Peds to Parents

by Sue Karl, CCLS
Child Life Specialist, Upstate Golisano Children’s Hospital

Are you smiling and laughing enough???   I hope so, but I don’t think so…. When did we all get so serious?  How nice is it to see a young child dancing and giggling while they wait in line at the grocery store.  But, how often do we hear their parent tell them to stand still and be quiet?  And what if you started to dance or giggle while you were in line? Oh the looks you would get!  Sad isn’t it? 

Consider this, a staggering statistic:  kids smile 400 times a day, adults 20 times a day! Sure, smiling is still a novelty when you’re a kid, but really what makes us turn those smiles off as we age?  Could we really have become so jaded that we reduce our beam wattage from 400 to 20 by the time we reach adulthood?

Consider the following data from Intelligent Life Magazine concerning the smile’s twin sister, laughter: 11 percent of laughter is a result of joke-telling; 17 percent is from media (LOL cats, YouTube, etc.) and a whopping 72 percent arises spontaneously from social interaction. That says a lot about how we get our happy fixes.  The fact is we don’t smile or laugh enough as we age.  If you are hanging around children like we do here in a children’s hospital we need to up the smiles and the laughter.

Did you know that laughter has been shown to boost hormones that can, in turn, reduce levels of stress?  That laughter can help us release endorphins which help us to relax our muscles, decrease tension, boost our immune system?  Laughter burns calories too.  So does reading this blog but that’s beside the point.

What can you do to add more laughter into your day?  Lots of things can turn that frown upside down.  Start reading the funnies and using more humor in your interactions with your peers, your partner and your children.  Read silly joke books for your own pleasure or read them with your kids and family.

If you drop something or break something make a joke about it.  I didn’t really like that plate anyway or that’s one less dish to wash.

Stop taking yourself and life so seriously.  Use a funny voice when your child has a chore they don’t want to do…PLEASE feed the dog …in an OPERA STYLE voice ….he’s really hungry sends a more pleasing signal than a sharp tone would.

Social laughter is contagious too, ever notice that when others are laughing you feel better and start to laugh a little too even if you don’t know what they are laughing about.  Sharing laughter and play also adds joy, vitality, and resilience.

Now we do have to be careful…laughter should never be used at anyone’s expense.  Insensitive joking can be offensive and distressing.  We also need to be mindful that children are just developing their sense of humor and cannot be included in joking the way that adults can.  Their sense of reality can make a joke not seem funny or just the opposite a riddle or joke that they find humorous will not hold the same value for us as adults.  How many times have you had a child tell you a knock-knock joke or a riddle only to retell it and retell it changing just one part of the joke and they laugh and laugh while we merely smirk.  That’s because of where they are developmentally.  They are just learning about humor and joke telling and need us to model positive uses.

So…. Look for the humor in a bad situation, and uncover the irony and absurdity of life. This will help improve your mood and the mood of those around you. Pay attention to the children around you they can be our teachers.  They are the experts on playing, taking life lightly, and laughing.

Let’s try to smile more, add more humor and play into our daily interactions it can improve the quality of your relationships— as well as your connections with children, co-workers, family members, and friends. It can help us have a better day!

References and Resources:

The Humor Project, Saratoga Springs, NY12866 www.HumorProject.com
Laughter is the Best Medicine The Health Benefits of Humor and Laughter www.helpguide.org/life/humor

The Healthful Effects of Laughter, Christine Puder, The International Child and Youth Care Network, Issue 55, August 2003

http://laughteryoga.org/

http://www.funfunnyfacts.com/

http://www.webmd.com/balance/features/give-your-body-boost-with-laughter

http://www.care2.com/greenliving/8-health-benefits-of-laughter.html

http://www.brainyquote.com/quotes/topics/topic_humor.html

http://www.laugh-of-the-day.com/

Nutrition Facts: Cranberry Sweet Potato Bread
Serving Size: 1/10 of recipe (122g)
Servings Per Recipe: 10
Calories 300 Calories from Fat 80
% Daily Value*
Total Fat 9g 14%
Saturated Fat 1g 5%
Trans Fat 0g
Cholesterol 40mg 14%
Sodium 170mg 7%
Total Carbohydrate 51g 17%
Dietary Fiber 3g 10%
Sugars 25g
Protein 4g
Vitamin A 70% Vitamin C 25%
Calcium 4% Iron 10%
*Percent (%) Daily Values are based on
a 2,000 calorie diet.
www.jsyfruitveggies.org

by Lucy Barbera, PhD, LCAT,  Medical Art Therapist

Why Art is important for the healthy growth and development of children:

