Ever wonder what’s in your medical records?  Have you ever looked at your whole medical record?  Have you seen your child’s medical record or chart?  You know the joke about the doctor’s poor handwriting?  Well, it’s true.  Many of us, too many of us, have poor handwriting, myself included.  We write all day long.  Let me share with you what pediatricians write in our medical notes.

In the outpatient office, there are a lot of commonalities in patient records from office to office.  There’s a section of the chart that contains insurance information and consents.  We need authorization to treat the patient and to send records to other physicians caring for your child. Every chart should have demographic information:  Who lives at home? What is in the home?  Pets?  Smokers?  Lead paint?  Family history is also important.  If a sibling, uncle, and cousin have a medical condition, someday it may help lead to a diagnosis in your child.

A problem list will contain the important diagnoses or problems that your child has faced over the years.  It is a summary or important illnesses, surgeries, and hospitalizations.  This is especially helpful with older children, because doctors and parents sometimes forget things from the past.  Allergies to medications and other drug reactions are also listed.  At each visit we also have the Medication Reconciliation form.  This lists all of the medications your child is taking.  If your child is admitted to the hospital or upon discharge from the hospital, we will use this list  to ensure we have an accurate accounting of the medications.

Pediatricians love growth charts.  Hopefully, your pediatrician shows you these at each visit.  They include graphs of the growth of your child’s head size, weight, and height.  The growth pattern is extremely important in deciding if your child is doing well.  Healthy children tend to grow well and children with illnesses tend to not follow the appropriate growth curve.

Every chart has an immunization record.  In New York State, almost every office participates in the New York State Immunization Information System or NYSIIS.  This is a great computer network whereby children’s immunizations are entered so authorized health care providers can easily access immunization records.  If you have a computerized printout of your child’s immunization record, there’s a good chance it came from NYSIIS.

There is a section for letters to and from consulting physicians, lab tests, and radiology results.  If you had care at another office prior to your current doctor, the “old” medical records will be here.

The note from the child’s visit to the doctor varies a lot from one office to the next.  All notes should contain information about the “chief complaint” which is why the patient is being seen.  This may be for ear pain, asthma, or a Well Child Visit.  We will write down patient symptoms, concerns, medications, and other aspects of the “patient history.”  The section on physical examination includes the vital signs of temperature, weight, height, pulse, blood pressure, and respirations.  A detailed description of the physical exam is then written down.  The end of the note includes the doctor’s “Assessment” or diagnosis.  The “Plan” includes orders for immunizations, laboratory tests, referrals to other doctors, and when to return to the office.

At Golisano Children’s Hospital, our outpatient or ambulatory physicians transitioned to an electronic medical record on March 6, 2012.  Many offices in the community have already made this transition.  Our system will allow every physician in the hospital to have access to a complete record of your child’s visits to any of our physicians.  We will add the inpatient hospitalizations to the same system next year.  Our system, called Epic, will allow parents and patients to access portions of their charts from home.  By this time next year, Epic will be in use throughout the University Hospital system for children and adults, both inpatient and outpatient.

Using a computer has the potential to “get between” the doctor and the patient.  Some of us may be looking at the computer screen too much or may be typing when you want us to look you in the eye.  We will work very hard to make sure that doesn’t happen and I am confident we can be successful. The other concern is that it will slow us down until we become skillful in the new computerized medical record.  This should be temporary.

As a physician who teaches students and residents, I love reading my patient’s medical records.  There is a lot of interesting and useful information in there.  I try to teach my trainees the following:

• The growth chart is key to evaluating the patient’s health.  Let the parent and patient look at it during each visit.
• Always check the immunization record.  Immunization administration is one of the most important things we do for children.
• Write something non-medical about the patient at each visit.  I write about their progress in school, sports, music, etc.  It helps me remember each one as a kid, not just a patient.
• Write down important things about the patient.  This may be about a discussion we had, a parental concern, or a plan for the next visit.
• Read the record.  We spent a lot of time writing it and there is important information in it.
• Write neatly so the next person can read it.  Many don’t follow this advice, but that’s ok.  Since March 6, 2012, it is all computerized.

