Crestview Hills, Kentucky
859-341-5400
513-820-2312 (after hours)
859-578-3172 Fax



Pediatric Practice News


We now have in stock the Meningitis B vaccine.  This is different from the 4 strain meningitis vaccine we give at age 11 and again at age 16. It is currently not required in Kentucky. There have been Meningitis B outbreaks at a few colleges in the U.S.  
We are now scheduling flu shot clinics for October and November.  There will not be any FluMist (nasal flu) this year. Please call to set up your appointment.
Dr. Bolling is being honored for his contributions to improving connectivity between the medical community and the community at large.  He co-wrote the Community Engagement section for the University of Cincinnati and Children’s Hospital Clinical and Translational Science Award and reviewed grants from the community who apply for funding through this grant, worked with Avondale on health disparities around nutrition, gave trainings for various social service agencies in motivational interviewing and Community-based Participatory Research, and served on several initiatives on homeless LGBT youth. He has also done work with African-American, Latino and Appalachian communities on health issues mostly in Avondale, Price Hill and Covington. Oh yeah, and he sees patients at our practice, too! We are lucky to have him.
The attached video details why we recommend the HPV vaccine for all boys and girls age 11 to 26 years. We are giving HPV vaccine booster doses as nurse visits during the week. Please call us to schedule an appointment.

Safety Rules and Tips for Biking.
We are pleased to announce that Whitney Rich is now offering her services to our patients. She will be located at the Mt Zion office.  She has an excellent background and is familiar with a wide variety of nutrtion issues affecting children.  Please see this flyer for more information:  Whitney Rich Flyer.pdf
Starting July 1 we will be able to give vaccines to all our Medicaid patients at all office locations due to administrative changes in the VFC (vaccine for children) program.  Unfortunately, uninsured patients as of July 1 will have to get their vaccines at the health department.
Great news for our teenagers under 15 years old! The Human Papilloma Virus vaccine is showing very good immune responses in our young teens.  
Little league shoulder is an overuse injury seen in skeletally immature boys and girls.  It is also known as osteochondrosis, apophysitis or stress fracture of the upper arm.  The bones of children who are still growing have growth plates.  These growth plates are typically weaker than tendons and ligaments and are the first tissue that gets injured.   The long bone of the upper arm is called the Humerus and its growth plate is just below the shoulder.
This condition is seen mostly in boys, and rarely girls.  97% of patients were baseball players and 86% of those were pitchers and 8% were catchers.  Affected patients typically have diffuse shoulder pain.  Some other symptoms include catching and locking and fatigue and weakness.  Symptoms initially start with sporting activity only, then progress to pain with daily activities.
X-rays are the first diagnostic study ordered and widening of the growth plate is the positive finding.  Typically, no other imaging is needed unless there concern for another injury.
Relative rest and physical therapy for strengthening and improving throwing mechanics are the first treatments.  The vast majority kids with “outgrow” this condition and the growth plate will close.  Some children continue to have shoulder pain with throwing into their adolescent years.
The average time to return to sport is 3 months.  Some children may return sooner and play a position other than pitcher or catcher.  Hitting usually does not cause pain, so young athletes may be able to continue to practice hitting. 
In conclusion, Little League Shoulder is a condition that affects predominately boys, and baseball players more than any other sport.  The young athletes almost always “outgrow” the growth plate irritation and the average time to return to sport is 3 months.  Little League Shoulder is treated with rest from throwing and physical therapy.

From Our Friends at Nova Care
We are always surprised that many parents forget that the office is open every Saturday.  Before you head off to a local ER, urgent care or retail clinic for that untimely weekend malady, give our office a call.  
Stress fractures are bone-related overuse injuries; most commonly seen in running & high-impact athletes.  Putting repetitive strain on bones can break them down slowly, leading to small cracks or “micro-fractures” in the bone.  Stress fractures are primarily seen in the tibia or fibula bones (shins), however can also be seen in the femoral neck of the hip bone or the metatarsals (midfoot region).   They can result from repetitive use of the same body part or appear when the athlete performs in a high-training sport.  These sports are most commonly basketball, tennis, track & field, soccer, gymnastics, and dancing.  Other risks include:  a history of stress fractures, wearing worn-out shoes, a low-level of physical fitness or exercise, poor bone health or nutrition deficits (low vitamin C or D levels or a child/adolescent with an eating disorder), and/or having flat feet.  Girls are also more at risk for developing stress fractures than boys. 
 