As parents, we know first hand how important art activities are for our children. Art-making provides children with pleasurable and relaxing activity, especially because there are very few rules to follow and their spontaneous expression is “right” just the way it comes out on the page.  Children receive positive reinforcement for their whimsical drawings and paintings, from parents and friends alike. In this way, art builds self-confidence and self-esteem, while giving children the opportunity to make choices on their own and take appropriate control of their expression.   When children are wound up and stressed out from things like: school, holiday hype, too much television, or technology, art-making supplies the perfect antidote because it is naturally relaxing.

Art Therapy: Why Art is important in the hospital setting:

Knowing what we do about the importance of art for children’s healthy growth and development helps us to understand why the art-making option is so valuable for children in the hospital setting.  At some point in their youth, children may have to be hospitalized in order to receive the care necessary for them to heal.  Unfortunately, along with its positive effects, hospitalization can trigger anxiety and stress in children.  As a normal, pleasurable activity, art-making provides pediatric patients with a known and trusted way to safely adapt to new conditions and surroundings, because it allows them to have choice and control in a setting where, understandably, they have very little.  Art-making enhances their sense of predictability, (because they are making all of the decisions as they create a painting or sculpture), while at the same time providing a medium through which they can express their anxiety or other feelings. Art works powerfully as a distraction from pain. I have seen patients so involved in their creations that their pain actually subsides.

Art-making helps pediatric patients cope with trauma, build resilience, and feel empowered.   Art provides an alternative form of communication, helping pediatric patients tell us about the physical aspects of their illness and pain in a unique way.

Finally, art allows patients to create a permanent visual record of their feelings, so that one day they can look back on their experience and their courage, and safely re-tell their story.

It is comforting for parents to know that while children are in the hospital receiving the medicine they need to feel better; art-making is there to support them with “a healing medicine for the spirit”.

By Mary Ann Russo, MS, RD, CDN, Pediatric Nutritionist

New research has found that kids are big consumers of energy drinks.   Adolescents and young adults represent 30-50% of the rapidly growing billion-dollar market.  The energy market is also not confined to beverages.  Products such as Cracker Jacks, jelly beans, gummy bears, brownies, mints, and maple syrup are just a few products being promoted as “energy boost” products.  The growing popularity of energy drinks and some recent adverse effects have parents and medical professional concerned about children’s intake of caffeine.

What is in energy drinks that could cause concern?

Most energy drinks claim their boost of energy from caffeine or vitamins and herbs. The caffeine content can vary and most products do not list it on the nutrition fact label.

Why is caffeine not listed?  

Energy drinks are regulated as dietary supplements, a designation that means the product label does not have to list caffeine content.  Also, there are no limits to how much caffeine they can contain.   Some products have up to 240 mg of caffeine per serving and some packages contain more than one serving.  This is in stark contrast to the FDA rule that a 12 ounce soda cannot contain more than 71 mg of caffeine!

Why the concern over caffeine?

The AmericanAcademyof Pediatrics (AAP) recommends adolescents get no more than 100 mg of caffeine a day and that younger children should not consume caffeinated beverages on a regular basis.   Health professionals have become more cautious due to the increasing number of health problems tied to caffeine intake of young children. Health issues that can occur with intake of caffeine are nervousness, irritability, insomnia, rapid heartbeat, and increased blood pressure.

Children and adolescents are more susceptible to the adverse health effects of caffeine compared to adults. This may be because they are not used to regular caffeine consumption.  The first time a kid buys an energy drink that contains 300 mg of caffeine and drinks it, his/her body won’t be used to it.  Remember…caffeine is a stimulant!

Other experts add that energy drinks may be harmful if they replace drinks like water and milk that contain minerals and proteins for growing bodies.  Energy drinks also provide non-nutritious calories that could contribute to obesity.

The beverage industry’s response to these concerns is that caffeine is one of the thoroughly tested ingredients in the food supply and has been deemed safe by the US FDA.  They state most energy drinks contain about half the caffeine of a similar size cup of Coffee House coffee. 

