Category Archives: Physicians Blog

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.

flue-shot flu-mist

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.

Catrece Dantzler








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.

PLay Therapy 2

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.



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

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.

Potty Training 1

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:


Best Pediatricians in Columbus GA

Each year, we at Preferred Medical Group assist more than 6,000 patients with their healthcare needs.  We have two locations, Phenix City Children’s for pediatric patients only and Fort Mitchell Clinic for pediatric and family practice patients. We have been offering pediatric services to the Phenix City, AL and Columbus, GA area since 2006.

best pediatricians in columbus ga

We realize that we are not in network with all insurance plans, and because so many folks recognize us (from this website) and trust us on all things “pediatrics,” they often ask us about our competitors and other pediatricians in the Columbus GA area.

We pride ourselves on being blatantly honest with respect to competition. Thus, here is a list of some of the pediatricians that have a solid practice history in the Columbus area:

1. Dr. Nora Tan Ngo, Tan Ngo Pediatrics– Dr. Tan Ngo is a board-certified pediatrician who cares for all children and adolescents and promises to provide good quality care to everyone regardless of insurance, race or socio-economic status. This practice recently re-located into an office on 19th Street (at the corner of 12th Avenue and 19th Street), Columbus GA 31901.

2. Dr. David Flowers, Columbus Regional Pediatrics Dr. Flowers is a board-certified pediatrician who recently joined Columbus Regional Pediatrics after more than 12 years in private practice in Columbus, GA. He is located at The Medical Center.

3. Dr. Mark Oliver, Rivertown Pediatrics Dr. Oliver is a board-certified pediatrician. He is a member of the American Academy of Pediatrics, the American Academy of Pediatrics (Georgia Chapter), the Medical Association of Georgia and the Muscogee County Medical Society. He practices at Rivertown Pediatrics, located on Capstone Court in Columbus.

4. Dr. Richard Mansfield, Pediatrics at Brookstone Centre Dr. Mansfield is a board-certified pediatrician. He attended Nova-Southeastern University College of Osteopathic Medicine, and then completed his residency at Brooke Army and Wilford Hall Medical Center. He is located on Brookstone Centre Parkway in Columbus.

5. Dr. Lloyd Hudson Jr.– Dr. Hudson is a board-certified pediatrician. He has a private solo provider practice on Veteran’s Parkway in Columbus. He is affiliated with Doctor’s Hospital and the Medical Center and has practiced in the Columbus area for many years.

So, here are five pediatricians in the Columbus, GA area to consider if you are searching for a pediatrician for your family. The key to finding the best pediatrician for your child is to schedule an office Meet and Greet, if at all possible. This option is especially important for Expectant Parents during the third trimester of pregnancy. We always recommend scheduling advance in person meetings with each pediatrician, to get a feel of his/her bedside manner and medical philosophies, to ensure you find the right fit for you and your family.

Some things to consider:

  • What are the operating hours of the Clinic? What is the procedure for after-hours emergencies?
  • How long does it take to get an appointment for a sick child?best pediatricians in columbus ga
  • What is the average wait time for each appointment?
  • How many physicians are in the practice? What is the procedure for taking care of your child when your doctor is out of town or unavailable?
  • Does the physician’s philosophy align with your own philosophy regarding breastfeeding, vaccinations and other medical issues?


We hope you will find a well-qualified pediatrician who also has a nice office and will be an exceptional fit for your child and your family. We wish you and your family all the best!

Avoiding New Sibling Jealousy

By Michelle DeRamus, Ph.D.

There’s a lot to think about when preparing for a new baby. For families who already have at least one child, that prep work should include making sure older siblings are ready for the new baby. A little preparation before the baby arrives and following a few guidelines after the baby is born can minimize new sibling jealousy and maximize helpful behavior from older children.

Jealous over new baby

When considering how to prepare siblings for a new baby, it is important to consider the developmental stage of the siblings. Toddlers and preschoolers are very sensitive to changes in their routines, so it can be helpful to make any big adjustments to daily routines (e.g., moving to a new bed/room, starting preschool, potty training) either several weeks before baby arrives or after baby is a few months old. Adjusting to baby will be a big change, and keeping all other routines as familiar as possible will help toddlers and preschoolers feel safe and comforted.

