Kids Corner with Dr. S

Welcome to my blog! I am Dr. Lauretta Stombaugh (Dr. S) and I have been part of the Hendersonville Pediatrics family for over 6 years. I have decided to share this blog because I feel that it is vital for parents and caregivers to be well-informed as well as have access to solid, accurate medical information. Your children are our children and we take pride in the excellent care we provide here at Hendersonville Pediatrics. Please join me monthly (or every two weeks if my four kids allow me time to write!) and I will in turn provide interesting, helpful and maybe even comical blogs.  Ready, set, go!!

Beach Babies

As I write this, I am on my way to the beach with four energetic kids, 8 years and under. Echoing behind me ( in my very hip 12-passenger van, with the faint smell of poop, cheese popcorn and Luca's sweaty feet) is the sound of " are we there yet? what time will we get there? I see palm trees, does that mean we are close? how many more minutes? "All the while the baby keeps breaking free from her car seat. I know I know, you're envious. Isn't vacation with kids so relaxing? I love being with my kids, but as they say, I might need a " vacation after my vacation." If I'm seeing your little on my first day back to work feel free to bring me an extra large, very caffeinated coffee.

As you head to the oceans, rivers, lakes and pools this summer, remember a few safety tips. And remember to play with your kids. Phone down. Facebook break. Dirty dishes in the sink.

Never leave a child without adult supervision even for 1 second, even in only 2 inches of water ( as in a bath, pool, river)a child can drown. According to the CDC (Centers for Disease Control), "drownings are a leading cause of injury death for young children ages 1 to 14, and three children die every day as a result of drowning." Three families and all of their loved ones touched by tragedy and changed forever. Three young lives everyday lost to accidental drownings. Three kids who will not get tucked in tonight. If you ever say to yourself, " it's just for one minute...." it's likely too long. Drownings happen quickly and quietly. It's not usually a child thrashing about in a pool. Fence in your pools. Learn CPR. Kids who know how to swim drown, too. Never get comfortable near water when kids are close by. Parents picture this- you are feeling relaxed, no laptop nearby, an icy beverage is in your hand, your toes are in the sand, no one is puking, pooping or peeing within a five foot perimeter around you, and no one is saying " Mommy!" Or "Daddy". Amazing. Ok, wake up now. Something is wrong with this beautiful image. You simply cannot completely relax and keep them safe near water. Unless of course you bring a babysitter or a family member to help and their eyes are on your littles. Then the kids might give you your five foot perimeter. Maybe.

I get asked a great deal about sunblock and what age to begin using it on our littles. Under 6 months, the recommendation is to use physical barriers against the sun such as shade, shirts, umbrellas and canopies. If you must have the baby in direct sunlight, use sunblock, sparingly and only on exposed areas. Use an SPF 15 or above. Over 6 months, use SPF 30-50 and apply every 2 h or after swimming. Use a broad spectrum sunblock because it protects against UVA and UVB rays. Don't forget the ears, feet and scalp! Zinc oxide containing "sunblocks" do not absorb into the skin. They provide a barrier reflecting the rays. Whereas, "sunscreens" have chemicals which protect by absorbing into your skin to prevent sunburn. Fact: studies show that the overall lifetime risk of developing Melanoma climbs 80 percent with 5 blistering burns in childhood. With one bad sunburn, the risk is approximately 50% higher. Wow. I am so regretful as I think back to my teen (sunblock free) summers on the Long Island beaches. Geez. I used baby oil! Please don't do this. Ever. My mom also ironed away my curls on an actual ironing board. That's for a whole other blog. In all seriousness, if your child has multiple skin moles, any enlarging or changing skin mole, any lesion that looks questionable or a family history of Melanoma.... bring them in! We are open 7 days a week and are happy to examine them. Counsel your teens about skin cancer and tanning beds. Change it up a bit from the usual lectures about cleaning up their rooms and studying. They might welcome the new topic. Maybe not.