If your child is having problems sleeping or has become more anxious, investigate what they are drinking and eating. If you find out they are utilizing these products for an energy boost, educate them on the negative side effects of excessive caffeine. Discuss healthier options for an energy boost such as getting adequate sleep, a healthy diet, and daily physical activity.

by Amanda Griffin

As the Community Activities Coordinator at Upstate Golisano Children’s Hospital, I wear many hats. Serving as Coordinator for Safe Kids Upstate NY Coalition is one my favorite hats. Safe Kids is a community group led by Upstate GCH that advocates for preventing unintentional injuries to kids. Our coalition and its members host various outreach events throughout the community including: car seat checks, bicycle helmet giveaways, sports safety clinics and pedestrian safety activities just to name a few. Our goal is to share important information and education with parents and caregivers on preventing injuries to kids. In my role, I am reminded daily of all of the potential risks that can lead to injuries and even death to children. Like most parents, I am always trying to keep up with any new information and ways to keep my kids safe. There are practices that I, like many parents, am automatically aware of either through common sense, instinct or laws which are in place to keep kids safe. For example, as a parent of three young children, I know that all of my kids need to ride in car seats, must wear a helmet when riding their bicycles, we have plug covers in our outlets and keep all medicine out of reach of our kids. But even in my role at the Children’s Hospital, I am often reminded of many lesser known threats…

Last month at Upstate Golisano Children’s Hospital’s Radiothon for Kids I met and listened to a mother who was interviewed on-air about her daughter’s recent death. She had lost her daughter from a tragic accident, their television and the cabinet it was in had toppled over on her. Listening to this interview, I was amazed at the strength this mother had and her desire to share her story in an effort to prevent this accident from happening to other families in our community. That evening, I spoke with my husband about our televisions and how they are set-up. Her heart breaking interview reminded me that this type of accident could easily happen in anyone’s home, including my own.

Safe Kids Upstate NY is spreading the word to remind all parents and caregivers of this threat and how we can all make our homes safer by preventing TV tip-overs. Safe Kids USA recently released the following statistics and tips as part of their nationwide television and furniture tip-over campaign:

• Every three weeks, a child dies from a TV tipping over
• Nearly 13,000 more children are injured by tip-overs each year in the U.S.
• Every 45 minutes, less than the length of a Sesame Street episode, a child is sent to the emergency department due to a TV tip-over.
• Injuries from TV tip-overs have risen by 31% over the last ten years
• Seven out of ten children injured by TV tip-overs are 5 years old or younger.

Here are precautions you can take to prevent your child from becoming injured or killed from a television tip-over:

TV Safety Check

• Assess the stability of the TVs in your home.
• Mount flat screen TVs to the wall to reduce the risk of TVs toppling off stands.
• Follow the manufacturer’s instructions to ensure you have a secure fit.
• If you have a large, heavy, old-style cathode ray tube (CRT) TV, place it on a low, stable piece of furniture.

Secure Furniture

• Use brackets, braces or wall straps to secure unstable or top-heavy furniture to the wall.
• Install stops on dresser drawers to prevent them from being pulled all the way out. Multiple open drawers can cause the weight to shift, making it easier for a dresser to tip-over.

Rearrange Household Items

• Keep heavier items on lower shelves or in lower drawers.
• Avoid placing remote controls, food, toys or other items in places where kids might be tempted to climb up or reach for them.

Please take the time to review your home and make any suggested changes as noted above to child proof it. Be sure to spread the word with others who care for children in their homes; babysitters, grandparents and friends so that they are aware of possible dangers. For more information on preventing tip-overs and other safety programs visit:

http://www.safekids.org/our-work/news-press/press-releases/one-child-dies-every-three.html

http://www.upstate.edu/gch/parents/safekids/

by Steven D. Blatt, MD

Since its opening in February 2012, other members of my department and I have been working at Upstate Golisano After Hours Care at Community Campus. I have a daytime job at Upstate University and Pediatric Adolescent Center, so why do I often work nights at After Hours, especially when I do not get home until midnight?  The main reason I work there is because I love the work.  I thought you might be interested in some of the types of cases I see.