Here is some extra information related to this article:

• Upstate makes health records digital, accessible
• Growth Charts: By the Numbers

by Steven D. Blatt, MD

Starve a cold, feed a fever? Or is it, feed a cold, starve a fever? Everyone knows a normal temperature is 98.6º Fahrenheit. What’s a fever? 99º? 101º? Why does my doctor care if my child has a fever? Do fevers keep going up and up? Can it hurt if it gets too high? How do I treat a fever?

Before we even start this discussion, we need to consider the concept of body temperature. Most people know that there are two scales, Celsius and Fahrenheit. 99º Fahrenheit is equivalent to 37.5º Celsius. There are different places to take the temperature: rectal, oral, or in the ear. There are some important differences. A rectal temperature is higher than oral and is considered the most accurate. Ear temperatures are more difficult to interpret. Of course, this all is based on a thermometer that is accurate.

The “normal” body temperature is 98.6º Fahrenheit, but that might not be your child’s normal temperature, which may be 98º or 99º. A better way to say it is 98.6º Fahrenheit is an average normal temperature. Body temperature varies during the day so that it is elevated in the evening. There is also variation with the menstrual cycle. Doctors don’t start considering an elevated temperature to be a fever until it’s greater than 100.4º F (38º C) for infants or 101.3º F (38.5º C) for older children. Fevers may actually help the body fight the infection that is causing the fever.

A fever is a physical sign that there is an infection. Common childhood infections with fever include ear infections, throat infections, pneumonia, and viral illnesses. Some infections have fever as the only physical sign or symptom. Signs and symptoms may help the pediatrician diagnosis an illness. For example, ear pain without fever may be from a viral illness such as a cold or Upper Respiratory Infection while ear pain with a fever may be due to a bacterial middle ear infection or Otitis Media. The physical examination would add additional information to this diagnosing process.

Should a fever be treated with acetaminophen (Tylenol) or ibuprofen (Motrin or Advil)? Certainly if the fever makes your child uncomfortable, antipyretics (fever reducers) should help them feel better. Other than that, the fever isn’t harmful. If your child with a fever feels cold, add blankets and additional layers of clothes. If your child feels hot, remove the blankets and clothes. You can place the child in a bath of warm water; even warm water will make your child feel better whereas cool water will make your child uncomfortable. If you do choose to treat the fever with medication, remember that acetaminophen needs to be administered every 4 hours and ibuprofen every 6-8 hours. Be sure to check the medication label for the proper dose. It is not uncommon for parents to give this medication at too low a dose or not frequently enough.

Is a fever harmful? Parents often ask me if the fever will get so high that it will cause harm. There are some toddlers who have a brief, non-harmful seizure with a fever. This is called a febrile seizure. These are scary to the parents but truly are non-harmful. In general, fever does not cause significant harm. The body is made so that the highest temperature with a fever is almost always less than 105º F (40.5º C). Although a temperature is a sign that there may be a serious infection, the fever is not itself harmful. There is a condition called heat stroke or hyperthermia which is a high body temperature caused by environmental factors, such as running a marathon in 95º heat. This is not due to infection. These conditions are potentially harmful and need prompt medical attention.

So what’s the bottom line?
• What is considered a fever varies on the situation, but in general a temperature is considered a fever when it is greater than 100.4º F (38º C) for infants or 101.3º F (38.5º C) for older children
• Fever can be treated with acetaminophen or ibuprofen for comfort
• Fevers are rarely harmful
• Fever is a sign of infection
• Most fevers and the associated infections are due to viruses, but some are caused by bacterial infections
• When in doubt, contact your doctor. Although most fevers resolve without any intervention, some do require medical intervention

By the way, I have no idea if one should feed the cold or the fever.

http://www.healthychildren.org/English/health-issues/conditions/fever/Pages/default.aspx

http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000319.htm

http://streamed.wired.md/display2.pl?doc_user=suny1&submit_type=play&enter_type=web&resize=615×700&Procedure=W1403&streamtype=fhi&suppressButtons=yes

http://kidshealth.org/parent/general/body/fever.html

“Steven, don’t talk with your mouth full of food.”