What are the recommendations regarding bug spray? The main rule is to use insect repellant with up to 30% DEET for 2 month olds and up) for any outdoor activity. This not only helps prevent uncomfortable bites from mosquitoes, but lessens your chances of contracting certain viral illnesses and bacterial illnesses, such as Lacrosse Encephalitis or Lyme Disease. Always wash with soap and water after coming indoors. Apply on exposed skin and clothing. Do not spray under clothing. I can't speak for the herbal home remedies except to say that many of them have not been studied on all age groups. Not all of them protect against both mosquitoes and ticks. DEET is the best defense against these bugs scientifically, lasts 2-5 h and has been studied more extensively. Keep in mind, there are potential risks with each and every choice we make for our kids.

Enjoy your summer! Enjoy your kiddos! Stop in for a check up this summer before the August rush:) I'll be waiting and ready with a strong cup of caffeinated coffee!


PS - curly girls out there ...Love your curls! 

Sent from my iPhone

There have been many shifts in medicine over the last decade. Regardless, most of us still continue to practice in a way that focuses on our patients and providing quality medical care. Despite the obstacles, we remain dedicated. There are barriers. One of these being the “pop up” urgent care clinic.

“I go to an urgent care clinic because they take walk ins and have weekend hours.”

Both of our Hendersonville Pediatrics offices take walk ins during office hours, five days a week. We have evening hours most days (except for the summer months) and weekend hours every Saturday and Sunday. It is our goal to be present for our patients and their families. We understand how unpredictable illness can be and how difficult it is to have a sick child. We provide a clean, friendly and convenient medical home every day of the year. And we know your kids better.

“I go to an urgent care clinic because it provides similar medical care.”

Well, not exactly. When you bring your child to us, we have access to and review your child’s entire medical history. We can track disease trends, growth curves and developmental milestones. We do this at each visit for every patient before we even enter the exam room. Urgent care staff do not have access to your child’s complete history. They do not have their growth charts to view. They do not do developmental screenings. They often times do not do a complete physical exam when doing a sports physical. We do.

“It’s just a check for Strep throat.”

It could be that simple. It could not be. Each of us could tell you stories of visits which were scheduled as “cough”, “possible Strep” or “headache” and turned out to be “pneumonia”, “peritonsillar abscess” or “encephalitis”. We have incidentally found leukemia in kids coming in for “just fever”. This is the scary part of our job. It is the art of medicine which allows us to look a little further, ask a few more questions and order the correct test. We know your kids better.

“My child is healthy. There is no need for a detailed pediatrician visit.”

I am an osteopathic physician. As a “DO” I have been trained to center my focus on treating the whole person. The mind, the body and how they are interconnected. It’s about balance. Each work day I diagnose mental health conditions, developmental delays, nutritional deficiencies. I listen to stories and struggles of families in crisis, dealing with addiction, reaching out to get support. Hendersonville Pediatrics has a mental health team. Our psychologist, Dr. Will Dalton is available to our patients for help with issues such as potty training, discipline, ADHD, phobias, food refusal to name just a few. Our psychotherapist, Michael Thomas provides support for our patients with depression, anxiety, posttraumatic stress, ADHD, among others. As pediatricians we are trained to ask lots of detailed questions about physical symptoms, pooping, hobbies, social lives, academics. We might even ask the color of your bedroom rug:) We thrive on details. While this all takes time, we need to know these things to know your child. We need to ask some hard questions because it enables us to be complete. We want your children to feel comfortable telling us anything. Urgent care clinics may keep it quick and simple - less attention to your child’s needs. We are their medical home. We know your kids better.

Also, there is the issue of continuity of care. We have a medical team where everyone communicates and the electronic medical record is complete. We do not however, always receive updates from the urgent care clinics. So we do not have that Strep infection documented or that fourth ear infection. Similarly, if not communicated to us through a note from urgent care we may not have the medication list updated. Would you want your physician treating you without a complete medical record?

So, I’ll end with this: next time you consider going to an urgent care for a last minute sports physical or a sick visit, remember that we are here. We are willing to accomodate you the best we can. We know your children and want them to have a medical home here. 

Dr. SUrgent care clinics keep it simple but not necessarily complete.

There is no catchy title for this blog with good reason. I believe immunizing our children is a serious topic. It deserves this longer, thoughtful, well-intentioned blog.

As I sat down to write this, I wondered how I could present it in a way that is nonjudgemental and thorough. This topic stirs up lots of drama on social media, at mommy groups and elsewhere. It is a serious concern for us pediatricians, as we see vaccine preventable illnesses kill children. Present day. In our communities. In our local hospitals. My partners and I strongly encourage vaccines. So while I tackle the myths about vaccinating, I have the strong intent to educate and keep you well- informed. Our goal is to create a trusting relationship with you as we guide your children and keep them healthy into adulthood.