Older children may be less sensitive to minor changes in routine because they can better understand how and why the family is changing. However, older children are often faced with greater responsibilities and an expectation to act more “grown up” when a new baby is born. Be sure to keep expectations reasonable and age-appropriate. There are many websites available that provide suggestions for chores and responsibilities that are appropriate for different age groups. And, just like with younger children, adding responsibilities for older children gradually in the weeks before and after baby arrives can help the transition go smoothly.

Newborns require a great deal of time and attention. It can be a big adjustment for older siblings to have less of their parents’ attention. Many siblings go through a phase of new sibling jealousy. To minimize siblings’ jealousy, help big brother or sister get ready for baby by allowing them to be a part of some of the decisions and preparations before baby arrives, such as choosing a special toy for baby, decorations for baby’s room, or where to put some of baby’s belongingSibling Jealousys.

Siblings might want to “hand down” a special stuffed animal or toy from their own collection to share with baby, although it is OK for siblings to keep some toys as their own and away from baby’s reach. When baby arrives, be sure to praise siblings for all the helpful things they do, from little things like handing you a diaper to bigger responsibilities such as cleaning up their toys. Giving lots of praise is a good way to help siblings feel like they are still getting attention from you even though your hands may be occupied with caring for baby. Finally, even though babies need lots of time from you, it is important to carve out some one-on-one time with siblings on a regular basis. Even 10 minutes a day of special play time where you can give your undivided attention to siblings will go a long way for helping them feel valued and loved, which will cut down on new sibling jealousy of baby.

Additionally, it is important to acknowledge and validate the older child’s feelings. I would advise parents to problem solve with the child by saying things like, “I understand that you feel sad that you will have to share Mommy’s attention now; what can we do to help you feel that you are still just as important?” or “I understand that it upsets you when the baby cries and it’s really loud; how can we help you to feel better about this?” On the other hand, I would tell parents not to tell a child “Don’t feel that way.” It is OK for the older child to feel mad, sad or confused, which are all perfectly normal emotions, as long as those feelings are expressed in an appropriate way. For example, it would not be OK for the older child to act aggressively by hitting the baby, breaking baby’s toys, or hitting mommy’s stomach. If those things are occurring, discipline may need to be used, just as it would be used in similar situations when children are not following the rules.

Positive redirection can also be useful; for example, if a child was to say, “I hate the baby and wish he was never born,” parents could interpret why the child is feeling that way in this particular moment and respond by saying, “I understand that you really don’t like how the baby sleeps all the time, and we have to be quiet. What if we went to play outside later, just you and I, and let Daddy watch the baby? Then, you can yell and scream and get all of your energy out.” You are replacing strong words like “hate” and the idea that the baby is the problem and replacing it with the idea that the older child simply does not like a particular behavior and the effect that the particular behavior has in his/her own life. By offering a solution, such as a louder playtime outdoors later that day, the child will hopefully see that his/her life can continue even with baby in the house, and new sibling jealousy will gradually decrease.

After the birth of the baby,Sibling excited about new baby life will never be the same for your older kids, so advance preparation and a few steps taken by the parent can go a long way in easing a family through this major time of transition. Positive redirection and scheduling reserved one on one time for the older child to spend with a parent can go a long way in helping older siblings love and accept the baby. It takes kids different amounts of time to adjust; some love baby from Day 1, and other kids continue to be jealous of their younger sibling throughout their life.

If your child continues to express extreme negative emotions including aggression, extreme sadness, or excessive worrying about the family or even the baby itself, and you as the parent begin to feel that this issue is affecting the child’s quality of life or the overall family dynamic, you may seek assistance from a counselor or therapist.


Dr. DeRamus is a child psychologist with Preferred Medical Group and works at the Phenix City Children’s clinic. She specializes in Autism Spectrum Disorder (ASD) and provides diagnostic testing and therapy services for developmental delays, learning problems, ADHD, and behavior problems. She also helps children from infancy through 18 work through anger, anxiety, depression, family problems and peer relationship issues.

