Author Archives: Preferred Medical Group

No Nasal Flu Mist in 2016

In June 2016 there was a surprise announcement by the Centers for Disease Control (CDC) that the nasal flu vaccine was not being recommended at all for the upcoming flu season! A committee of 15 immunization experts at the CDC analyzed data and concluded that the nasal flu vaccine had not been effective for the last three years. They said that the nasal flu vaccine had and effectiveness rate of 3%, as compared to 63% effectiveness for the injectable flu vaccine. After the CDC recommendation, in August 2016 the American Academy of Pediatrics (AAP) endorsed the recommendation to not use the nasal flu vaccine.

Ironically, in August 2016 a Canadian study was published that showed almost identical efficacy rates for nasal and injectable flu vaccine over the time period October 2012-May 2015.

It is also ironic that in previous years the CDC had said that the nasal flu was more effective than the flu shot in children younger than age 8 years of age.

Scientists are working hard to find out the reason why the nasal flu vaccine was not effective. The CDC will meet again in October 2016 to reevaluate data and recommendations on the flu vaccine. It should be encouraging to parents and doctors that the experts in the US are continuously monitoring vaccines and their efficacy.

In view of the recommendations by the CDC and AAP, pediatricians had no choice but to cancel the orders for nasal flu and to only offer the injectable flu shot.

Pediatricians are mostly surprised and not thrilled with this development- for two reasons. Firstly, anecdotally neither I nor several of my pediatrician colleagues feel that we saw vaccine failure with the nasal flu vaccine over the last few years. Secondly, we know that it is so much harder to convince some kids to take a shot than it is to convince them to take a nasal spray.

I know from practical experience that some kids are simply ‘shot phobic’ and consequently the flu vaccination rates will go down this year because some kids will refuse to take the flu shot whereas they would have taken the flu mist nasally. I am disappointed that our kid friendly nasal spray flu vaccine is gone. However, we do believe that prevention is better than cure and hence we are proponents of getting a flu vaccine each year.

We are working hard to educate parents and families that the flu shot is much easier to handle than getting the flu which comes with high grade fever, cough, body aches, vomiting, weakness. So, the pediatricians and our nurses are pulling out all the tricks in the bag to help kids take the flu shot- distraction, stickers, toys and by enlisting the help of the parents’ bribe for ice cream or lollipop after the shot.

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Picking the Right Formula

In this day and age, a parent might just look down the formula aisle in the grocery store and easily get overwhelmed by the vast variety and brands of formulas that are available. So, I am going to simplify it for you and provide a brief overview of the infant formulas.

Over the last 10 years, we have seen more varieties being added than ever before. It is very crowded and competitively marketed; sometimes the different companies are quite creative with their naming and labeling strategies- all of them are fiercely competing for your attention and your business, trying to entice the newborn’s parent towards them.

The formulas can be broadly categorized into 4 different categories:

  1. Cow’s milk-based formula- made of cow’s milk protein and has lactose as a sugar. Some may come as ‘lactose free.’
  2. Soy-based formula- made with soy based protein and they are always lactose free
  3. Protein hydrolysate formulas- the proteins are broken down into simpler particles called amino acids. These are used for babies who have true protein allergy.
  4. Formulas for premature and low birth weight babies- they have extra calories and minerals for catch up growth.

The cow’s milk or soy based formulas might also have enhancements like a rice formula thickening agent to help with reflux. Formulas that are specifically made to help with reflux or spit-ups contain rice cereal and they are labeled ‘AR’ for ‘added rice’ and ‘anti-reflux.’

Some other formulas have the proteins a little bit more broken down and/or contain less lactose for easier digestion. They have labels like ‘gentle,’ ‘sensitive,’ or ‘hypoallergenic.’

Whether a formula is brand name or it is store brand, they are all made per the strict guidelines of the FDA. Therefore they are quite comparable. You do not necessarily need to pay more for the name brand formulas.

All of the formulas have certain common characteristics, whether or not the manufacturer is making big claims on the label or packaging. All formulas have iron supplementation though some might claim to be low-iron. Iron supplementation is important for the baby until the baby starts eating iron rich foods.

In recent years, 2 fatty acids known as DHA (docosahexaenoic acid) and ARA (arachidonic acid) have increasingly been added to formulas. These lipids are crucial for the development of the eyes and the brain. The formula might have prominent labeling with words such as “lipids,” “lipil,” “advance,” or just plain “DHA and ARA.”

