Is that sports form due again?


Every year, schools and athletic organizations require that you see a Raleigh, NC, pediatrician to complete a sports physical. So, what are the most common sports-related problems we see at Carolina Kids Pediatrics? For many of the conditions listed below, check out my favorite pediatric orthopedic website, www.orthoseek.com, for more information on how to recognize and recover from sports injuries.

(1) Ankle sprains: Ankle sprains are common, and often cause swelling and pain on the outer portion of the ankle. Many can be treated with a simple splint, maybe crutches for a week or so, ice for a day or two, rest, and ibuprofen.  Often a strengthening program is a good idea before a gradual return to sports (for example, tracing the alphabet in the air several times with your toes, using elastic bands with resistance to strengthen ankle muscles, etc.) Growth plate fractures can look like sprains, so if there is pain over bone or your child is limping a lot, please come and see us.
 
(2) Patellofemoral pain: This is typically considered an overuse injury and referred to as “patellofemoral syndrome.” Pain in the front of the knee is due to pressure overload on the kneecap or patella.  In young athletes, this is often due to different degrees of muscle imbalance and high activity levels. It’s important to strengthen, stretch and condition the quadriceps muscle in the thigh if this occurs, in order to stabilize the kneecap. Bicycling and other low-impact activities can help – check out the Orthoseek website above (look under “chondromalacia patellae” under the topics listed) to learn more.

(3) Osgood-Schlatter disease: Osgood-Schlatter disease is an injury at the growth place at the top of the tibia (the bump in your knee under your kneecap). The traction comes from strong and relatively tight muscles (that develop during puberty) and high activity levels. Pain and sometimes swelling can be felt directly over a bump at the bottom of the knee. Treatment includes rest, stretching, ice, ibuprofen, and possibly an over-the-counter knee strap. Although this condition can be painful, it seldom causes serious injury. 

(4) Little League elbow & shoulder: This is why growing kids have “pitch count” limits in baseball! These conditions cause pain at the growth plates either on the inside of the elbow or the shoulder. It’s important not to ignore elbow (or shoulder) pain in growing baseball or softball players. If these growth plates are injured significantly, they can require surgery to repair. Early Little League elbow and shoulder injuries often go away with rest, stretching and attention to proper throwing form.

(5) ACL tears: Unfortunately, this injury occurs far too often in young athletes. The anterior cruciate ligament (ACL) is a stabilizing ligament of the knee that is torn during an uncontrolled twisting motion. It almost always requires surgery in young people.  While there is a high rate of return to sports after this injury, it is safest to wait at least 7-9 months before considering a return to play.
 
(6) Hand or wrist (fractures/sprains/tendonitis): Fractures of the wrist usually occur with a fall on the outstretched hand. If swelling at the wrist and pain with movement occur, there is likely a sprain or fracture. An x-ray is typically needed to tell whether the wrist is broken. Many milder wrist fractures can be treated with a cast or splint for several weeks.
 
(7) Concussion: Concussion usually occurs from a direct blow or rapid turning of the head. Common symptoms and signs include headache, dizziness, nausea, or slowed thinking. The main treatment for a concussion is rest, which means no sports, plenty of sleep and brain rest, including minimal use of electronics and school work. Young athletes may be more susceptible to concussions and may require a longer period of rest for their brains to return to normal function. According to the Gfeller-Waller concussion law, you will need to see a medical provider, such as a Raleigh, NC, children’s doctor at Carolina Kids Pediatrics, or (in more severe cases) a neurologist or sports medicine physician, to complete a return-to-learn and return-to-play plan. Gradual increase in mental and physical activity as symptoms subside is recommended.
 
(8) Dehydration: Most athletes who become dehydrated are simply not drinking enough. A cup for every 15-20 minutes of activity is a good rule of thumb. Other factors that can lead to dehydration include exercising in the heat, drinking too much caffeine or having a viral illness. Extreme thirst, headache, nausea, abdominal pain and muscle cramping are common signs of dehydration. If an athlete suffers from dehydration, they should stop exercising and drink plenty of fluids. Young athletes may be more prone to dehydration because their thirst drive is not as well developed.
 
(9) Shin splints: Pain in the front of the shins with running can indicate an overuse injury, excess pressure in the tissues in the front of the leg, or sometimes a stress fracture of the tibia (shin). Rest, ice, compression sleeves, and elevation are often enough to treat shin splints, but if pain persists, if pain is severe, or if it is localized to one area, ruling out a stress fracture is a good idea. 
 
(10) Heart problems: Although rare in children and teenagers, some of the most serious sports-related health problems are heart-related. If your child every faints during exercise, or experiences significant chest pain, dizziness, or palpitations (sensations of an abnormally rapid heartbeat) with exercise, it’s important to come in to Carolina Kids Pediatrics to evaluate this further with an exam, and sometimes with an EKG or further cardiology evaluation. These can be warning signs of an underlying cardiac problem.

Remember that the pediatricians at Carolina Kids Pediatrics in Raleigh, North Carolina are here seven days a week to help address any sports-related injuries or problems your child experiences.

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 – breast, 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!

It seems to me that managing physical illness often represents the easy part of being a pediatrician. The real challenges we often face are in 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

Well-child visits aren't just important during the first year or two of life but help ensure good health as your children grow. The pediatricians at Carolina Kids Pediatrics in Raleigh, NC, offer a range of services that will help you protect your child's health.