“Michael, take your elbows off the table.”

“Ed, finish eating your vegetables.”

Not great conversation.  When I was growing up, my brothers and I did hear those types of things at our dinner table.  We also talked about what we did during the day and our parents talked about what they did at work.  We talked about our friends, school, sports, politics,…stuff that was going on in our lives.  We did that every day of the week.  We always had dinner together.

In my house, we don’t have dinner together every day.  A lot of the time it’s my fault because I come home late from the hospital.  I’m fortunate my family is understanding about my time away from home to care for patients.   At other times, one or more of my kids would have a late practice, a game, a school project or something to get in the way of eating dinner together.  I’m glad my kids have things to do, but our schedules and activities make it hard to eat together.  My family is like a lot of other families, maybe like your family…it’s difficult to get everyone at the table for dinner time.

There are many reasons I wish we ate together more often.  First, there are the practical reasons.  If you eat with your kids, you can prepare and serve their food, and have more input into your children eating a healthy diet.  Once your kids leave your house for the day, they will be making the decision as to what they actually put in their mouths. When you are at the table with them, you have an opportunity to guide their choices and develop good nutritional habits.

Dinner time should be more than just food.  Dinner time should be fun.  Do you like your family?  I hope so.  Eating a meal with them is a great time to talk with your kids.  Any time with your kids is also a time to teach.  Study after study has shown the benefits of families eating together. Children from families that have meals together have less involvement with drugs and alcohol, better performance in school, and better nutritional habits.

Go to a nice restaurant during lunch and you’ll probably see some tables where there is a “business lunch” occurring.  Why conduct business over lunch?  People are more agreeable when they eat; it relaxes them.  They have to sit at the table, and in between bites of food, they can talk.  People aren’t going anywhere, so they are a captive audience.

Have a “business” meal with you kids.  Here are some suggestions for having a “business” meal with your kids.

• These family meals don’t happen by accident.  You need to plan.  Make meal time a habit.  You may not be able to eat together every night, but try to develop a routine so everyone expects to eat together.
• Serve healthy food.
• No electronic devices.  No texting. No phones…the phone won’t break if you don’t answer it.  No television.
• Talk about things that you care about and things your kids care about.  That might be school, work, sports, books, friends, family, the weather….You know what you care about; you don’t need me to tell you what’s important to you.
• Talk about things you REALLY care about.  You don’t want your kids to smoke cigarettes?  Use drugs?  Drink alcohol?  Tell them.  At dinner they are sitting at the same table with you.  I know it’s hard, but only when you start.  The more you talk, the easier it is to share this information.
• Talk about things that you REALLY, REALLY care about, but are difficult to talk about…SEX!  Every parent I have ever met has an opinion about “sex” and their children, yet many never talk about it on a regular basis.  Your children look to you for advice and guidance. Have discussions with them about important topics.
• Try to have discussions, not lectures.  Express your thoughts, but just as importantly, let your children express their opinions.  Everyone at the table should feel free to say what they think and ask questions about what you think.

Your kids shouldn’t talk with their mouth full of food, but more importantly they should talk with you at the dinner table.  Enjoy your meal!

by Steven D. Blatt, MD

I’m tired.  I stayed up too late last night reading.  Ok, I was reading while I was watching the football game.   Anyway, I went to bed too late and got up too early resulting in only 6 hours of sleep.   Ironically, my colleague at the Golisano Children’s Hospital, Dr. Zafer Soultan just spoke about sleep disorders in adolescents at Grand Rounds.  Dr. Soultan didn’t disappoint us; this was an excellent discussion on the importance of sleep, a topic that is often overlooked.

