Dr. Todd Harris

Banner Change: Summer Edition

Written by Dr. Todd Harris

Kids having fun at the pool during the summer

June 21, 2017 – Yesterday was the official beginning of summer, so yesterday we said “goodbye” to spring – and “goodbye” to our spring website banner picture of ‘family walking on the partially tree-shaded path‘.

We welcome summer, and – with summer – we welcome a new summer website banner picture: “Welcome” we say to ‘three children at the pool with a pink floaty’.

A few things going on this summer at Raleigh Children and Adolescents Medicine:

  1. CHECK UPS: Did you know that your teenage child’s well visit (a.k.a. “checkup” or “complete physical”) meets the requirements for participating in school sports? At that visit, we can complete your child’s school sports form (and in Wake County that will cover the next 13 months of athletic participation). If you need a form completed and you have already had a check up this year – no worries – we can complete that form based on information gathered at that visit. There is no need for a ‘Physical’ at an Urgent Care or a Pharmacy Clinic. Just send us your school’s sports form with your portion already completed. You can drop it by, mail it, or send it to us through your email or fax.
  2. Dr Emily Ross joins RCAMNEW PEDIATRICIAN joining RCAM! Dr. Emily Ross begins August 1st. More about Dr. Ross later, but we are excited for her to join the RCAM-ily for the next 40 or so years (imagine the stories she will tell at RCAM’s 90th anniversary).
  3. ePRESCRIBING MEDICATIONS that previously required a hand-delivered, paper hard copy: For over 10 years, we have been able to send most prescriptions electronically directly to your pharmacy. This practice reduces transcription errors and typically is more convenient for our patients. However, certain medications have continued to require a paper hard copy that must then be hand-delivered to the pharmacy. The Pediatricians at RCAM are currently working through the authorization process for sending these prescriptions electronically. We are happy to offer a service that improves patient safety and convenience.
  4. PAYMENTS THROUGH THE PATIENT PORTAL: Do you prefer electronic bill paying? Coming in July, payments on your account will be able to be made electronically through our Patient Portal.
  5. CHINI WAPI DONATIONS: Many will recall Dr. Rick Gessner and his family spent 2 years on a medical mission in Kenya. His daughter Anna returns there this month and she has been collecting women’s underwear to distribute to women there living in prisons or remote tribes. You may have seen signs in our office about her trip. She collected more than 800 pairs. We estimate 200-250 were donated by families at RCAM. Thank you for your contributions.

And now, what would summer fun be without your pediatrician there to remind you about safety?

  • A brief video from the AAP about sun protection:

  • If you like lists (I know you are out there), here are some tips from the AAP’s website: healthychildren.org: Summer Safety Tips
  • Finally, from our local paper, The News & Observer, here is a video about what to do should you find yourself in a rip current. A terrifying thought, but more proof that having the right information can save your life:
RCAM hopes your family makes memories of a summer full of good health and good play!

Dr. Todd Harris

From the AAP: Updated Safe Sleep Guidance

Written by Dr. Todd Harris

January 12, 2017 – Recently, the American Academy of Pediatrics (AAP) came out with some updated and expanded safe sleep recommendations.

They list 19 recommendations for a safe infant sleeping environment and it is definitely worth taking a look at the details.

The 19 recommendations for a safer infant sleep environment:

  • Small detail: The 19 recommendations are listed with their strength of recommendation at the bottom of this post
  • Some detail:  A listing that includes brief explanations is found here.
  • More detail: The official AAP policy statement is found here.
  • Lots of detail: The AAP technical report is found here.

What your pediatricians at RCAM think about these new safe sleep recommendations:

1. New recommendations reflect the best information available now

First of all, we don’t shy away from new recommendations. Not at all. That is one of the strengths of medicine.

We know that we don’t know everything, and there is a vast and constant pursuit of better information. When more complete, up-to-date knowledge about how to keep our children healthy comes available, we want to incorporate it into what we do.

That is why it is okay that we sometimes hear grandmothers say, “That’s not what I was told when you were a baby.

Medicine strives to recommend based on the best information available now.

2. Old habits are sometimes hard to kick

It has taken us a few months to comment as a practice because these 19 recommendations include some real game changers.

