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:

https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/covid-19-and-breastfeeding.html
 
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
Raleigh, NC

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: 


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

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 themselves 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.

If you are planning to breastfeed, the first few weeks of your baby’s life can be the most challenging.

Even if this is your first child, you’ve probably heard stories from other moms discussing the trials, tribulations and triumphs of breastfeeding. At Carolina Kids Pediatrics in Raleigh, NC, our pediatricians and our lactation consultant are here for you every step of the way to make breastfeeding more successful for you and your baby.

Latching Takes Time 

The chances of a successful latch increase if you are able to attempt nursing in the first hour or so after a baby is born. Babies tend to be alert and readier to breastfeed during this first hour – afterward, they (and their exhausted parents) often fall asleep for the better part of the next 8-12 hours. Although it’s still important to wake babies to breastfeed during this time, it tends to be more challenging than during that first hour.

Remember that your milk does not come in for about 3 to 4 days after your baby is born – so when they are breastfeeding, they are getting only small amounts of colostrum (early milk) for those first few days. 

During this time, it’s less important how much a baby gets, and more important that they develop a deep latch – with the baby’s mouth wide open, their lips flanged apart, and the nipple in the back of their mouth – not between their gums. Support your baby’s head close to the breast – I often tell new moms that if you aren’t worried that the breast will suffocate your baby (no worries, it won’t!),  then your baby probably is not close enough to your breast. If they back up, they will slip off and bite down on your nipple with their gums. Not only is this painful, it’s just not an effective way for your baby to express milk. 

Breastfeeding Happens Around the Clock 

Babies should be breastfeeding about every 2 to 2 ½ hours – or more often if they are asking for it – for the first few weeks. That time is measured from the beginning of one feeding to the beginning of the next – so, unfortunately, your break between feedings is usually even shorter than this. 

At first, they may only nurse for 5 or 10 minutes. That’s fine on the first day, but your baby should start to feed longer on the second and third day. Eventually, they may latch for 20-30 minutes on the first side, and a few minutes on the second. Once your milk comes in, your breast should soften with the feeding – and it’s always a good idea to empty the first side before switching. The last part of the milk feeding (the hindmilk) is higher in fat and calories, so it’s important to empty the first breast before offering a baby the second side. 

Babies can lose up to 7 to 10% of their birth weight before your milk comes in. Once your milk comes in, your baby should gain close to an ounce a day. They should also be more content after nursing; their stools should change from dark to light yellow and loose - sometimes 8 to 12 stools a day or more (you’ll never look at mustard the same way again!). 

Remember that at Carolina Kids we have a lactation consultant, Jerrianne Webb, working in our office. She is happy to meet with patients for in-depth lactation consults – or just answer your questions by phone.  If you are having trouble breastfeeding at any point don’t hesitate to talk to our pediatricians or our lactation consultant at Carolina Kids in Raleigh. Remember, successful breastfeeding takes all kinds of support - roadblocks can and do happen but we are here to help.

If you are looking for resources online, check out www.kellymom.com. You’ll find a wide range of information on breastfeeding, from the basics to more unique topics (like how to get through surgery or jury duty while breast feeding). 

Do you have questions about breastfeeding? Whatever you need, Carolina Kids Pediatrics in Raleigh, NC, is here to help. Call us today at (919) 881-9009 to schedule an appointment or to address your breastfeeding concerns with us.

Have your kids struggled with asthma symptoms? Do you wonder if your child’s respiratory symptoms are 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