During his remarks, Dr. Soultan, an expert in pediatric pulmonary medicine and sleep disorders, noted, “The only thing that replaces sleep is sleep.”  I tried to replace sleep with a football game and a book, but there was no way to make up for my “lost sleep.”  What about our kids, how do they fare with lost sleep?

Data shows our kids don’t get enough sleep.  In my neighborhood, the high school bus comes at 6:50 am.  Although some kids will roll out of bed at 6:35 and make the bus, many more will be up before 6 am.  Too many won’t even get breakfast.  After school, there are so many activities; sports, jobs, and dinner that must be juggled.  Undoubtedly, these students will stay up late at night doing homework or some other activity.

Even if your adolescent makes it into their bedroom at a reasonable time, there are impediments to your child getting proper sleep.  The National Sleep Foundation (NSF) found in 2006 that the average sleep duration was 7.6 hours for 14 year olds, decreasing to 6.9 hours for 17 year olds.  That’s about 1.5 hours less per night than their parents had in the mid 1970’s.  97% of adolescents have at least one electronic device in their bedroom including 57% with a TV.  Today, many kids sleep with an iPad or smart phone in their bed, watching TV on the device, texting, accessing Facebook, and listening to music.  Up to the second news from their friends.  Light from the screens.  Music, beeps, vibrations (isn’t this what an alarm clock does?).  It’s no wonder they can’t fall asleep.

When I got to work after that night of watching football, the first thing I did was make a pot of coffee, which is a bad habit I learned as an overworked resident.  Drinking coffee does not replace sleep, but it may keep me up during the day.  Our kids have adopted the same habit.  In the NSF 2006 poll, 75% of adolescents reported drinking at least one caffeinated beverage and 31% had two or more.   Additionally, there are now non-caffeinated energy drinks to keep us up.   It may seem to help a little, but remember what Dr. Soultan said, “The only thing that replaces sleep is sleep.”

Ok, it’s clear that our kids don’t get enough sleep.  We also know that caffeine helps a little, but not a lot. Does it really matter?  The NSF 2006 survey found that 28% of students fell asleep in school at least each week. On top of that, 22% fell asleep doing their homework each week.  When they looked at the relationship between sleep and grades they found that those with more sleep had better grades.

While bad grades are one thing, risking a child’s life is another. In fact, 58% of High School seniors reported driving while drowsy 15% of each week.  That is pretty scary.  Just like using a cell phone while driving or driving while intoxicated, sleep deprived drivers are involved in an increasing number of motor vehicle accidents.

What should parents do?  Parent.  Parenting can be difficult, especially with teens, many of whom don’t want to be told when to go to sleep at night.  Your adolescent needs you and your skills.  Most teens will not pay attention to their sleep patterns, so you need to help them.  Discuss this topic with them during dinner.  I know, many families don’t eat dinner with their kids.  Everyone is too busy.  Parents should take the time to eat with their kids to allow conversations about important things, like sleep!

How does a parent tell their child to sleep more?  That’s a hard question and the answer will be different for every family.  It will take more than one short discussion.  It will be something to address over time.  Sleep is a habit and lack of sleep is a bad habit.  Bad habits are hard to break and you must work at it.

Remember, sleep is free, it’s organic and it has no side effects.  It can help your child get better grades in school and make him or her a safer driver.  Keeping our children safe and healthy… sounds good to me!

For more information, please talk to your pediatrician.  The website for the National Sleep Foundation is http://www.sleepfoundation.org/ .

“Dr. Oz Investigates: Arsenic in Apple Juice”

“Bachmann (Presidential Candidate Michele Bachmann) claims HPV vaccine might cause ‘mental retardation”

It seems that every day there is a new medical claim in the news. Dr. Mehmet Oz shared with his television audience his concerns about apple juice concentrate, 60% of which comes from China. Dr. Oz found that apple juice in this country contains higher levels of the poison arsenic than is considered safe. The US Food and Drug Administration called this claim “irresponsible”.