Some formulas are also fortified with probiotics, which are types of “friendly” bacteria. Others are now fortified with prebiotics, which are natural food substances that promote healthy intestinal lining.

Infant formulas come in 3 different kinds:

  1. Ready to Feed
  2. Liquid Concentrate
  3. Powder

Which kind you choose to use will depend upon how much you will use, where you will use it (ready to use being easiest when you are on the go) and how much you want to spend. The liquid and the powder formulations are comparable in price and the ready to feed is more expensive than the other two.

Some basic measurements to remember are as follows

1 ounce= 30cc or 30 ml

8 fluid ounces= 1 cup

32 fluid ounces= 1 quart

Most babies do fine on cow’s milk or soy-based formula. Babies have a natural tendency to have spit ups and gas, and it is not always necessary to change formulas for these conditions because the formula may not be the cause for the baby’s symptoms. Please consult with your pediatrician before you make rapid changes to the baby’s formula.

However, about 10% of babies are truly intolerant of milk or soy-based formulas- a condition known as Milk Soy Protein Intolerance, which is caused due to the baby’s intestines truly being intolerant of the proteins in these formulas. These babies are not happy. They might have symptoms of fussiness, spit up a lot or become excessively gassy, or they may develop constipation or diarrhea. In this case, your pediatrician will probably recommend that you try one of the special formulas in which the proteins are broken down.

Other babies just show a clear preference for one type or even brand of formula over another or a preference between the consistency of powder-based versus liquid formula. Parents are prone to a fair bit of trial and error when they have a picky eater. I do caution the parents that once a formula change is made one should give it for a few days before deciding whether or not it is a good fit for the baby. After all, it might take a day or two before the old formula clears the baby’s gut and the new formula shows its effects.

The good news is that most newborns do quite well with whatever brand or type of formula they are given. Some do fine even with switching between formulas.baby-1
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Welcome to Dr. Catrece Dantzler, LPC

Preferred Medical Group is thrilled to welcome Licensed Professional Counselor, Dr. Catrece Dantzler, aboard at our Phenix City Children’s & Family Clinic location as of March 2016. She is accepting new patients for therapy, and can help children and adolescents with a variety of issues, including anxiety, depression, trauma, abuse and anger management.

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Here are a few words from Dr. Dantzler, just for you!

Hi Preferred Medical Group Clientele,

My name is Dr. Catrece Dantzler. Years ago when I was just in high school the Lord impressed upon my heart to be a helper to and a listener for my peers and many others that I was around. Therefore, I began working in the school counselor’s office. While in that position, I found that I liked what she did and I also liked helping others solve their problems. After that year of assisting Ms. Martin in the counselor’s office, I dreamed of becoming a counselor so that I too could assist young people in fulfilling their dreams. However, just like so many others, my life’s journey took me in a different direction. Years later, I remembered the dream that God placed in my heart and I went after it full steam ahead. I received my Marriage and Family Therapy degree in 2004 and completed my Doctorate of Education in Counseling, Education, and Supervision ten years later in 2014.

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My theoretical orientation is behaviorally focused. By using a Cognitive Behavioral approach to therapy, I help clients create workable goals that lead them to succeed. Cognitive Behavioral Therapy (CBT) is a model that has a lot of variety. Therapy can be achieved through the use of talk therapy, play therapy, educational therapy, art therapy, and many other treatment techniques. With CBT, I can focus on the problem at hand first then later deal with the underlying causes.  CBT also has a number of techniques that work well with clients that get them involved even when they do not want to be such as positive reinforcements, checklists, and contracts.  CBT allows the client to buy-in to their treatment. Using this approach therapy is done with the client verses to the client.

Assisting others is my purpose in life and I am able to do that by working in a profession that I love. Everyone goes through struggles. Some can deal with the struggles on their own and some need assistance. My job is to be your assistant. When life becomes unmanageable due to life’s circumstances, behavioral challenges, grief, or an illness, I can help.  I ask that you allow me to assist your family in building hope for a better tomorrow and a prosperous future. I am excited about the opportunity to work with you all.