A mother brought in her 18 month old who seems to have a painful right arm.  The child was fine in the morning but complained of arm pain in the afternoon.  The child is active and healthy without any medical problems.  I suspected “Nursemaid’s Elbow” which is a surprisingly common condition.  It results from someone, once upon a time, the “Nursemaid”, abruptly pulling on the child’s hand.  For example, a toddler may start to run into traffic and the parent may pull him back onto the sidewalk, averting a terrible accident.  Every so often, this results in dislocation of the elbow.  Once I suspected this, it’s easy to maneuver the elbow back into its proper position.  Within minutes, the child feels better and the parent is relieved.  Best of all, we don’t need an x-ray.  It’s the definition of instant gratification for the patient, the parent, and the doctor.

A common case is the child with a laceration.  Many of us, including me, love procedures.  It shouldn’t be surprising that many doctors enjoy “fixing things with their hands.”  Under the best circumstances, we can apply a topical anesthetic, clean out the wound with water sprayed from a syringe, and use glue to close the wound.  The glue is medical grade super glue.  I hold the edges of the wound together for 10 seconds and the glue dries.  That’s all.  No needles.  No pain.  The glue will fall off on its own.  And the cosmetic result is as good as suturing.  There are many times when gluing is not feasible, so we must use suturing.

A mainstay of my work at After Hours is taking care of ill patients.  I know it’s not fun to be a sick kid and it’s even worse to be the parent of a sick kid.  However, it is gratifying to be the doctor or the nurse caring for an ill child.   Sometimes, we can pinpoint the cause to something treatable, such as pneumonia, strep throat, asthma, or an ear infection.  This is usually a great situation:  we know the cause and know how to treat it.

There are many times when we can figure out the cause, but we don’t have any cures.  The most common example of this is a virus.  The 3 year old with a cough and fever will often have a virus. We don’t have many medicines available to cure these types of illnesses, but can offer some advice to make the child feel a little better.  Honey for the cough; there is scientific evidence to support this.  Fluids, yes, chicken soup is good to take.  Rest is always good. Also, remember to get your flu shot…it’s not too late!  Even though I often feel badly because I can’t always offer curative treatments, parents usually tell me that as long as they know the virus will resolve on its own, they are relieved.  Many parents just want to make sure nothing bad will happen or they aren’t missing anything.  After 30 years of being a pediatrician, I sometimes forget that reassuring words from a physician can go a long way to relieve a patient’s or parent’s anxiety.

I enjoy working at After Hours.  The cases are varied and interesting.  I usually find them fun, well, fun if you are a doctor!  It’s always great to work with kids and to reassure their parents.  Nothing is better for a doctor than making their patient feel better and no doctor is luckier than the doctor who takes care of children.  That’s what gets me through those late nights….and gets me up the next morning so I’m not late for my day job.

by Anne Sveen, MD

Sunscreen is important and necessary to use in order to protect our kids from sunburns. In Upstate New York, it is especially important in the summer months. School is out, as is the sun, and kids are spending more time outside and in the water. Here are some helpful tips as far as what products to use, how to use them and risks to watch out for.

1. What sunscreens are best for children?
The best sunscreens are actually sunblocks. This means they contain either zinc oxide or titanium dioxide. These ingredients block out all UVA and UVB rays to protect against sunburn and skin damage. They are considered safe to use in children, but there are some reports that they may be harmful.

2. What is the best SPF to use?
There are many levels of SPF to choose from when buying a sunscreen. A good level is probably between 30-50. These will block out up to 99% of UV rays. As you go higher than that in SPF strength, you do not get much more protection. The most important thing is to apply a thick layer 15-30 minutes before kids go outside and reapply every 2 hours while they are in the sun.

3. Are sunscreens really waterproof or sweat proof?
Some will claim to be but they cannot be totally waterproof and you should still follow the rule of reapplying after 2 hours in the sun. Some are called water resistant which means they stick to the skin better than others after swimming or sweating.

4. Are spray sunscreens as good as lotions?
No they are sometimes considered worse than lotions because they may not be sprayed on thick enough, it is easy to miss spots and it is unclear if the aerosol is harmful if breathed in. If you do use a spray it is best to spray it on your hands first, and then apply to the face or body. In general, it is not recommended to use spray sunscreens on children.

5. Is it okay to use sunscreen on a baby, especially under 6 months?
Yes, if they must be in the sun. They should wear a hat and thin, cotton clothing that covers them well and keep them in the shade as much as possible. Coppertone Water Babies SPF 50 is a good product, but, rarely, some children may get a rash from this.