Congresswoman Bachmann claimed that HPV vaccine is dangerous and could lead to mental retardation. The American Academy of Pediatrics characterized these statements as false. For the record, I am a member of the AAP and completely agree with my pediatric colleagues. More than 35 million doses of HPV vaccine have been administered. There is no data that has ever suggested it causes developmental delays or mental retardation.

How does a parent or a patient determine who is correct? How do we figure out who to believe? Where should we get our medical information? Dr. Oz seems like a nice guy and a pretty smart doctor. In fact, I’ve occasionally seen a few minutes of his show and he seems like a smart doctor to me. His advice seems to help a lot of people. Shouldn’t I believe him?

I don’t know how TV personalities, even TV personalities who are doctors, decide how to interpret medical information. How about a Congresswoman or a Senator? They must have access to good medical information. Their medical information should be right also. Or should I believe my nurse and pharmacist and doctor? They’re medical people. They should have the best information, shouldn’t they?

People approach medical decision making differently. There are cultural influences, family traditions, economic considerations, and a set of beliefs that we all have about ourselves and the world we live in. Many of us look to others for information to help us make these decisions. How should we manage the information that we encounter from TV shows, the internet, our family and friends, our doctors….this website?

“Evidence Based Medicine” or “EBM” is the concept that we should base medical practice and medical decision making on the available medical evidence. Oftentimes, the evidence is incomplete or contradictory. All too often, the “evidence” seems to change. For example, 20 years ago, the evidence suggested that children with possible ear infections should be aggressively treated with antibiotics. Since then, we have learned that most ear infections resolve on their own and overuse of antibiotics leads to resistant germs, such as MRSA. Now the evidence suggests we use antibiotics only for those more severe ear infections. So, if the evidence is going to change or is incomplete, what should a parent or a patient do? Should one even bother reading about new medical information if there’s a good chance it will be incorrect or eventually turn out to be wrong?

After reading the literature, you, the patient or parent, either believes exercise is a healthy endeavor, or you don’t. After hearing someone speak on TV, you believe that lowering the bad cholesterol is good for your health or don’t. After gathering information, you believe you should get that vaccine or you should take that vitamin or supplement or this medicine will help you or this treatment is safe, or you don’t. In other words, you learn what you can and then you have to decide what to do with the information. One way or the other, we all have to make decisions.

Here are my recommendations for handling the medical information that is available to us:

• Recognize that there are a lot of decisions to be made; not making a decision on medical treatment is a decision.
• For many things in medicine, we never know the answer to “What is the best thing to do?” Recognize that even with incomplete information we may still have to make a decision.
• Read about medical topics from sources that are reliable. Reliable websites include:
  • Medical Organizations: American Academy of Pediatrics, American Academy Family Practitioners, American Medical Association, American Congress of Obstetricians and Gynecologists. These websites often end with “.org”
  • CDC, FDA, Department of Health. These websites often end with “.gov”
  • Medical schools such as Upstate Medical University. These websites often end with “.edu”
  • The Upstate Family Resource Center (FRC) at the Golisano Children’s Hospital is staffed by medical librarians who can assist you in your search of health information for children and adults. You can reach the FRC by phone 315.464.4410 or by email frc@upstate.edu. This service is free and confidential.
• Use your common sense and instinct. If something doesn’t seem right, keep looking for more information. Does it make sense to you that apple juice has arsenic or that a vaccine makes teenagers mentally retarded? If not, look for more information.
• Look for hidden agendas. Is something being said or written for shock value, to raise ratings, win a vote, or to push an agenda? If so, then there’s a good chance the information isn’t valid.
• Discuss your thoughts with people in your life who you trust and who have given you good advice in the past.
• Discuss what you read or what you hear with a trusted health care professional. Bring the article in question to your doctor and discuss it in detail.

The internet is a great source of information, but interpret it wisely.