Sincerely,

Catrece

Happy #DrSeussDay 2016

Roger Kirk, our Pediatric Nurse Practitioner enjoyed reading to the kids at Lakewood Primary School in honor of Dr. Seuss’ birthday! He and our Office Manager, Amanda Bradshaw, even got to meet The Cat in the Hat!
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Setting Boundaries with Grandparents

By Michelle DeRamus, Ph.D.

Setting boundariesRules with our children’s grandparents is hard. We are taught since early childhood that talking back to our elders is not OK. So even when we need to do what we believe is best for our children, setting boundaries with our parents (or our in-laws) can feel like we are being disrespectful, making it very challenging. In addition, because many of us look to our parents as the best example of how to be parents, to go against something they want to do can make us question whether we are really doing the right thing. As children, many of us viewed our parents as superheroes who could do no wrong; as adults, we begin to realize our parents do sometimes make mistakes and incorrect decisions. That can be a tough realization for us. All of these issues can work against our desire of setting boundaries with grandparents or telling grandparents what we like and don’t like about how they are doing things with our children. However, to have a healthy core and extended family, boundaries are necessary. In our society, while we continue to respect and seek advice from our elders and extended family, we generally recognize the parents as needing to have the final say about how to raise their children. So how can parents set boundaries while still being respectful toward grandparents?

Family visits baby

First, communicate your wishes clearly. Sometimes other caregivers do things differently from parents simply because they do not know the parents’ wishes. Having everyone on the same page can often prevent, or quickly resolve, any conflicts about caregiving. State your wishes respectfully and calmly, without attacking or accusing. It’s best to have this type of conversation in private; none of us likes to be “called out” on our mistakes in front of others. Explain your reasoning for your preferences. Often, when others understand the reasons why we do things the way we do, they are much more understanding, supportive, and willing to comply with our requests. Be sure to listen if your parents or in-laws would like to explain why they did things differently or if they have questions. Good communication is key to solving any conflict.

Second, be willing to compromise sometimes, and know when to pick your battles. Just because grandparents do things differently does not necessarily mean it is wrong. Often, if we use good communication skills, we can discuss our differences and meet in the middle for a reasonable solution. We all know that grandparents like to “spoil” their grandchildren, and occasional indulgences are OK. For example, while you might not normally let your child eat French fries for lunch and dinner, having an extra serving of fries once a month while visiting grandma is not going to cause long-term harm. If we turn every difference of opinion about raising children into an argument, it will make for a very unpleasant visit with grandparents and can lead to long-term tension between you and your parents or in-laws.

Stand your ground on the things that are really important to you. While the occasional indulgence with grandparents may be fine, if grandparents are part of the regular, day-to-day caregiving for your children and they consistently let the rules slide, it can have a negative impact on children and family relationships in general. Children need consistency, and when caregivers have different sets of rules, it can lead to confusion about expectations for behavior, which can then lead to behavior problems both at home and at school. If parents feel that grandparents are “undermining” them or not respecting their authority as parents, it can lead to feelings of resentment between parents and grandparents. It’s best to address disagreements head-on (calmly and with good communication) so that long-term problems do not set in. Ultimately, as a child’s parent, you are responsible for making sure they are raised to be fully-functioning, well-adjusted adults. If you believe a grandparent is repeatedly acting in a way that is counter to that goal, you may have to set guidelines about time spent with grandparents. For example, if grandparents are consistently letting children watch scary TV shows that parents know are giving the child nightmares, you may decide that children can only visit grandparents if a parent is also present to provide supervision for TV viewing. Or if you have asked grandparents not to curse around your young children, but they continue to do so, you may decide to take the children home early the next time you hear a curse word.

While setting boundaries with grandparents can be an uncomfortable situation to navigate at times, just remember that at the end of the day, it’s nice to know that your children have so many people to love them and who want them to be happy.

 

Mom with friends

Holiday Hours Christmas 2015

HolidayHours

Preferred Medical Group will close all 3 locations: Phenix City Children’s & Family Clinic, Fort Mitchell Clinic and Opelika Pediatrics & Family Clinic on December 24, December 25, and December 26 in recognition of the Christmas holiday.

We will reopen for normal operating hours at 8 a.m. EST on Monday, December 28.

For immediate assistance on these days, please call our answering service at (334) 664-0463, which can connect you with a doctor on call.