6. What should you use if you have eczema or sensitive skin?
Use a sunscreen that has little to no perfume or fragrance. Neutrogena makes some nice products for sensitive skin that say that on the tube. Blue Lizard (Australian sunscreen regular) is also good for kids with sensitive skin. Look for the ingredients avobenzone and oxybenzone; these may cause skin rash in some people.

7. What are the best brands to use?
You do not have to spend a lot of money to get a good, safe sunscreen. Some of the nicest ones are by NO-AD and the Target brand “Up & Up”. They have little perfume, they offer good UVA/UVB protection and they are not expensive. They are generally safe to use on children. Some other brands that offer good protection are: Neutrogena, All terrain (Aquasport) and Coppertone Water Babies SPF 50 and some Banana Boat sport performance products. (Consumer reports, June 2012) Keep in mind that they may stain clothing and bathing suits.

8. What about sun protective clothing or clothes that have an SPF built in to them?
These are thought to be very helpful for protecting children from sunburn. You can buy hats, shirts, bathing suits and rash guards that have an SPF in them and they are good to use in all children, if possible.

9. Will you cause vitamin D deficiency by using sunscreen or sunblock?
The current evidence tells us that, yes, sunscreen use decreases production of vitamin D but it is probably not enough to cause a health concern or serious deficiency. If you are still concerned, allowing a child to play outside for only 10-15 minutes twice a week without sun protection is probably enough to give them a healthy dose of vitamin D and not cause sunburn. It is even better to make sure they are eating foods that contain vitamin D, like fortified milk, and fish like salmon.

Remember, to keep kids safe in the sun, it is best to wear a hat and sun protective clothing, keep babies out of the sun as much as possible, reapply sunscreens every 2 hours, especially after swimming or sweating and avoid a lot of sun exposure between 10am and 2pm.

by Steven D. Blatt, MD

I took my dog to the veterinarian last week for an annual check up. As she does every year, Dr. Harris checked him for Lyme disease. When he was a puppy we had found a few ticks on him and his blood test showed he did have Lyme disease. He was treated with antibiotics and has been fine ever since. Every month, even during the winter, we use anti-tick medicine on him and he’s been tick free.

Not so with my daughter. She is 15 and one evening at the end of April she told me she had a bug on her thigh. I looked at her and the bug was a tick. I removed it without incident. About a month ago when I was working at Upstate Golisano After Hours Care at Community General Hospital I removed a tick from a young girl. There’s an increasing chance that this summer, one of your children will have a tick on them. What exactly does that mean and how worried should you be? What is Lyme disease? How can I prevent Lyme disease?

Lyme disease was first identified from patients in Lyme, Connecticut in the mid 1970’s. The spirochete Borrelia burgdorferi is the bacterium that causes the disease. B. burgdorferi is found in mice, squirrels and other rodents. When a blacklegged or deer tick feeds from those small animals, the tick becomes infected and will pass the infection on to other animals such as deer, dogs, and people. A 2008 study of ticks collected at Green Lakes State Park in Fayetteville, NY found that more than 60% were positive for B. burgdorferi.

Deer ticks live in shady, bushy areas within 24 inches of the ground. Ticks don’t jump, but once on a person or animal, they will climb to an area they prefer. Avoiding tick areas is now hard to do in Central New York. Ticks are everywhere, including your back yard. Detailed tips for avoiding ticks can be found at the CDC and NYS Department of Health websites. In general, three things one can do are:
• Avoid direct contact with ticks by avoiding the places they live. If you like the outdoors, this is really hard to do.
• Use tick repellents that contain at least 20% DEET and treat clothing with permethrin.
• Conduct a full body tick check on your child at the end of every day. If doing this to yourself, you will need a mirror. Be sure to check under arms, between legs, around the ears, in the hair, around the waist, and in the belly button. Remember, ticks will move on a person to find the spot they want.

What should you do if you find a tick? First, breathe. Don’t panic. It is better that you found the tick than to have missed it. Use good quality, fine-tipped tweezers to pull the tick out. Both CDC and NYS DOH websites have good instructions for tick removal. If the tick has been on the person for less than 36 hours, then treatment with antibiotics usually isn’t necessary. Call your pediatrician for advice on whether your child should be seen for follow up or treated with antibiotics.

