Although summer itself is not over, the summer relief for allergy sufferers seems to have ended.  This week, allergy levels have been on the rise, and this weekend, they are at a sky high level.  What does this mean??  Its time to go back on your allergy meds, and if you have asthma triggered by allergies, its likely time to start back on those meds as well.  Whatever it is that your family uses, whether its oral anti-histamines (Claritin, Zyrtec, Allegra, Benadryl), nasal steroids (Nasonex, Nasacort, Rhinocort, Flonase, Omnaris, Veramyst), nasal anti-histamines (Asteiln, Patanase), oral anti-leukotrienes (Singulair), steroid inhalers (Flovent, Pulmicort, Advair, QVar, Asmanex, Dulera), nebulizers, or others, its probably time to get back on those meds.

Pollen levels are useful to track in order to know when symptoms are coming and when they may be going.  It allows us to PREVENT symptoms in patiens we know will have them, rather than just TREAT them when they occur.  This is the key to starting meds early.  Pollen levels can be seen locally on several websites; one of the easiest is on pollen.com.

Please note, we have moved!!  After months of discussing, planning, organizing, and re-organizing, we have finally moved our office.  Don't fear, we have not gone far.  We are just 1.5 blocks away, on Lincoln Avenue one block north of the Lincoln/ Elm intersection and one block East of Green Bay Road.

Our office is located on the ground floor at 572 Lincoln Avenue, Suite #3.  Suites #1 and #2 are located on the street; our office is off the street, to the back of the courtyard.

Parking is available both on the street in front of the office, and in the parking lot on the northwest side of our office.  See here for details.

We are still putting the finishing touches on the office, but we are excited about it, and look forward to seeing you there.  Office hours continue at the new location on Monday, July 25th, and are the same as they have been all year.  Thanks for your patience with the move.

See you soon!!

Everybody knows about the importance of sunscreen.  It protects the skin from sunburns, reduces the formation of freckles and sunspots, and significantly reduces the risk of skin cancer in the later years.  However, there are so many sunscreens out there these days, it may be hard to know which ones to use.  Here are some tips about sunscreen use for the summer:

1. Remember to re-apply frequently.  This is perhaps the most often overlooked sunscreen rule.  Many parents are great about remembering the first layer, but for an all-day sun adventure, please remember to apply a second and even third time if staying in the sun for long periods of time!  Most dermatologists recommend re-applying every 3-4 hours, and after playing in the water.
   
2. Contrary to popular belief, sunscreen IS ok for infants under 6 months of age.  The safest method of sun protection is wearing hats and keeping them in the shade, but sunscreens are the next best thing.  A physical-based blocker, such as Zinc Oxide or Titanium Dioxide, is recommended, and select one that is fragrance free and hypoallergenic for your infant.   Some good options include Neutrogena Sensitive Skin SPF 30, Neutrogena Pure and Free SPF 60, and Vanicream Sunscreen for Sensitive Skin SPF 30 or 60.
3. The higher the SPF, the better.  At least SPF 30 is always recommended.
4. Protection against both UVA and UVB light is best (ultraviolet A and ultraviolet B rays).
   
5. Avoid buying sticks and sprays for the best results.  Sprays certainly are convenient, and of course are better than nothing, but typically are less effective than creams or lotions.
6. Make sunblock part of the daily routine for sun-exposed areas and use it on the face year-round.  If you start young, it will become a habit and less of a struggle.  
7. Do not rub sunblock in, as this is really rubbing it off.  Put on a thicker layer, let the little one run around for 5 minutes, and then rub in whatever is left visible on the skin. 

Enjoy the summer and enjoy the sun, but be smart about it!  And if you have any questions at all, call

Below are 20 tips for new parents.  Most of these are straight forward, but some may surprise you.  Many of the recommendations are taken from the guidelines for pediatric care from the American Academy of Pediatrics (AAP).

1. All babies will lose some weight after they are born.  In fact, losing up to 10% of the birth weight is considered normal; they typically regain this weight by 10-14 days of life.
2. All babies should sleep on their backs, not on their side or on their stomachs.  This is done to reduce the risk of Sudden Infant Death Syndrome (SIDS), and was known as the "Back to Sleep" campaign.
3. All babies should receive play time on their tummies, known as Tummy Time, several times per day for at least 3-5 minutes per session.  This allows them to strengthen their neck and back muscles, and reduces the development of flat heads.
4. All infants who are exclusively breastfed should receive 400 IU per day of Vitamin D supplementation.
5. Baby bumpers in cribs are not recommended, as they can pose a safety risk to infants sleeping in their cribs.
6. Shaking or hitting a crying infant is never OK, and actually can cause permanent damage to your baby, including blindness, mental retardation, and death.
7. It is not recommended to feed water to infants.  In most cases, it is not recommended to feed cereal or other baby foods to infants until at least 4 months of age.
8. In the past, it has been recommended to administer a pain reducer, such as Acetaminophen (Tylenol) to infants prior to them receiving vaccines.  This is no longer suggested.  Studies have shown that their response to the vaccine, and the vaccine's effectiveness, can be somewhat lessened if Acetaminophen is given prior to the vaccine administration.
   