Cyberbullying for Kids

By Ritu Chandra, MD

Bullying is unwanted, aggressive behavior among school aged children and includes  behaviors that focus on making someone else feel inadequate, or focus on belittling someone else and is done with the intention of bringing another person down. There are different kinds of bullying: physical, social, verbal, cyber.


Cyberbullying is bullying that takes place using electronic technology, including devices and equipment such as cell phones, computers, and tablets as well as communication including social media sites, text messages, chat, and websites.

Examples of cyberbullying include mean text messages or emails, rumors sent by email or posted on social networking sites, and embarrassing pictures, videos, websites, or fake profiles.

Why Cyberbullying is Different

-Cyberbullying can happen 24 hours a day, 7 days a week, and reach a kid even when he or she is alone. It can happen any time of the day or night and even during the summer vacation. It is hard to get away from the behavior.

-Cyberbullying messages and images can be posted anonymously and distributed quickly to a very wide audience.

-It can be difficult and sometimes impossible to trace the source.

-Completely deleting inappropriate or harassing messages, texts, and pictures is extremely difficult after they have been posted or sent.

Effects of Cyberbullying 

Kids who are cyberbullied are more likely to use alcohol and drugs, skip school, experience in-person bullying, be unwilling to attend school, receive poor grades, have lower self-esteem, and have more health problems.

Real Examples of Cyberbullying for Kids

  • A kid in Pennsylvania committed suicide because he was called a ‘freak’ and was told that no one liked him.Cyber bullying for kids
  • A kid jumped off a bridge because his homosexual sexual encounter video was posted online.
  • An OH girl sexted a nude photo of herself to her boyfriend. When they broke up, he posted this photo on social media sites and then the entire school started calling her names; she hung herself in her closet. This is called ‘Revenge Porn.’

Why children do not seek help?

-No language or framework, feel alone, fear of retaliation, think others may not believe them, parents or teachers may not know what to do

Prevent Cyberbullying for Kids

Parents and kids can prevent cyberbullying. Together, they can explore safe ways to use technology.

  • Talk with your kids about cyberbullying and other online issues regularly.
  • Be Aware of What Your Kids are Doing Online- know the sites your kids visit and their online activities, ask where they’re going, what they’re doing, and who they’re doing it with.
  • Tell your kids that as a responsible parent you may review their online communications if you think there is reason for concern.
  • Installing parental control filtering software or monitoring programs are one option for monitoring your child’s online behavior, but do not rely solely on these tools.Cyberb
  • Have a sense of what they do online and in texts.
  • Learn about the sites they like.
  • Try out the devices they use.
  • Ask for their passwords, but tell them you’ll only use them in case of emergency.
  • Ask to “friend” or “follow” your kids on social media sites or ask another trusted adult to do so.
  • Encourage your kids to tell you immediately if they, or someone they know, is being cyberbullied.
  • Explain that you will NOT take away their computers or cell phones if they confide in you about a problem they are having.


Establish Rules about Technology Use

  • Be clear about what sites they can visit and what they are permitted to do when they’re online. Show them how to be safe online.
  • Set a strong password.
  • Help them be smart about what they post or say. Tell them not to share anything that could hurt or embarrass themselves or others. Once something is posted, it is out of their control whether someone else will forward it.
  • Encourage kids to think about who they want to see the information and pictures they post online. Should complete strangers see it? Real friends only? Friends of friends? Think about how people who aren’t friends could use it.
  • Tell kids to keep their passwords safe and not share them with friends. Sharing passwords can compromise their control over their online identities and activities.


Steps to Take ImmediatelyCyberbullying for kids 1

  • ALWAYS TELL. The most important thing is that you tell someone about the bullying. “A problem shared is a problem halved.” If possible, this should be an adult that you trust.
  • Don’t respond to and don’t forward cyberbullying messages.
  • Keep evidence of cyberbullying. Record the dates, times, and descriptions of instances when cyberbullying has occurred. Save and print screenshots, emails, and text messages. Block the person who is cyberbullying.
  • Change the phone number or online ID of your child

Report Cyberbullying to Online Service Providers

-Cyberbullying often violates the terms of service established by social media sites and internet service providers and it should be reported so they can take action against users abusing the terms of service.