From time to time we hear stories on the news about toys or cosmetics having lead paint in them. If you are old enough, you may remember that gasoline was once “leaded” but federal legislation led to its removal in the 1970’s. Many people know that paint in old houses contains lead. Since 1978, house paint has been lead free. It may seem we no longer have to worry about lead exposure. Why is it still important to prevent lead poisoning and how can you keep your child safe from lead poisoning?

Lead can harm the body in many ways. If there is a lot of lead in the body, it can cause developmental delay. That is, it prevents the brain from developing as it normally would. Fortunately, we can identify children who have been exposed to lead and prevent the lead levels from getting high enough to cause serious damage.

The only way to know if your child or an adult has been exposed to lead in the environment is by a test to measure the amount of lead in the blood. New York State requires physicians to test all children with a blood lead test at one and two years of age. In many pediatric offices, the doctor will order this test at the one and two year Well Child Visit. If your child is found to have an elevated blood lead level, don’t panic. For most children, no medical treatment is necessary. Whenever a child’s blood lead level is even mildly elevated, the source of the exposure needs to be identified and eliminated.

If your child does have lead in the body, where did it come from and what do we do about it? Even though house paint bought at the store no longer has lead in it, three out of every four houses in Central New York were built when paint did have lead it. That means if your house was built prior to 1978, it most likely has lead on its walls, both indoors and outside. When the paint chips get in the dirt on the outside of the house or in the dust inside of the house, lead may eventually find its way into the child’s mouth. Children often put their hands or toys covered with “leaded-dust” into their mouth or may actually eat paint chips. Chipped paint, especially on window frames and railings are common sources of lead.

Your local county Health Department can help you identify the sources of exposure in your house and make recommendations for making your home safe. They will help even if you are renting the home or apartment. The lead in house doesn’t have to be removed. It would be impossible to remove all the lead from all the houses in Upstate New York. The practical approach is to ensure that the lead in the house paint stays on the walls. If your house has chipping paint, it needs to be corrected safely.

Rarely, some children are found to have high blood lead levels. These children will be offered medical treatment to help the body excrete the lead quickly. This is called chelation. Most children will never need this treatment.

As an adult, you may be at risk for exposure to lead especially if you are a pregnant woman, if you participate in certain hobbies which use lead (fishing sinkers, lead solder, stained glass, and jewelry work), or if you work in certain industries.

In our pediatrics office, we follow New York State requirements and do a blood test for lead at one and two years of age. When you take your child for his or her checkup, your child’s doctor should do the same. If not, ask for a lead test. Tell the doctor you want to be sure your child does not have lead exposure and you can only be certain by doing a blood test.

“It’s only the flu.” 

“It’s no big deal.” 

“Everybody gets the flu.” 

“The flu shot will make me sick.” 

“I got it once.  Why do I need it again?” 

These are just a few of the responses that people say when offered a flu vaccine.  What are the facts and how does one decide if they should get the vaccine?

First, what is the “flu?”  Patients often use “flu” interchangeably with “viral infection.”  For example, someone will say, “I was home sick for three days with a stomach flu.” That is not the type of flu we are discussing.   Flu vaccine protects against Influenza.  There are many different varieties of Influenza and ways of categorizing them.  There are Influenza A and Influenza B.  Influenza A has different subtypes based on two proteins “H” and “N.”  For example, the strain that caused “swine flu” in 2009 was a strain of H1N1.

The flu vaccine comes in two forms, the “shot” and the nasal spray or “mist.”   The shot is an inactivated or killed vaccine.  During the manufacturing process, the virus is killed and purified.  It is impossible to get Influenza from the shot.  This formulation is approved for anyone older than 6 months of age.   The nasal spray vaccine is made from a live virus that is weakened.   This vaccine is only approved for healthy people, aged 2-49 who are not pregnant.  Individuals with respiratory illnesses, such as asthma, or who have diabetes should not receive this vaccine.  Since flu vaccine manufacturing process involves chicken eggs, those with a severe allergy to eggs should not be vaccinated.  If your child has an egg allergy, tell your doctor before receiving the vaccine.  Both vaccines are safe and both work well.  Surprisingly, the one without the needle, the nasal spray, works a little bit better.

