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.

For years, the pediatricians at Carolina Kids Pediatrics in Raleigh, NC have taught free prenatal education classes at Babies R Us locally. This week, we were saddened to hear that Babies R Us stores will be closing nationally. We will continue to look for ways to reach out to our community to provide prenatal education classes and resources for future parents. 

What can you expect from a Prenatal Education Class?
We cover a range of topics, including what to expect as you initiate feeding (breast or formula), what to have at home, and what to expect in a newborn’s first few weeks of life. For a list of more prenatal education topics, check out the page:
https://www.healthychildren.org/english/ages-stages/prenatal/Pages/default.aspx

Our lactation consultant, Jerrianne Webb, also joins our prenatal education class periodically to provide additional guidance on preparing for breastfeeding. Our prenatal education classes are held every 2 weeks at Carolina Kids Pediatrics in Raleigh, NC. A few other reminders about your prenatal care:

• Take a prenatal vitamin with at least 400 mcg folic acid as soon as possible in pregnancy. Early supplementation is critical for decreasing your baby’s risk for a number of birth defects, including spina bifida
• Avoid cat litter, pet rodents, lizards and turtles during pregnancy: all can pose a risk for infections that are particularly concerning during pregnancy
• Let your obstetrician know if you are traveling to the Caribbean, Latin America, or other areas where Zika virus is transmitted
• Talk to your obstetrician about prenatal vaccination, especially against pertussis and influenza
• Avoid undercooked meat, unpasteurized dairy, and certain fish with potentially high mercury levels (including swordfish, shark, tuna, tilefish, orange roughy and mackerel)

Take advantage of Prenatal Education opportunities and prenatal classes not just at Carolina Kids Pediatrics, but throughout the Raleigh area – remember that local hospitals also provide prenatal classes on various topics. If you are part of an organization which provides resources for new parents, we are always happy to provide community outreach education for parents!

Dr. Nechyba
Carolina Kids Pediatrics
Raleigh, N

Should a mother continue to breastfeed if she has been exposed to influenza?

What if she has tested positive for the flu, or has other children that have it? Should she temporarily wean the baby to protect him? 

These questions have been frequently asked by many mothers of breastfeeding newborns over the last few weeks. As the lactation consultant at Carolina Kids Pediatrics in Raleigh, NC, I have been asked these questions several times in the last few days alone.

Breastfeeding mothers SHOULD continue to breastfeed even if they have influenza, or have been exposed to it. Breastfeeding protects the newborn from infections, as antibodies from the mother’s body are passed to the newborn through the milk. The flu virus, as with any virus, has an incubation period. This is the time before the onset of symptoms. Since breastfeeding mothers and babies share the same environment, the mother and baby are likely exposed to the virus at the same time. During this incubation period, the mother’s body begins to produce these protective antibodies for the baby. Breastfeeding (and handwashing!) is the best protection for the newborn.

In the case where a mother is receiving anti-viral medications, such as Tamiflu, breastfeeding is still not contraindicated.  The mother should continue to breastfeed as desired.

Please do not hesitate to contact your pediatrician in Raleigh, NC, to discuss any concerns you have about flu symptoms, or breastfeeding.

You may call Carolina Kids Pediatrics at (919) 881-9009 to schedule an appointment with me. I’ll be glad to help with any of your breastfeeding concerns. 
Jerrianne Webb, RN, IBCLC
 
For more information:
https://ibconline.ca/maternal-illness1