  Report Cyberbullying to Law Enforcement

Cyberbullying for kids should be reported to law enforcement officials in cases of threats of violence, child pornography, sending sexually explicit messages or photos, talking and hate crimes.

Report Cyberbullying to Schools

Cyberbullying can create a disruptive/hostile environment at school and is often related to in-person bullying. The school can use the information to help inform prevention and response strategies.

Dr. Ritu Chandra is the founder of Preferred Medical Group. She is a board-certified pediatrician, and school related-problems, such as bullying is a special area of interest.

Eating Disorders/Body Image in Teens

By Michelle DeRamus, Ph.D.

The first time I remember being aware of my own body image was when I was in second grade. I was on the bus, and a girl a few years older than me asked with a smirk, “Do you think you’re fat? ‘Cause I don’t… I think you’re skinny as a rail.” I didn’t think I was fat, but I could tell by her sarcasm that she did. And so began the lifelong battle that so many of us face – developing and maintaining a positive body image.

So many things affect our body image, that is, the way we perceive their own bodies and how we think others perceive our bodies. It is influenced by our own personality, our life experiences with peers and family, and of course, what we are exposed to in the media. While most people have some difficulty with their body image at some point in their lives, girls and women tend to have a significantly greater struggle than boys and men, especially during the teenage years. The effects of a negative body image in teens can be devastating, leading to low self-esteem, unhealthy habits, depression, anxiety, and even eating disorders.

As we enter summer (and swimsuit season), following are some tips to help promote a more realistic and positive body image in your child or teenager.

  • Help your children have a realistic understanding of media images. As adults, most of us know that the models we see in the media have been airbrushed and “touched up” in a variety of ways. Several examples in recent years have given us the opportunity to see “before” and “after” pictures of models and actresses to help us understand that the final image we see is not reality. It is important for our teens to realize that the images they see in the media are not realistic. These images are also not attainable by approximately 95% of the population. Just because we see dozens of images of “beautiful people” each day does not mean that is the norm. However, if children and teens do not understand this concept, it can lead to expectations that most people look like those we see in the media, which creates unrealistic expectations for perfect bodies and creates poor body image in teens.body image in teens


  • Help your children develop a positive self-esteem. Everyone has strengths and weaknesses. It is important for children and teens to recognize their strengths across different aspects of life, whether it is sports, academics, personality and character traits, hobbies, other extracurricular activities, or social skills. Help your child identify and then strengthen their positive qualities. Guide them in understanding how these positive qualities can help them reach their goals and that success is not dependent on physical appearance.


  • Help your children develop good social skills. Much of our desire to look a certain way is driven by an underlying desire to fit in. Society, peers, and sometimes even family tell us that we will be more successful or better liked if we are a certain size or shape. However, the reality is that there are other ways to make friends and feel like you belong to a group. Children who know how to get along with others and have a positive peer group that supports and encourages them may be better able to keep their body image concerns in perspective.


  • Help your children learn how to focus on being healthy rather than focusing on looking a certain way, weighing a certain amount, or eating a certain number of calories. A focus on overall health can help children learn moderation in all things, both the excesses (e.g., desserts, sedentary activities) and the restrictions (e.g., limiting food intake). A focus on health also takes the emphasis off the image in the mirror and back onto how your child feels. Point out that your body is an amazing tool that can help you reach your goals, rather than something to be scrutinized and criticized.

Body Image 2 Mom and Teen

  • Help your children learn positive stress management techniques. Many unhealthy habits develop in response to stress. Teaching children and teens to manage stress appropriately with fun activities, social support, problem solving, exercise, and relaxation can prevent unhealthy habits from developing.


  • Be an example. Children, and even teens, learn the most about how to “be” from their immediate family members. Even at a very young age, children notice when adults are critical of their own bodies in front of their children. If children see other family members modeling poor body image, they will grow to think that is the norm. One of the best ways to teach the above strategies to your children is to follow them yourself.