So, what happens at routine checkups in older kids?

Well-child visits include a number of routine screenings in addition to routine measurements of height, weight, body mass index, blood pressure, vital signs. Some additional examples of routine screenings recommended by the AAP and routinely performed in our office include:

• Vision screening beginning at age 1 with new photo-screening technology
• Audiometry (hearing evaluation) annually beginning in the preschool years
• In-office laboratory screening for iron deficiency, cholesterol, lead exposure and more
• Standardized developmental screening for communication skills, fine motor skills, gross motor skills, personal/social skills and autism spectrum disorders
• Fluoride treatment to prevent early tooth decay beginning in infants 6-12 months of age
• Adolescent screening for mood disorders, substance abuse, and sexual health
•  Routine immunizations from infancy through college
• Opportunities to discuss health issues and concerns: During well-child care visits, your Raleigh pediatrician is available for a wide range of other questions about nutrition, school performance, injury prevention, behavior, and many other issues.

Is it time to schedule your child's well-child visit? Call pediatricians at Carolina Kids Pediatrics in Raleigh, NC, at (919) 881-9009 to make an appointment.

Age 1 to 5 has been described as the “Age of Beige.”
 
Beige and bland - the color and taste of foods eaten by picky toddlers and preschoolers.
 
So, how can you win the Battle of the Plate with your toddler or preschooler? At Carolina Kids Pediatrics in Raleigh, our pediatricians offer these ideas for vanquishing your picky eater:
 
RULE #1: AVOID SHORT-ORDER COOKING. So, what can you do if your toddler rejects the pasta and broccoli you have just worked so hard to prepare? Do you fix the peanut butter and jelly sandwich (with the crust cut off) that you know they will eat? Don’t. Do you force your toddler to eat the food you just spent 30 minutes cooking? Again, don’t. Instead, force a smile, and say, “Not hungry? That’s OK, I’ll save your food for you in case you get hungry later.” Then, leave the food out - the top of a chair works well, as a toddler can change their mind, come back, and the food is available at eye level. Just remember to put the dog outside first, or he’ll think that food you left out on the chair is all for him!
 
RULE #2: SAYING “NO” TO EATING IS OK.  By allowing young kids to say “no” to the meal we prepared, we are supporting their sense of autonomy. However, by not short-order cooking their favorite meal instead (or getting out the packaged snack foods), we avoid giving them more choices than they can handle. A child who gets chicken nuggets and fries every time they reject a meal will end up eating…nuggets and fries, and very little else. By providing a child access to the rejected meal until it’s time for another meal, we are insuring they don’t go hungry and can reconsider their choice when they do get hungry. The hardest part? Don’t suggest your child go back and eat it. Let them figure that part out themselves, and let it be their choice. Kids almost never lose weight or become malnourished when we allow them to say “no” to a meal this way.
 
RULE #3: ABANDON THE 3-MEAL-2-SNACK MYTH. Many toddlers and young children eat a mid-morning snack, a mid-afternoon snack, and even an after-dinner snack. Often these snacks are packages of processed food – cheese sticks, goldfish, crackers, etc. Remember that your toddler or preschooler may only need about 1200 calories a day – if they have 3 snacks with 300 calories each, it’s no wonder they don’t want to eat that nutritious meal we cook for them at breakfast, lunch or dinner. Skip the packaged snack foods. Instead, allow kids access to the previous unfinished meal if they get hungry before the next one – or just offer some sliced fresh fruits or veggies.
 
RULE #4: DUMP THE LIQUID SUGAR. Many young kids become juice-a- holics quickly if given the opportunity. Juices, sodas, and other sweetened drinks offer sugar and very little nutritional benefit – and they often fill kids up, which leads to the “hunger strike” at mealtimes. A cup of milk with each meal is great – but stick to water in between. 
 
RULE #5: WHAT’S GOOD FOR THE GOOSE IS GOOD FOR THE GANDER. THIS MEANS YOU. The most powerful motivator for healthy eating habits is watching a parent or an older sibling eat well. Even if life gets too busy to swing family meals every night, make sure at least one adult is eating at least a small meal with your young child – and that you are eating the same thing. If you are planning a meal at a different time, just have a small plate of what your toddler is eating and take a few well-timed bites. It also takes the pressure off – there’s nothing that gets a toddler to reject food as much as an adult staring at them and not eating themselves.
 
RULE #6: TODDLERS ARE NOT SMALL ADULTS. We routinely over-estimate portion sizes for toddlers. Try the “palm of the hand” rule – a portion of food for a child should roughly equal the size of the palm of their hand – not your big, grownup hand. Use smaller plates for little people to remind yourself of this rule. And never ask kids to clean their plate. If they learn to eat to please you instead of eating until they are full, we risk excessive weight gain, and all the health risks that come with it. Remember that toddlers and preschoolers naturally have a lower body mass index than they do at any other time in life – it’s probably OK if you can see and count their ribs!

RULE #7: WE’RE HERE TO HELP. Although most young picky eaters can be well-managed with these rules, real health problems are out there also. If you think your child is underweight, has chronic abdominal pain, chronic diarrhea or constipation, or signs of food allergy, please contact your Raleigh pediatricians – contact us here at Carolina Kids Pediatrics by calling (919) 881-9009 or sending us a message through our patient portal.