For those children who develop Lyme disease, the most common symptom is a “bulls-eye” circular rash that occurs 3-30 days after the tick bit at the site of the tick bite. Other symptoms include fatigue, stiff neck, numbness in arms and legs, or facial paralysis. If you notice any of these symptoms, let your doctor know. The doctor may want to perform a diagnostic blood test and begin antibiotic treatment. Most patients treated with antibiotics for Lyme disease have a complete cure. Late symptoms occur months or even years later and include severe headaches, arthritis, joint swelling, and heart and central nervous system problems.

In the past, the Health Department would identify ticks and analyze them for B. burgdorferi. This service is no longer available. There was a Lyme vaccine for people but manufacturing was discontinued in 2002. There is still a vaccine for pets. In case you’re wondering, you cannot get Lyme disease from cats and dogs or mosquitoes.

My dog remains Lyme and tick free. My daughter never developed a rash and will probably not develop Lyme disease from that tick. My family and I will still hang out in our backyard. During the summer we will be at Green Lakes State Park many days each week. And every night, we will check for ticks.

More information on ticks and Lyme disease can be found at the links below.

New York State Department of Health
http://www.health.ny.gov/diseases/communicable/lyme/

Centers for Desease Control and Prevention (CDC)
http://www.cdc.gov/lyme/

By Karen Teelin, MD, Fellow in Adolescent Medicine, Division General Pediatrics

Should I give the HPV vaccine to my son?

You may have heard the news that the HPV vaccine (brand name Gardasil) is now recommended routinely for boys as well as girls, and you may be wondering what this shot is for and why you should consider it for your son. Your pediatrician will likely offer this vaccine to both your son and your daughter at age 11 or 12 (or older).

First of all, what is HPV? HPV stands for human papilloma virus. This is a very common virus. Approximately 75% of adults have been exposed to it. It is transmitted by close contact, including sexual contact.  Fortunately, HPV is usually harmless. However, in some people, it can cause cancer.  In addition, HPV is the cause of warts. Although rarely discussed, genital warts are common, and can be very upsetting and embarrassing to teens and young adults. 

Vaccinating girls against HPV protects against cervical cancer, a serious, common, and potentially deadly type of cancer.  We now know that giving boys the HPV vaccine protects against genital warts and may protect against some rare cancers.  And vaccinating the boys as well as the girls helps create “herd immunity”, which means better protection for everyone.

Even if you think protection against cancer and warts sounds like a great idea, your next question is probably, “Is it safe?”  Answer:  Millions of doses of this vaccine have been given and it has been shown to be safe.  Fainting episodes have been slightly more common after the HPV vaccine than with other vaccines (although still rare).

But how can you talk to your children about the need for this vaccine? This is a great opportunity to initiate an important conversation with your adolescent to share your values and to answer his or her questions. The topic can be daunting and many parents wonder how to approach it. In general, you should meet your child at his or her level and answer questions in a straightforward manner.  Be willing to engage in an ongoing conversation as questions arise. It’s important that teenagers understand that sex is something to be shared in a loving, mutually committed and respectful relationship. Sexually transmitted diseases (STDs) are very common, and anyone can catch them. The myth of safe sex should be dispelled.  Abstinence or saving sex is the only way to guarantee protection against STDs. For adolescents who are sexually active, a condom should always be used.

In the end, it is up to you to decide about the HPV vaccine for your child. In our clinic, we recommend the HPV vaccine for boys and girls starting at 11-12 years old. (The vaccine only works if given before the child has been exposed to the virus.) Most importantly, we strongly recommend maintaining open lines of communication with your adolescent children in order to provide them with the information and support they need to make good decisions.

More information on HPV and the HPV vaccine can be found by clicking the links below.

Information on HPV from the National Library of Medicine: http://www.nlm.nih.gov/medlineplus/hpv.html

Frequently Asked Questions on the Vaccine from the Centers for Disease Control: http://www.cdc.gov/vaccinesafety/Vaccines/HPV/hpv_faqs.html

Information more in tune with teens’ way of thinking and asking questions from KidsHealth.org: http://kidshealth.org/teen/sexual_health/stds/hpv_vaccine.html

by Steven D. Blatt, MD

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