While almost everyone struggles with body image at some time, most people are able to ultimately keep appearance in perspective as only one part of who they are as a person and do not develop serious consequences as a result of their perception of ideal body image. However, for some individuals, body image becomes so distorted or such a priority, that significant problems develop, such as depression, anxiety, or eating disorders. Some warning signs of body image issues in teens that preclude a more serious condition include:

  • Changes in eating patterns (e.g., decreased intake, binging, vomiting after meals) Body Image 1
  • Preoccupation with weight, food, calories, exercise, etc.
  • Dramatic changes in weight
  • Frequent comments or anxiety about being “fat” or overweight
  • Development of rigid food or exercise rituals
  • Withdrawal from friends, family, or previously enjoyed activities

If you are concerned your child may be experiencing emotional problems or an eating disorder as a result of poor body image, it is important to get help right away. Early treatment leads to better outcomes. Talk to your child’s doctor about resources in your area.

Dr. DeRamus is a child psychologist with Preferred Medical Group’s Phenix City Children’s clinic. She specializes in Autism Spectrum Disorder (ASD) and provides diagnostic testing and therapy services for developmental delays, learning problems and ADHD. She also works with kids with anger, anxiety, depression, family problems and peer relationships.


Jaundice in Newborns

By Shilpa Vernekar, M.D.

 What is hyperbilirubinemia or  jaundice?

Hyperbilirubin or increased levels of bilirubin/jaundice – is the yellow discoloration noted on the skin and the conjunctiva (the white part of the eye). Jaundice in newborns is fairly common.

 When does it happen?Newborn

Most healthy newborns have jaundice during the first few days of life which disappears on its own without any specific intervention.

What causes jaundice?

Common causes of jaundice in newborns can be blood group or Rh incompatibility, trauma and scalp bleeding during delivery, infection, poor feeding, enzyme defects, RBC structural defects, biliary or liver conditions, metabolic conditions like hypothyroid, infants of diabetic mother and so on…

Why does it happen?

Newborns have relatively larger number of red blood cells (RBC ) with a short life span of these red blood cells. When RBC break down, bilirubin is formed as a byproduct. It is this bilirubin which imparts the yellow color to the skin and the eyes, or jaundice in neworns.

Jaundice may be categorized into two types:

  1. Physiological jaundice in newborns – This type of jaundice happens in most newborns. Start after the first day of life, reaches peak in 3-5 days in term babies and 5-7 days in preterm babies and resolves in 7-10 days.

a.) Breast feeding jaundice in newborns is another form of physiological jaundice. Decreased milk intake can exacerbate or worsen the jaundice. Breast feeding jaundice generally improves by increased and more frequent feeding of the baby.

b.) Breast milk jaundice in newborns is another type of physiological jaundice, where certain substances in the breast milk inhibit enzymes that are responsible for the breakdown of the bilirubin in the liver.

This jaundice generally happens by the second to third week of life and may sometimes stay for a month.

No treatment or intervention is necessary for physiologic jaundice in newborns.

  1. Pathological Jaundice- This type of jaundice in newborns can pose a problem. Jaundice that happens in the first 24 hours of life or jaundice that is higher than expected for a baby that age (in hours) needs to get medical attention.

How is jaundice diagnosed and treated?Bilirubin test jaundice

Jaundice levels can be checked by a device on the skin which is a quick screening method. The definitive way is to take blood sample/heel stick from the baby and have it analyzed for bilirubin levels. In most cases of physiological jaundice, improved feeding helps flush the bilirubin out.

For breast milk jaundice, it is recommended to discontinue breast feeding for 48 hours, supplementing with formula in the meanwhile (pumping the breast milk to maintain supply). This method helps decrease the jaundice, after which breast feeding can be re-started without worrying about jaundice coming back.

Another treatment is photo therapy, where blue fluorescent light is used to break the bilirubin, which is then excreted to the urine.

In severe cases, an exchange transfusion may be necessary. This involves taking a small quantity of baby’s blood and replacing with a similar matched donor blood to decrease the bilirubin levels.

Why should I look out for jaundice?