For example, consider #4 below: “Room-sharing with the infant on a separate sleep surface is recommended” (for the first 6-12 months).

As a practice, we have generally agreed that establishing a healthy, through-the-night sleep pattern is greatly aided by the move of your infant into a separate room. But, some studies have shown a 50% reduction in the incidence of Sudden Infant Death Syndrome (SIDS) in infants who room-shared (not bed-shared) for the first 6-12 months. That is what I mean by a game changer.

There are 19 recommendations. No one will be perfect and follow all of them 100% of the time for the first 12 months of life (if your child has ever fallen asleep in their car seat and you didn’t as quickly as possible move them to a firm, flat surface, then you haven’t followed all the recommendations all the time).

However, it is important that we assess what we do and change our habits to be as safe as we can with out most valued members of society – our children.

3. Some old habits do not need to change

Back to sleep for every sleep is still very important for a safe infant sleep environment.

Summary of Recommendations With Strength of Recommendation

The list below comes from the AAP (link). The linked article provides more information along with references with each recommendation. The recommendations are grouped based on the Strength-of-Recommendation Taxonomy (SORT) for the assignment of letter grades to each of its recommendations (A, B, or C).

A-level recommendations (Level A: There is good-quality patient-oriented evidence.)

  1. Back to sleep for every sleep
  2. Use a firm sleep surface
  3. Breastfeeding is recommended
  4. Room-sharing with the infant on a separate sleep surface is recommended
  5. Keep soft objects and loose bedding away from the infant’s sleep area
  6. Consider offering a pacifier at naptime and bedtime
  7. Avoid smoke exposure during pregnancy and after birth
  8. Avoid alcohol and illicit drug use during pregnancy and after birth
  9. Avoid overheating
  10. Pregnant women should seek and obtain regular prenatal care
  11. Infants should be immunized in accordance with AAP and CDC recommendations
  12. Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
  13. Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth
  14. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising
  15. Continue the “Safe to Sleep” campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. Pediatricians and other primary care providers should actively participate in this campaign

B-level recommendations (Level B: There is inconsistent or limited-quality patient-oriented evidence.)

  1. Avoid the use of commercial devices that are inconsistent with safe sleep recommendations
  2. Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly

C-level recommendations (Level C: The recommendation is based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening.)

  1. Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely
  2. There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS

Note: “patient-oriented evidence” measures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life; “disease-oriented evidence” measures immediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (eg, blood pressure, blood chemistry, physiologic function, pathologic findings). CDC, Centers for Disease Control and Prevention.


Dr. Todd Harris

College Basketball 01 16 16

January 16, 2016 – Isn’t it nice to hear good news once in a while?

Some days you could really use that good news.

For certain college basketball fans, today might be a good day to seek out some good news.

The American Academy of Pediatrics made a list of 7 great advancements in pediatric research. Read about how life is better today for our children due to pediatric research here.

And guess what?

Even if your team happen to win today – or if you don’t care about college basketball – all of these advancements are still good news.

The achievements are listed below. Click on each one for more information.

  1. Preventing Disease with Life-saving Immunizations
  2. Reducing SIDS with “Back to Sleep”
  3. Curing a Common Childhood Cancer
  4. Saving Premature Babies by helping them Breathe
  5. Preventing Mother-to-Baby HIV Transmission
  6. Increasing Life Expectancy for Children with Chronic Disease
  7. Saving Lives with Car Seats and Seat Belts

 

 


Dr. Sarah Owrey

Baby on Board

November 4, 2015 – Not sure whatever happened to these signs. Not sure if anyone drove safer because of them.

Once again, it is proven that transporting your child safely includes a car seat that has been chosen carefully, installed properly and used appropriately.

Here is another link from the AAP with some timely car seat information.


Dr. Jamila Fletcher

2 Charleston Girls

September 21, 2015No, not really…

I see this a lot in the office – a parent hands a smartphone to a toddler – and I get why it happens – when it comes to keeping a young child ‘settled’ –  it really works in that moment…

But, the American Academy of Pediatrics points to some legitimate concerns about the impact of “screentime” beyond that moment for a young child.