9. Fever is defined as a temperature >100.4 degrees Fahrenheit.  For infants, take temperatures rectally, as this is most accurate.  Any fever in a newborn under 2 months of age necessitates an immediate call to your pediatrician; no medication should be given until speaking with your doctor.  In addition, Ibuprofen (Advil, Motrin) should NEVER be given to any infant under 6 months of age.
   
10. There have been NO reliable studies to date linking ANY vaccines with the development of autism.
11. Co-sleeping with an infant, with them sleeping in the same bed as the parent, increases the risk for infant injury or suffocation, and is not recommended.
12. Use Bisphenol A (BPA)-free bottles to feed your baby; do not use bottles that contain BPA, which are often marked by the recycle number 7 or the letters PC on the side of the bottle.
13. Infants are at high risk for sunburn and overheating, and should not be in direct sunlight, especially during peak sun hours; keeping them in hats and under shade is advised.  
14. If sun exposure is unavoidable, sunscreens are OK to use for infants.  However, they should contain physical blockers (titanium or zinc based, for example) instead of chemical blockers, protect against both UVA and UVB light, and be at minimum SPF 30.
15. It is NOT necessary to clean the umbilical cord with alcohol or other cleansers on a routine basis.  Keep it dry, and it usually falls often within 2 weeks of life.  
16. Bathing in a tub may occur once the umbilical cord has fallen off; until then, sponge baths are recommended.  In general, bathing is only needed a few days per week, and washing hair once per week or so.
17. Diaper wipes, soaps, lotions, and other products used for your baby should be chemical-free, alcohol-free, non-fragranced and hypoallergenic to minimize the likelihood that the product will irritate the skin or cause a rash.
18. It is normal for newborn skin to appear dry and flaky.  The skin is used to being in water for 9 months, and is just adjusting to the outside world.  No emollients or lotions are necessary, unless there are deep cracks or bleeding.
19. Developmentally, the first milestones pediatricians look for are cooing and smiling, and these typically occur around 6 weeks of age.
20. Baby acne is very common between 1-2 months of age.  Unless severe, it typically does not require treatment, and will resolve on its own within a few weeks.

Good news!  We are moving to a new and bigger space this summer!  We anticipate moving in late June or early July.  We will NOT be changing our name, and will still be known as Elm Street Pediatrics.  The new location is at 572 Lincoln Avenue, suite #3, which is one block north and one block west of our current location.  It is in the same gallery building as the former Salon Millenium and across the street from the old Cafe Aroma location.  Our office will be located on the ground floor, just off the street towards the back.  Here are some photos of our new building; in the right hand photo, our office will be to the right of the columns in the middle of the frame:

The AAP has recently changed their recommendations for infant and toddler car seat use.  Previously, the recommendation stated that infants should be in a rear-facing car seat until age 1 year old.  At that time, it was advised to turn them around so they are forward facing.
After reviewing both European and American data on deaths, head injuries, and limb injuries, car safety seat (CSS) recommendations have been updated. 

• Children are now recommended to remain rear-facing in their CSS until age 2 (or until they exceed the weight/ height limits for their particular CSS). 
  
• Children age 2 or older who have outgrown their rear-facing CSS (by exceeding the weight or height limit of that particular seat) should remain in a forward-facing CSS with a harness for as long as possible (until they outgrown the limits of that seat).
• Children whose weight or height exceed the forward-facing limit for the CSS should use a belt-positioned booster seat until the lap-and-shoulder seat belt fits properly, typically at a height of 4'9" tall (and over 8 years old).
• Children under age 13 years are recommended to ride in the rear of the vehicle, not in the front seat, regardless of size.

Some interesting facts to remember in support of these recommendations include the following:

• Children under age 2 are 75% safer facing backwards than forwards.
• Children between 12 and 24 months old are 5 times less likely to die or be seriously injured if they are rear facing during a collision.
• Only 1 in 1000 children who are rear facing will suffer a lower extremity injury during a crash, while that rate is exponentially higher for forward facing toddlers.

Some of this information was taken from aapnews.org, and more can be seen about this topic on that site.

Families these days are not drinking nearly as much milk as they used to.  More and more individuals are lactose sensitive, dairy allergic, or vegan.  And there are many more options of beverages these days than ever before.  As a results of all of this, many children nationally may not be getting enough calcium.  In general we recommend getting your child 3 solid servings per day of dairy, which is the most common calcium source in our diets.  The IOM has issued new guidelines, telling us exactly how much calcium is recommended for each age.  Here are their recommendations:
    Ages 1-3: 700 milligrams per day of calcium.
    Ages 4-8: 1,000 mg.
    Ages 9-18: 1,300 mg.
    Ages 19-70: 1,000 mg - but for women the amount rises to 1,200 mg at age 51.

