2605 Blue Ridge Road, Suite 100 Raleigh, NC 27607(919) 881-9009

Carolina Kids Blog

Posts for category: Children's Health

By Carolina Kids Pediatrics
February 26, 2020
Category: Children's Health
Tags: Immunizations  

At the beginning of each year, the American Academy of Pediatrics and the CDC release revisions in immunization recommendations for immunizationsthe 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: 


https://www.cdc.gov/vaccines/schedules/hcp/schedule-changes.html
 
Dr. Nechyba
Carolina Kids Pediatrics
Raleigh, NC

By Carolina Kids Pediatrics
January 29, 2020
Category: Children's Health
Tags: small cuts   bruises  

Kids can’t help but get into just about anything, whether that means climbing trees, jumping from the top step of a staircase, or flinging minor bumps and injuriesthemselves off of furniture. 


Of course, with all of this activity comes the risk of injury. Here at Carolina Kids Pediatrics in Raleigh, NC, we know that bumps and bruises are a part of life, but our pediatricians also want parents to be able to avoid those scary emergency room visits. There are over 8 million pediatric ER visits annually for accidents and injuries – the good news is, most of these can be treated without ever needing to go to an ER. 


Here at Carolina Kids Pediatrics, our team of pediatricians provides both acute injury care and suturing, so you usually don’t have to rush your child to the nearest ER.


Most wounds can be treated by holding pressure to stop bleeding, properly washing with soap and water, and then bandaging at home. However, it’s important to know when a cut might require the attention in our Raleigh office.


You should bring your child in for care right away if a cut:
·Looks deep or very wide
·Has debris in it
·Is becoming increasingly red and swollen
·Is more than a half-inch long
·Bleeds through a bandage
·Still bleeds after 5-10 minutes of applying pressure


If you decide that your child’s cut needs to be looked at, our pediatric docs can usually take care of this problem and provide wound care and suturing. If in doubt, you can always give us a call and find out whether your child’s injury warrants a trip to our office for care.


Bruises are most common in children once they start standing and walking. Wrap ice in a towel, and apply briefly (a minute on, a minute off). While bruises may be tender to the touch, it’s important to see your pediatricians if the bruise is causing serious pain.


What are the options available nowadays for closing a small cut?

  • Skin glue was approved for use in 1998 and has become popular. It is applied by rubbing it over the cut while the cut is being held closed. It’s a good choice for straight cuts and is quick and painless. However, it cannot be used to close a wound that has any tension on it from muscle usage. This is because skin glue is not as strong as stitches and, when used in areas of tension, the risk of the cut reopening is high. It also should not be used on wounds that are likely to ooze or bleed – this will cause a bubble under the glue and can disrupt the wound closure. 
  • Steri-strips (or "butterfly" bandage closures) are narrow adhesive strips placed over a cut, with a bit of tension to keep it closed. They are used for small cuts that are not very deep or over a joint or areas of tension. If they stay in place for at least three days, the outcome can be just as good as stitches. However, they are not as strong as stitches and do not stay in place as well.
  • Stitches provide more strength and less risk of being pulled off too soon. However, they can be traumatic due to the time and pain involved in putting them in. At Carolina Kids, we can utilize both numbing ointments and anesthetic injections before closing a wound with stitches. 
  • Staples are most often used for cuts in the scalp behind the hair line.  They can be placed very quickly and close the cut almost as well as stitches.

How soon after an injury does your child need to see a doctor for stitches? 
 
Most cuts can generally be closed up to 18 hours after the injury. This means we might be able to stitch a minor cut that occurs in the evening during office hours the next morning – especially if it is not bleeding and has been appropriately cleaned and covered. Definitely give us a call if you think stitches might be needed, though. Some cuts, like cuts on the face or very deep cuts, should be closed sooner, but it is usually safe to wait at least 12 hours to have a cut closed. If you do decide to wait: clean the cut well, and don’t let it dry out. Wet some gauze pads and tape them over the cut. 
 
When should you be concerned about scarring from stitches?  
 
Facial cuts in children usually heal remarkably well and with very little scarring. Pediatric plastic surgeons recommend that most facial cuts be repaired using simple stitches. The suture size and needle type are specifically designed for the delicate skin of the face.
How can you make your child's scar less visible?
 
Although scars cannot be completely erased, there are some simple things you can do to help minimize them. 