First time parents, pediatricians and old folk love discussing poop. When, what and not usually how, thankfully. As I go about my day in the office, it is inevitable that I will talk about poop at least a few times. While at home, I clean it up a few times and hour. Parents often have legitimate questions about what is normal, when to be worried and when to just “go with the flow.”

I was thinking about adding photos and graphics to these blogs, but I’ll spare you the visual details.

Let’s review normal and abnormal stools by age.

     There are a few times when I recommend things to parents, believe all that I share with them, but I understand where they are coming from when they challenge my advice. Safe sleep practices with newborns/ infants is one example. I understand parents are exhausted. I understand that breastfeeding or any feeding is easier at 3 am when mom is in a cozy bed. I understand that nothing feels better than embracing your new baby. But I don’t understand knowingly risking the life of your baby for these reasons. This blog is meant to be informative, not demanding. We need to be well-informed and keep our babies safe. We are always willing to sit down with you to discuss this in a nonjudgemental way - just call us. We all have the same goal of keeping your baby safe.

     According to the American Academy of Pediatrics, thirty-five hundred babies die every year from Sudden Infant Death, accidental suffocation, accidental strangulation or unexplained (ill-defined) deaths. Suffocation happens. Head injuries happen if baby rolls off the bed or chair. After the “back to sleep” campaign the number of SIDS deaths/unexplained deaths drastically decreased.

Here are some guidelines for keeping your baby safe. Please strongly consider following them. We know that your baby is your world. Be proactive in all aspects of their care, especially sleeping.

Sleep Environment:

-on BACK for any sleep time, naps and nighttime (baby’s anatomy keeps baby from choking, they are highly unlikely to choke on spit ups), side sleeping can be dangerous as well despite what older generations believe

-flat surface, firm mattress

-no bumpers, wedges, stuffed animals or pillows

-no gaps between mattress and sides of bassinet or crib

-no heavy blankets, quilts- a light blanket is OK, sleep sacks are OK.

-pacifiers are protective and decrease the chance of SIDS occurring

-breastfeeding can decrease the chance of SIDS

-do not smoke around the baby

-do not allow your baby to smoke (just kidding)

-keep baby in your room on this flat mattress until 1 year old, SAME ROOM, DIFFERENT SURFACE

-do not cosleep, baby can suffocate if you roll onto them (I have seen this happen), the soft pillows and blankets can be dangerous, baby can fall off the bed, baby can wedge between bed and wall or headboard

-make sure the fitted sheet on the mattress is tight fitting

-vaccinate your baby

-avoid having your baby sleep in the swing or carseat when they are newborns with poor head and trunk control, if they bend forward or head goes to chest they can suffocate

-try not fall asleep with your newborn when you are on a couch or chair

Avoid overheating:

-don’t bundle them too much. I prefer sleep sacks which are sleeveless, have a closed bottom and a zip up the front. This is better than a regular blanket which can move while they sleep. I prefer cotton over fleece, but it depends on how warm your home is.

-keep the thermostat at a reasonable temperature.

Some other considerations:

Babies can get flat heads when they spend a lot of time on their back. Give them lots of tummy time when they are awake and you are watching them. It helps with their motor skills and can lessen the chance that they will have flatheads. If they do develop an abnormal head shape, we can refer you for a helmet fitting if needed.

Just a side note. Moms often tell me that they are light sleepers and will know if the baby is in danger. While there is evidence to believe moms and babies are “in sync” and moms are more responsive to their babies if they are near, this does not have to be in the same bed. We are all tired parents when we have a newborn/infant. So keep your baby near, in the same room, not the same bed. Let's be real. Our partners take up enough room. We want the rest! Trust me, most of you will someday find yourself in bed with multiple children and a partner and a dog and pillows and a quilt and some kind of kiddy fluid or maybe juice? Enjoy this time when you have a whole 25% of the bed to yourself. 

We are here for you to discuss any questions at your next well child check. Remember that most of us have been there:)

Stay tuned for the next blog on the hot topic of vaccines. 

Dr. S