For more information on this, please check here.

There are many questions out there about what is safe to feed babies and what is not.  For some foods, there is more of a consensus.  For example, generally speaking, babies are not given any kinds of nuts or shellfish due to concerns about allergies.  However, for other foods such as root vegetables, there are differing opinions and lots of misinformation out there... especially for parents making their own baby foods.

When talking about root vegetables-- such as carrots, squash, spinach, kale, green beans, beets, cabbage, broccoli --  the concern is the risk of too many nitrates, which are potentially harmful compounds that these foods have from the soil.  For babies under 3 months of age, there is a theoretical risk of ingesting too many nitrates from these foods, which could potentially cause methemoglobinemia (a dangerous blood condition).  However, for babies over 3 months old (which hopefully all babies being fed ANY solid foods are), this risk is essentially nil.

When discussing this topic, the AAP has a statement that confirms that root veggies are OK for babies over 4 months of age.  Their statement is as follows: "Infants fed commercially prepared infant foods generally are not at risk of nitrate poisoning.However, home-prepared infant foods from vegetables (eg, spinach,beets, green beans, squash,carrots) should be avoided until infants are 3 months or older,although there is no nutritional indication to add complementary foods to the diet of the healthy term infant before 4 to 6 months of age."  In fact, it appears that once infants are 6 months old, the amount of stomach acid they produce is sufficient to effectively reduce the amount of nitrate-producing bacteria in the digestive tract.  Thus, at this age, the production of nitrates is limited and the risk is reduced.

Also of note, is the following: while this risk is most often discussed with regards to parents making their own baby foods from raw vegetables, all of the jarred commercial baby food carrots and vegetables have nitrates too. Nitrates are naturally occurring and thus cannot be removed... so even jarred organic carrot baby foods have nitrates (though sometimes in lesser amounts).

More information on this issue can be found here.

Over the past several years, more families have turned to Minute Clinics for medical care for their children.  Often, this is for things that appear simple to treat, such as sore throat or ear pain.  Unfortunately, especially in children, these medical problems and their treatment may not be as straight forward as they appear.  At Elm Street Pediatrics, we have had an alarmingly high number of children mis-treated by these so-called Minute Clinics in the past few years.  We hope you will not allow them to continue to make these mistakes. 

Making an accurate diagnosis in a child is often challenging.  For example, a sore throat could be strep, which is what we all worry about; however, it could also be infectious mononucleosis ("mono") or a peritonsillar abscess.  Ear pain, while it could be from fluid in the ear, could also be from a sinus infection or an otitis externa ("swimmer's ear").  Several of our patients have been misdiagnosed with examples such as these when seen at local Minute Clinics in the recent past, and there are many more such reports nationwide.

Determining the correct medication to use to treat children is difficult as well.  Kids come in all shapes and sizes, and with a fairly high incidence of medication intolerances or allergies.  Thus, selecting the correct and safe medication at an appropriate dose is not easy.  To make matters worse, each particular medication may have different doses depending on the illness being treated!!  For example, the dose of Amoxicillin needed for an ear infection is higher than for treating strep throat.  However, the dose of Azithromycin needed for an ear infection is lower than for strep throat.  These subtleties are often missed by minute clinics, all too often with kids being put on the wrong medication... or the right medication but with the wrong dose.

And so.... those of us practicing pediatrics, including all of us at Elm Street Pediatrics, feel very strongly that the medical care we provide is superior to the care given at Minute Clinics.  We know your family better, including medication allergies, vaccine histories, medical histories, and more, and we are also much more experienced diagnosing and treating children's medical issues.  We strongly believe that your child will get better care at our office, and we recommend avoiding those tempting Minute Clinics and letting us treat your family.  The concept of a Medical Home is vital to our work as pediatricians, and we do our best to provide that for you.

Many parents of newborns and infants ask us about the use of baby bumpers in cribs.  Logically, they seem like a good idea, and they can certainly make cribs more visually attractive.  In this case, however, our intuition betrays us... baby bumpers in cribs can be dangerous, and can cause more harm than good.  Many groups have come out against the use of baby bumpers in cribs, including the AAP, the National Institute of Child Health and Human Development, and the First Candle/ National SIDS Alliance.  We agree, and also advise against using baby bumpers in cribs.

This is such an important issue, in fact, that our own State's Attorney General Lisa Madigan is currently making a push to legally ban the production and sale of baby bumpers.  Historically, the use of bumpers made sense, to prevent infants from getting their heads stuck between the slats of the crib.  Today, however, due to regulations placed on require that the slats be close enough together that an infant's head cannot fit between them.  This regulation makes bumpers unnecessary and, according to a September 2007 study published in the journal Pediatrics, they actually pose a suffocation risk to infants.

For more information on bumpers, see this website.