  • Sun protection. Damaged skin is susceptible to becoming permanently discolored by the sun for up to 6 months after an injury. It is important to minimize sun exposure to the healing cut. Keep it covered with a hat or clothing as much as possible or use a sunscreen to minimize darkening of the scar. However, do not apply sunscreen until two weeks after the cut.
  • Scar massage. Scars may soften and flatten more quickly when they are massaged. Use your fingers to apply gentle pressure and massage the scar in circles – but don’t start doing this until the wound is well healed (after about 3 weeks). It’s usually helpful to use a moisturizer like Vaseline with scar massage – although there are scar-specific moisturizers available (like Mederma and Vitamin E-containing moisturizers), evidence is mixed about whether these are significantly better than just a bland lubricant like Vaseline.
  • Silicone sheets or gels. Silicone products may help soften, flatten, and improve the coloration of a scar if used for at least 12 hours a day. You can get these products over the counter without a prescription – you can start using them about 3 weeks after the injury.

Concerned? Give us a call

If you are concerned about a child’s injury or fall, it’s important that you have a pediatrician who you can turn to for immediate care. Here at Carolina Kids Pediatrics in Raleigh, NC, it’s our policy to offer “work in” appointments for injuries that require urgent treatment whenever possible – so call us at (919) 881-9009 if that injury just seems like a bit more than a typical boo-boo.

By Carolina Kids Pediatrics
December 30, 2019
Category: Children's Health
Tags: asthma  

Have your kids struggled with asthma symptoms? Do you wonder if your child’s respiratory symptoms asthmaare reasons to be concerned about chronic asthma?

Asthma is one of the most common chronic conditions of childhood – according to the American Lung Association, there are over 6 million kids affected in the U.S. 

How can you recognize if your child has asthma? Symptoms can include:

  • Frequent dry cough, particularly at night
  • Cough that seems chronic, and is not limited to times when your child has a cold or during a peak allergy season
  • Shortness of breath
  • A wheezing sound when exhaling
  • Cough or wheezing with exercise 
  • Chest tightness

Kids with asthma are more likely to have a history of other allergic conditions, including eczema, food allergies or allergic runny nose or eyes (allergic rhinoconjunctivitis), or to have a family history of allergic conditions. 

Asthma causes air passages to be extra sensitive to certain triggers, including infections, smoke, pollens, animals, and dust. This leads to airway muscle spasm, airway swelling, and decreased lung function. In young kids, asthma is usually triggered by colds and respiratory infections. In older kids, it is commonly triggered by environmental allergies or exercise also.

What are the most important steps your Raleigh, NC, pediatrician can take to help you control your child’s asthma?

First, it’s important to know the severity of your child’s asthma. Is your child’s asthma under good control? One way to answer this question is with the rule of 2’s: If your child has an asthma cough or asthma-related wheezing requiring a fast-acting inhaler or nebulizer more than TWICE A WEEK during the daytime, more than TWICE A MONTH at night time, or if your child has needed oral prednisone more than TWICE A YEAR for a significant asthma flare, then your child’s asthma may be under poor control.

If your child has signs of poor asthma control, we will likely treat your child with a daily controller medication, given by inhaler or nebulizer. Many kids don’t understand why they need to take a daily medication even if they have no symptoms. The reason is simple – their lung function will improve if chronic airway inflammation is controlled. That means they will feel better, sleep better, have better exercise tolerance, and possibly improve their chances of outgrowing asthma completely. Ask your child why they brush their teeth daily even if they do not have a tooth ache. Same idea! Many parents worry that controller medications are usually inhaled steroids. No worries – inhaled steroids are NOT absorbed into your child’s body to any meaningful extent, and will not cause steroid side effects. In fact, your child would have to use an inhaled steroid daily for 5 years do get as much steroid into their body as they would from a couple of days of prednisone.

In kids who are 6 years or older, our pediatricians will also use spirometry (lung function testing) in the office to make sure their asthma is under good control. Your pediatrician may also do allergy testing in our office to clarify potential triggers of your child’s asthma.

If your child takes a daily controller medication for asthma, your pediatrician will also assign our asthma care coordinator to help track your child’s asthma. Michaela Frost is our current asthma care coordinator – she may reach out to you by phone or through the patient portal for several reasons, including:

(1)  To make sure you have an updated written asthma care plan.
(2)  Facilitate an asthma follow up visit (we recommend visits every 3-4 months for all kids with persistent asthma requiring controller medications).
(3)  Check in with you if your child has not received regular refills on their asthma controller medication.
(4)  Check in with you after any unscheduled asthma-related ER visits or hospitalizations.
(5)  Check in with you if your child seems to be requiring albuterol for quick relief more frequently than would be needed during periods of good asthma control.
(6)  Help you with lab follow up, insurance related issues with medication coverage, school medication authorization forms and school asthma plans.