If high jaundice numbers remain untreated, a condition called Kernicterus may develop.

This leads to long term irreversible brain damage. Hence physicians treat newborn jaundice aggressively.

It is important to ensure once you are discharged home from the hospital to keep the newborn follow up appointment within 3-5 days as jaundice levels peak in term babies by 3-4 days.

Also if you start to notice the skin color appear increasing yellow or jaundiced that lasts more than one week, it is important to have the baby checked out by the physician.

Finally, it is important to continue feeding the baby (through breast milk or supplemental formula depending upon your physician’s instructions,) and do not attempt to keep the baby in direct sunlight as this can result in dehydration, sun burn and more severe complications to the baby. Please do not worry, as with proper evaluation and treatment, jaundice in newborns is often easily resolved.

For more information, please consult your child’s pediatrician. This article is meant to serve as a guide about jaundice in newborns and is in no means is a comprehensive treatment plan for your baby.

Shilpa 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 and Fort Mitchell Clinic. Her special areas of interest include weight management and nutrition. Follow Dr. V. on Twitter at

Bonding with your newborn baby

By Shilpa Vernekar, M.D.

If you are reading this article, you are more than likely expecting a baby or have recently delivered; first and foremost, congratulations! Parenthood is an exciting journey that is unparalleled by any other you will ever take. This baby will certainly change your life in many ways, beginning with the first time that you lay eyes on one another!

If this is your first baby, please take a deep breath and know these two important things:

  1. You are doing (or will do) just fine as a parent! It is all very natural.
  2. You are not alone!

First-time moms are especially prone to worry about various things related to those first few days and weeks of infancy; but, please know your child’s pediatrician is here to help you along the way, from the moment you first hold your new baby in your arms. This is why it is especially important to pick your child’s pediatrician before you actually have the child (if you are adopting,) or during your pregnancy. The third trimester is usually the recommended time to pick the physician who will be your resource and advocate for everything from breastfeeding to soothing a baby with colic.

Once you have your baby, you will likely develop a strong, unique and inseparable bond with your new son or daughter.

What is bonding?Bonding with Newborn Baby

Bonding is a connection or attachment that you will feel towards your newborn. It is the same force that will bring tears to your eyes when you see your baby cry. You may want to take away all of his/her grief and replace it with laughter.

 When does it happen?

TV shows and magazine advertisements often portray bonding as instantaneous, and that it occurs as soon as your bundle of joy lands in your arms. While that may be the case for many, some parents may take few days to weeks to feel the bonding. So, do not worry if you are back from the hospital and do not feel the connection just yet.

How can I make bonding happen?

Spending time with you newborn is one of the easiest ways to initiate bonding. Look into her eyes as you feed her, run your fingers through her hair, gently massage her body with oil, sing to her, rock her, pat her, lay her on you to maximize skin-to-skin contact, and you will start to feel the connection. It will also help if you start bonding with the baby while pregnant.  Thinking about how the baby is growing can be beneficial. Some people choose to photograph their pregnancy each week to keep track of how the baby is expanding in their belly.  Or, like in olden days, knitting sweaters/socks for the baby will also help to train your mind to welcome your bundle of joy and form the bond.


When should I worry about bonding?

Bonding with your newborn baby cannot be quantified, so even if one thinks that there is a weak bond or it hasn’t happened yet, maybe it has. You may just not be aware of it. As lo

If you have the feeling of being depressed or unhappy on most days, feel hatred or anger towards the newborn, or you are unable to care for the baby, then it is time to visit the as you are meeting all of the baby’s needs, please be reassured that you will soon start to feel the magic feeling.

However, most of the time, bonding is very natural, so please do not worry too much about the process. And remember, most importantly, you are not alone!

Please call upon your child’s pediatrician as a resource for your family from the day your child is born through age 18. At Preferred Medical Group, for example, we will be there with you as your baby turns into a toddler, a pre-teen, and a young adult. And, we provide continuity of care, so that you and your child can request to see the same doctor each and every time. If you have not found a pediatrician for your baby just yet, please visit our website to see if we might be a good fit for you and your baby:


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