.
CoVID-19 has been stressful for all parents, here at Carolina Kids Pediatrics, throughout Raleigh, NC, and throughout the country This may be especially true for mothers who are breastfeeding and concerned about transmitting infection to their infant. However, the CDC has published guidelines for breastfeeding moms during the pandemic, with some recommended precautions. To view these guidelines, check out:
Although none of the pediatricians at Carolina Kids Pediatrics have yet seen patients positive for CoVID-19 during the past 3 months, we know that CoVID-19 has been on the rise in Raleigh and throughout North Carolina in recent weeks. So can breastfeeding spread infection to babies if a mom is asymptomatic and does not know that she is infected? In general, respiratory viruses, including coronaviruses, are not expressed through breastmilk, and breastmilk would therefore not be a likely cause for spreading CoVID-19. However, a mother’s antibodies are secreted in breastmilk – including antibodies to CoVID-19 if a mother is infected, or has been infected in the past. Although we don’t have definitive evidence for CoVID-19 on this point yet, maternal antibodies are often the reason that breastfeeding infants are less likely to have severe respiratory infections when they get sick.
However, CoVID-19 is spread through close contact with respiratory droplets from those who are infected, whether symptomatic or asymptomatic. Therefore, it is possible for mothers to infect babies through the kind of close contact required for direct breastfeeding.
For this reason, the CDC recommends that moms who may be infected with CoVID-19 consider pumping and providing expressed breastmilk to their infants until they recover and are no longer contagious. If you have COVID-19 or are suspected of having COVID-19, staying in a different room from your baby is the safest way to keep your newborn healthy if this is at all possible. Washing hands thoroughly before touching bottles or pumping supplies is helpful. Cleaning your breasts before pumping and wearing a mask during the pumping process is also a good idea. If at all possible, a healthy caregiver can then feed breastmilk to your baby until you recover from infection.
It's also very important to clean your breast pump after each use. Remind all caregivers to wash hands thoroughly before touching bottles, or feeding or caring for your baby. If you decide to breastfeed directly, take all the recommended steps to prevent the potential spread of the virus, including using a mask and following careful breast and hand hygiene.
If you and your family decide to keep your baby in the same room as you while you are infected, keep a distance of at least 6 feet from your baby. When closer than 6 feet, wear a mask and make sure your hands are clean.
If you have COVID-19 (or suspect that you do), you can stop isolating yourself from your baby once you are fever-free without use of fever medicines (acetaminophen or ibuprofen) for at least 72 hours; when your other symptoms of COVID-19 are improving; and when at least 10 days have passed since your symptoms started.
If you have questions about breastfeeding as the pandemic evolves in the Raleigh, NC area, remember you can always give us a call at (919) 881-9009 to speak to our Carolina Kids Pediatrics lactation consultant, Jerrianne Webb.
We’ll post another general update about CoVID in the Raleigh, NC area within the coming week.
Christian Nechyba, MD
Carolina Kids Pediatrics
At the beginning of each year, the American Academy of Pediatrics and the CDC release revisions in immunization recommendations for the year. As Raleigh pediatricians, we also keep an eye on changes in immunization requirements within the North Carolina school system. Some updates and reminders for 2020:
1. Schools in Raleigh and throughout North Carolina will begin requiring proof of immunization for a second dose of meningococcal conjugate vaccine for rising 12th graders beginning in summer of 2020. At Carolina Kids Pediatrics, all our pediatricians have been administering a second dose of this vaccine at 16-17 years of age at annual checkups for several years now. As with all North Carolina school immunization requirements, you will have until 30 days after the start of school to submit proof of immunization for this vaccine.
2. We also offer a different type of meningitis vaccine (type B meningococcal vaccine) to older teenagers, especially if they are entering a higher-risk environment, like military barracks or college dormitories. This year, the AAP has added a recommendation that kids over the age of 10 with certain immune problems, including problems with normal spleen function or a condition called complement deficiency, receive this vaccine at a younger age - as early as 10 years old.
3. The AAP now recommends that all children and adolescents up to age 18 receive the hepatitis A vaccine if they have not received this vaccine previously. At Carolina Kids Pediatrics, we have routinely administered 2 doses of hepatitis A vaccine between 1 and 2 years of age for over a decade. However, if you have an older teenager, your child may have been a toddler before this recommendation came into effect. Previously the AAP considered catching up older kids on this vaccine as optional – but the AAP is now recommending catch-up vaccination for all older kids who were not previously immunized. The vaccine is given as two doses 6-12 months apart.
4. Tetanus boosters every 10 years have been recommended for a long time for all adults. According to current guidelines, the Tdap vaccine can now be used not just for preteens (we have done this for a long time), but also routinely every 10 years in adults instead of the old tetanus vaccine. This provides a boost to immunity against pertussis (whooping cough) in addition to protection against tetanus in adults. At Carolina Kids Pediatrics, kids get their first Tdap at their 11 year visit – but your 21 year old can now expect a Tdap booster instead of a standard tetanus shot if they still come to see us.
5. A word about measles: We are still experiencing a significant increase in measles cases throughout the United States as well as internationally (though thankfully not in the Raleigh, NC area). If you are traveling to an area with significant measles activity with a baby between 6 and 11 months, guidelines recommend an early dose of measles vaccination. Typically, measles-mumps-rubella vaccine is given to kids at Carolina Kids Pediatrics at 12 months and at 4-5 years. However, we recommend an early dose between 6-11 months for kids traveling to high-risk areas. You can find information on areas with a high risk for measles on the CDC website.
6. Remember that the human papillomavirus vaccine is recommended as a 2-dose series for kids who start before their 15th birthday, but 3 doses are required to achieve a similar level of immunity for teens who start the vaccine after their 15th birthday. Because younger teens seem to have a better immune response to the vaccine, we support the AAP recommendation to immunize at 11-12 years of age at Carolina Kids Pediatrics.
Remember that all immunizations received by your child at Carolina Kids Pediatrics since December 2013 (when our current electronic medical record system became active) should be visible and printable from our patient portal. Of course, you can also contact us at (919) 881-9009 for a complete printed vaccine record which includes all vaccines given prior to this time also.
For more information about updates to immunization recommendations, check out:
Carolina Kids Pediatrics
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