5 Reasons Not to Miss Preferred Medical Group’s Expectant Mommy Expo 2015


Heather Hughes 1

Expectant Mommy Expo 2015

Saturday, September 12th from 2:00-4:00 pm EST

Doors open at 1:45 for pre-registered attendees.

Location: Phenix City Chilren’s Clinic 3700 A Phenix City, AL 36867

Preferred Medical Group’s Expectant Mommy Expo 2015 is quickly approaching, and you may be wondering why you should take time out of your Saturday afternoon to attend. Yes, we know SEC football is on, and there are plenty of other events competing for your energy and attention, but we assure you that the Expo is one you don’t want to miss. It’s our third annual event, so we know what we’re talking about!

Here’s why YOU should be there:

1. It’s FREE. Yes, you read that correctly. There is zero charge for you to come out and receive invaluable education and resources as you prepare for your upcoming journey into parenthood. We have expert speakers addressing everything from keeping your newborn safe to breastfeeding to coping with the stress of having a new baby in the house. You’ll have the chance to ask questions so that you are fully prepared to be a Mom!

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2. Make Connections. At the Expo, you’ll meet more than 25 different businesses in the community that cater to expectant parents and/or babies. Looking for a newborn photographer? Check. We’ll have one at the Expo for you to meet. Still working to decorate the nursery? Check. Have you even thought about a pediatric dentist? We’ll have everyone that you could possibly imagine right here in one convenient place! Some of the businesses will even be selling small accessories, such as hairbows, at the event at exclusive Expo prices.

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3. Treat Yourself to a Little Pampering. The Expectant Mommy Expo is proud to offer complimentary pregnancy massages to our attendees. We also have pre-natal yoga classes onsite, that you can sign up for before or during the event. Or, relax and let us provide all of the supplies and direction that you need to make an adorable picture frame to top your new baby’s dresser. We will also have light refreshments on site for a quick afternoon pick-me-up. This day is truly all about YOU.

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4. Raffles, Raffles and More Raffles! We will be giving away the equivalent of $1000+ in goodies that YOU need. We have everything from a free 4D ultrasound to discounted or free newborn photography sessions to gift cards to your favorite baby store–all of the products and services that Mom and/or baby could desire.

 

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5. You can bring a friend, relative or soon-to-be-Dad. Due to space constraints, we do ask that you limit guests to one additional person, and we ask that all guests be above the age of 15 due to the nature of the event. However, it’s so much fun to begin this journey with someone by your side to walk with you along the way!

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If we haven’t convinced you yet, all we can say is that the Expectant Mommy Expo is a TON of fun and an event you will remember for a lifetime. Pre-register today by emailing: phenixcitychildrenspr@gmail.com. Once you submit your pre-registration form, you will be all set for the Expectant Mommy Expo 2015!

While walk ins are welcome, we do encourage pre-registration to ensure you are able to participate in some of the most popular events that are limited due to time and space constraints. Plus, the first 50 women to pre-register will receive a special gift from Preferred Medical Group.

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Here is a link to our official Facebook event with more information and our featured sponsors. Be sure to share this information with anyone you know who may be expecting!

Choosing the Best Pediatrician Columbus GA

Checklist: Questions To Ask the Pediatrician You’re Considering Choosing the Best Pediatrician Columbus GA

You’ve got a baby on the way–now’s the time to find a doctor you can trust. Below is our guide to choosing the pediatrician that’s right for you and your little one.pediatrician columbus ga
To begin your search, get referrals from your obstetrician/gynecologist or nurse-midwife, other parents in the neighborhood, the public affairs department at the nearest hospital, a pediatric floor nurse at a local hospital or medical center, or by checking the pediatrician referral database at the American Academy of Pediatrics (www.aap.org).

How long have you been in practice?
If you don’t have this information already, this would be the time to ask.

What is your childcare philosophy?
Talk to him about breastfeeding, circumcision, alternative medicine, vaccinations, sleep and discipline issues.

Do you have children?
It may be comforting to know if your doctor has children the same gender.

Are you part of a group practice?
If you go with a doctor in a solo practice, find out who covers when he’s away. If he’s part of a group practice, ask about the background of the other doctors. Some practices have pediatric nurse practitioners.

How long does a typical check-up last?
Ideally, at least 20 minutes.

What are the office hours?