At Carolina Kids Pediatrics, we believe that, in most cases, asthma is a disease that can and should be managed comprehensively by your primary care pediatrician – and that your Raleigh, NC, pediatrician needs to have all the tools and resources to manage your child’s asthma.

Our pediatricians at Carolina Kids Pediatrics in Raleigh, NC always want to be available to you to help provide long-term solutions for managing your child’s asthma.

Dr. Nechyba
Carolina Kids Pediatrics
Raleigh, NC

By Carolina Kids Pediatrics
July 08, 2019
Category: Children's Health
Tags: breastfeeding  

How Your Pediatricians in Raleigh, NC, Can Help You 


At Carolina Kids Pediatrics, we do what we can to support families as they navigate all the challenges that come with infant feeding – breastfeedingbreast, bottle, or both. The American Academy of Pediatrics policy on breastfeeding recommends:

“Exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” 

We fully support this recommendation, but we also recognize that for many families, it isn’t that easy. There are many challenges to successful breastfeeding, including difficulties with infant latching, flat/inverted nipples, infant tongue tie, breast infections, low milk supply, engorgement, and many other competing demands on a new mom.

Fortunately, it's not a path you have to navigate alone — your pediatricians and our lactation consultant here at Carolina Kids Pediatrics in Raleigh, NC are here to support you every step of the way. We recognize that while breastmilk provides ideal nutrition for babies, breastfeeding is not right for all families – and we are here to help your baby and your family thrive, whether you decide to breastfeed or formula fee. Our lactation consultant, Jerrianne Webb, is in our office weekly to provide extended lactation consultation appointments for families, and she is available to provide free telephone support at other times also.

For most families, I see three phases of learning to breastfeed which I call “learning to latch”, “learning to eat”, and “learning the routine.”

Learning to latch: Newborns are designed to require very little milk – breast or formula – in the first few days of life. In the first 24 hours of life, the focus should usually be on proper latch at the breast, not on how much milk a baby is getting. Your baby’s lips should be flanged wide apart, and the nipple of the breast should be in the back of their mouth, not between their lips. If it hurts or pinches through the feeding, the latch is probably wrong and needs to be corrected. Gently open your baby’s mouth wide and support their head in very close to the breast to achieve a proper latch. During this time, a brief 5 minute feed with a good latch is better than a 20 minute feed with a poor latch. Putting your baby to breast as early as possible after delivery, at least 10-12 times daily, and correcting a narrow, biting latch whenever possible can help increase your chance of success.

Learning to eat: Your milk comes in three or four days after delivery. Now, your breast feels full before the feeding, and hopefully softens after the feeding. Your baby will eat 15-30 minutes per side instead of the brief feedings of the first few days. If your baby has learned how to latch well in the first few days, she should be more content after the feeding, continue to eat every 2-3 hours on average, and start to have more frequent wet diapers and lighter yellow or brown stools. She should stop losing weight and start to gain 1/2 to 1 ounce daily.

Learning the routine: As your baby grows, you may choose to start introducing bottles of pumped breastmilk to get some breaks in your day and to allow family members to feed your baby. Ideally, your baby has learned to latch and nurse well first. A slow-flow bottle, like an Avent bottle, might be less confusing for your breastfeeding baby. Brief pumping after nursing several times daily will provide you the milk you need to supplement. You can freeze breastmilk for months, then thaw it in warm water – don’t microwave breastmilk to warm it. 

The list of advantages from breastfeeding for your baby may include reduction in  the risks of:

1. Infectious diseases such as ear infections, gastroenteritis, and pneumonia
2. Eczema and asthma
3. Obesity
4. Diabetes
5. Sudden infant death syndrome
6. Overall infant mortality
 
Mothers who breastfeed their infants also receive health benefits, significantly reducing their own risk of developing:

1. Type 2 diabetes
2. High blood pressure
3. Ovarian cancer
4. Breast cancer
 
Questions? Give Us a Call

To learn more, call your pediatricians or lactation consultant at Carolina Kids Pediatrics in Raleigh, NC, at (919) 881-9009, or send us a message through the patient portal!

By Carolina Kids Pediatrics
April 08, 2019
Category: Children's Health

It seems to me that managing physical illness often represents the easy part of being a pediatrician. The real challenges we often face are behavioral visitsin the domain of child development, behavioral health, and mental health.

Although there are plenty of excellent child psychologists and psychiatrists in our area, we believe that being a pediatrician in Raleigh, North Carolina means being available to address many childhood behavioral and developmental challenges in our office. In order to facilitate this, we provide extended visits for developmental and behavioral consultations to help you and your family.