Each year, scientists review surveillance data to predict which influenza strains are likely for the coming year.  This information is used to determine the components of that year’s flu vaccine.  For 2011-2012, the strains in the vaccines are an H1N1 virus that emerged in 2009, an H3N2 virus, and a B virus.  This year’s vaccine is made specifically for this flu season.  Manufacturers try to make just enough for the year.  Unused vaccine will be discarded at the end of the year.  Flu vaccines are available from your physician, flu clinics, and more recently, pharmacies.  They become available in September, but early on, the supply may be variable.  For those that delay, there is still value in getting the vaccine as long as flu is in the community.  There was still significant flu activity in New York State in April 2011.  Getting the flu vaccine in February still provided protection.

When you’re done reading this, please schedule your flu vaccine, for you and your children.  We don’t know when flu season will begin, so the earlier the better.  The more people in your family who are immunized, the less likely you can spread the flu to someone else.  Remember, the primary way to prevent the spread of any infection, including the flu, is with good hand washing, covering one’s mouth and nose when coughing and sneezing, and staying home from daycare, school or work for 24 hours after a fever is gone.  An excellent website to learn more about the flu is from the Centers for Disease Control and Prevention or CDC website at http://www.cdc.gov/flu/

Ever wonder why kids need a physical examination to go to school?  From June to September, pediatric offices are packed with kids and parents getting their forms filled out for school.  Ironically, the main purpose of the visit is not to detect disease; with the exception of a need for glasses, it is uncommon to detect a previously unknown illness during the school physical exam.  However, there are a number of important reasons to have the School PE.

One practical reason to have your child receive a School PE is that without it, your child cannot attend school.  New York State law requires a PE at Kindergarten, 2, 4, 7 and 10^th grades and for all students new to the district.  No PE, no school.  Another reason kids need a physical exam is for after school sports.   All children receiving medication during the school day need authorization by the health care provider.   The school PE is a great opportunity to discuss this with the pediatrician or nurse practitioner and obtain the authorization.  This can include medications for asthma, Attention Deficit Disorder, or even pain medications such as acetaminophen.

The school PE is a great opportunity to discuss your concerns about your child’s educational performance or progress.  Although the teacher is the educational expert, pediatricians also have expertise and experience in child development.  Often times, having known your child since birth, the pediatrician has insight into their abilities and educational needs.  There are medical conditions that can impact a child’s education, such as Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD).

Most parents know their child will need their shots to attend kindergarten.  That set of immunizations can actually be given anytime after 4 years of age, but they must be given by the time kindergarten starts.  The immunization schedule changes slightly each year, but in general, the kindergarten series includes DaPT (Diptheria, Pertussis, Tetanus), Polio, MMR (Measles, Mumps, and Rubella), and Varicella (chickenpox).

What parents may not realize is that as kids get older, additional immunizations are needed.  Children in 6^th grade need a Tetanus booster (Tdap).  Although not required by NYS law, children are eligible to receive Meningococcal vaccine at 11 years of age, with a booster after 16 years of age.  Human Papillomavirus can be administered in three doses starting at age 11.  Annual Influenza or Flu vaccines are recommended for all children older than 6 months of age.

Schools want your child to be healthy and want to insure that children will not be exposed unnecessarily to infectious diseases.  The school physical examination is one way to insure this.  Remember to do your homework and book your child’s school PE early… everyone in their class needs one too!

Resources

MedlinePlus article on Childhood Immunization
http://www.nlm.nih.gov/medlineplus/childhoodimmunization.html

Vaccines.gov
Federal gateway to information on vaccines
http://www.vaccines.gov/

MedlinePlus article on School Health
http://www.nlm.nih.gov/medlineplus/schoolhealth.html