How are emergencies handled?
Some offices accommodate same-day walk-in visits. Ask how after-hours emergencies and questions are handled.

When you’ve narrowed your choices down to two or three doctors, you’re ready to get specific questions answered. If possible, set up interviews–face-to-face meetings will give you the opportunity to get to know the doctor and his staff and to ask about office policies.

 

Potty Training: A Guide for Parents

By Shilpa Vernekar, M.D.
Potty Training Child First Steps

If you are a parent, you can most likely relate to the unparalleled feeling of elation and excitement that comes when your child reaches a big milestone. In the early years, those major accomplishments may seem minor to the outside world, such as baby’s first words, baby’s first steps, and baby’s first poopy in the potty, but as a parent you alone are enchanted and just so proud of your little one. As both a pediatrician and a mother, I get it. I will never forget the first time my child said “mama,” and I celebrate with countless other parents every day over their children’s achievements.

However, it is important to first understand that potty training – like most processes with children—may or may not be easy or come naturally for you and your child. Although a bowel movement on the potty sounds so simple to you as an adult, it is important to understand that it may take time, understanding and patience on your end. Please know that you are not alone! As your child’s pediatrician, I am here to help if needed at any point along your journey of potty training. And one day, I assure you, that child who is still using his/her diaper, will be independently using the toilet thanks to your hard work and dedication!

So, let’s start at the beginning, and I will answer the most common potty training questions that parents ask in my office.

When is the right time to start potty training?Potty Training 2

Potty training can start anywhere as early as 6 months to when the child is 2-3 years of age. Each child is different, and you know your child better than anyone else.

He will show signs of being ready like informing you every time he has to do stools or pass urine. Parents can also identify that it may be time to begin potty training based upon the child’s body language. When children are about to pass stools or urine, they often change facial expressions, squirm, and/or cross their legs.

Also, prior to removing the diaper, it helps to know if your child can understand instructions or be able to rush himself to the potty if needed.

 

My child is ready for potty training. So, how do I start?

First, invest in a potty training device which can be purchased from any store for as low as $15-20. Next, allow your child to become familiar with the potty and ensure that the child is comfortable when he sits on the potty with his feet resting firmly on the floor. Let the child know that every time the child needs to use the potty, he needs to sit on the potty chair. The child can wear a diaper to pass stools or urine while sitting on the potty, but it is best done without the diaper. Therefore, the child can help undress and remove the pull ups before he sits on the potty.

Another strategy is to allow the child to sit on the potty every 2-3 hours to help void urine. If there is a specific time during the day that the child passes stools, then allowing the child to be on the potty at that time will help reinforce the behavior. Stickers and reward charts help older children to become potty trained.Potty Training 3

Additionally, wiping from front to back is important, especially for girls, to prevent urinary tract infection. This is something that seems natural, so parents may forget to teach, but it is vitally important.

Finally, hand hygiene is important after using the potty. Parents should make it a habit that the child washes his hands each and every time after he uses the potty.

The parent should be patient with the whole process and understand that it may take 2 weeks to 2 months depending upon the child’s level of maturity. If you have tried for 1-2 weeks and feel your child is not ready, do not force the child. It will make the situation worse and make potty training even more difficult. Let the child grow, and try again few weeks or few months later.

While day time training and stool training happens in the first three months, bed wetting or being dry by night might take longer. Sometimes the child might continue to bed wet until five years of age or longer if there is family history of bed wetting. For further information of nocturnal enuresis or bedwetting, refer to this article.

When should I ask my child’s pediatrician to help with potty training?

If you child is unable to potty train by 3-4 years of age during the day or a previously potty trained child is now reverting back to passing stools/urine in the underwear on a routine basis, then it is time to visit your pediatrician.

But, remember it is normal to have some accidents at times, especially if the child is in an unfamiliar setting or with different care giver. Do not worry about it unless it happens on a daily basis.

For additional questions, please consult your child’s pediatrician. And remember: Stay calm and keep persevering: potty training will occur eventually.

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Dr. Vernekar, M.D., F.A.A.P. is a board-certified pediatrician who works at Preferred Medical Group, which has locations at Phenix City Children’s, Fort Mitchell Clinic and Opelika Pediatrics and Family Clinic. Her special areas of interest include weight management and nutrition. Follow Dr. V. on Twitter at: www.twitter.com/shilpavernekar.

 

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