During an extended visit and consultation appointment for developmental and behavioral issues, your pediatrician may address a number of concerns. Common challenges we address may include:

  • Infancy: Common concerns that in infancy include development of normal gross motor skills, including rolling, sitting, crawling, and walking, as well as challenges involving feeding, including breastfeeding and transitioning to solid foods. We conduct an evaluation at every well visit and perform standardized developmental screening through the Ages & Stages (ASQ) measurement tools in our office. Through these evaluations, we can help you evaluate if your baby’s development is truly behind. If it is, we can gauge how much additional evaluation and intervention is needed. For example, delays in gross motor development may require simply home intervention (for example, a neck stretching program for a baby with mild head flattening which we can teach you in our office). More significant delays may require intervention by a trained therapist. Some of these therapy services can be obtained through private referral. However, if developmental needs are likely to require more in-depth intervention over time, we often refer to the Children’s Developmental Services Agency. This is an arm of the school system which provides a free developmental assessment for kids from birth to age 3 with developmental delays. The CDSA can provide physical therapy, developmental therapy, speech therapy, and occupational therapy if it is warranted. You can contact the CDSA by calling (919) 662-4600, extension 239, if you believe that your child needs an evaluation – or check out the early intervention website at https://beearly.nc.gov/index.php/contact/cdsa .

 

  • Toddler years: Common developmental challenges include delays in communication skills, and sometimes concerns about autistic spectrum disorder, as well as increasing struggles with autonomy surrounding meal choices, potty training, aggression, and defiance. In addition to ASQ screening, we add specific, standardized screening for autism, as well as standardized vision screening in the second year of life. If you have concerns that your toddler has developmental delays that might be due to autism, please take the following steps: First, call us for an appointment. Second, please check out the website http://firstsigns.org – a great resource, with reliable information and screening tools. Third, consider contacting the Children’s Developmental Services Agency (contact information listed in last section) for a complete early learning evaluation through the school system.

 

  • Preschool: The focus during the preschool years often involves early learning skills and school readiness. This can include a more in depth consideration of peer social interactions, fine motor skills and skills needed for early literacy. Your best community resource for evaluating these concerns include Project Enlightenment, a public service offered by the Wake County School system which serves preschool age children and their families. Services include daycare and preschool behavioral consultation, developmental screening, parent behavioral workshops, and individual parent behavioral counseling. Check out their website at https://www.wcpss.net/projectenlightenment . If a preschooler has delays that might affect school readiness and require classroom-based services, you can request an evaluation for these public preschool services through Wake County also – for more information, check out https://www.wcpss.net/Page/4310 .

 

  • Elementary school: Changes in academic performance or behavioral concerns can raise questions about a possible learning disability or attention deficit hyperactivity disorder (ADHD) at this age. Review of school report cards, standardized testing assessments, as well as reports from psychoeducational specialists can be helpful in evaluating these questions. You can also complete standardized questionnaires including the Vanderbilt Teacher and Parent Diagnostic Rating scales – these can provide us with helpful information, and are available at https://www.brightfutures.org/mentalhealth/pdf/professionals/bridges/adhd.pdf . If your child has a medical condition that affects learning (including ADHD, depression, anxiety, etc.) or a learning disability, you have the right to request a Section 504 plan or an Individualized Education Plan (IEP) through your public school. These plans can provide access to specific modifications which might help your child, including behavior plans, extended time on tests or assignments, a modified homework schedule, etc. They can also provide access to special education services – which could be as limited as a once weekly “check-in” with a special education professional, or as extensive as separate classroom placement. When appropriate, we can advocate for you during this process by writing needed letters, providing needed documentation to your school, or making any additional needed referrals. Your best online resource for learning more about ADHD is the organization CHADD (https://chadd.org).

 

  • Adolescence: Although kids can struggle with issues surrounding possible depression and anxiety disorders at younger ages, these challenges can become more prominent during adolescence. We include confidential questionnaires for teens at well visits – these ask age-appropriate questions on mood disorders, substance abuse, and sexuality, which often opens the door to determining if other interventions are needed. These interventions might include cognitive behavioral therapy (changing thought patterns that affect mood), family therapy, and sometimes medication management.

The pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina can provide developmental and behavioral consultations on these and other concerns.


These are in depth conversations and require time and follow up – which is why extended visits for developmental and behavioral consultations are so important. To find out more about how a pediatrician can help with your child’s development and behavior, contact the pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina today by calling us at (919) 881-9009 or sending us a message about your concerns through the patient portal.

Dr. Nechyba
Carolina Kids Pediatrics
Raleigh, NC



Back
to
Top