Symptoms will include pain and inflammation to the area of the fracture, along with tenderness to touch.  Occasionally, there will be redness.  Stress fractures in the tibia bone can also mimic the same symptoms as shin splints, so being evaluated by a physician for a proper diagnosis is vital. 

If your doctor thinks you have a stress fracture, he or she will ask questions about your child’s activity level and other things that might put your child at risk for stress fractures.  
Your doctor may order imaging tests, like an X-RAY, MRI, and/or Bone Scan to confirm the diagnosis. 
There are things you and your child can do to prevent stress fractures.  Here are some helpful tips:
1.       Maintaining a proper diet, with foods enriched with Vitamin C & D to keep bones strong and healthy.
2.       When starting a new activity, increasing the intensity and duration gradually.  It helps to build your level of exercise over time.
3.       Taking appropriate and adequate rest between exercise sessions.
4.       Proper shoe wear.  Make sure your shoes are right for the specific activity, and the shoes have plenty of cushion and support. 

Here are some things you can do at home to treat stress fractures:
1.       Rest as much as possible.  Resting is the key.  Do not try to “play” or run through the pain.
2.       Apply ice for the inflammation.
3.       Call your doctor, for diagnosis and medication use. 
4.       Consult a physical therapist.  


Physical therapy is in essential for rehabilitating your child’s injury effectively.  With physical therapy, a treatment program is implemented for pain & swelling management, injury prevention, and an exercise regimen for returning to activities safely.  The exercise regimen will include flexibility stretches and muscular strengthening to the areas surrounding the injury.  If your child or teen has been diagnosed with a stress fracture, we at NovaCare Rehabilitation can approach physical therapy treatment with support & ensure they will get back into sports better than before!
Whitney Hartman, PTA
Resources
Gupta, MD, R.C. (Ed.). (2014,). Stress Fractures. Teens Health.  Retrieved 2017, from http://kidshealth.org/en/teens/stress-fractures.html
 
Hughes BS, MPT, L. Y. (1985). Biomechanical Analysis of the Foot and Ankle for Predisposition to Developing Stress Fractures. Journal of Orthopedics & Sports Physical Therapy, 7(3), 906-101.
 
Schneiders, PT, PhD, A. G., Sullivan, PhD, S., & Hendrick, PT, PhD, P. A. (2012). The Ability of Clinical Tests to Diagnose Stress Fractures: A Systematic Review and Meta-analysis. Journal of Orthopedic & Sports Physical Therapy, 42(9), 760-771.
 
Thelen, M. D. (2010). Identification of High-Risk Anterior Tibial Stress Fracture.  Journal of Orthopedic & Sports Physical Therapy, 40(12), 833

From Our Friends at Nova Care




Due to state and pharmacy regulations we may ask for photo ID when picking up prescriptions. Please plan ahead accordingly. Thanks for your cooperation!
Forgot to come in for your annual check-up last summer? Does your child play a spring or summer sport? At our annual well visits we can fill out your paperwork, screen vision, check hearing, check cholesterol, and give routine immunizations. Click on the flyer to see the difference between a check up and a "sports physical".  Well Checks vs Sports Physicals
This summer, Dr. Kevin Reidy will be leaving Pediatric Associates to take a full-time position at Cincinnati Children's Hospital. Since 2008, he has been part of a team of community pediatricians that have helped manage the patients on the psychiatry units at the College Hill campus. Starting In April, Dr. Reidy will be the Medical Director of pediatric services at College Hill. Until the end of August, he will be working a reduced schedule in our Cold Spring and Crestview Hills offices as he starts his new role.
While we're all sad to see Dr. Reidy go, we're excited about his new opportunity and wish him the best!
We encourage annual well visits for all our patients.  Starting at age 16 we are now giving a second Meningococcal ACYW135 booster.  We also recommend checking cholesterol and updating Tdap (tetanus, diphteria, and pertussis). The Meningococcal B vaccine is also a new option.
We have partnered with Beech Acres parenting organization and Cincinnati Children's Hospital Mayerson Center to help provide our families with more parenting and support resources.  This handout explains the impact of adverse childhood experiences. ACES-Handout-1.pdf
For many years we have told our grade school patients "no shots until 6th grade". However, at this time the NKY Health Department is recommending that we give the Tdap vaccine (tetanus, diptheria, acellular pertussis) at age 10 regardless of grade to help combat the outbreak of Pertussis ("whooping cough") in the area.
A big welcome from the Pediatric Associates family to our newest pediatrician, Stephen Warrick, MD!  Dr. Warrick will be joining us this fall and we couldn’t be more excited about him joining us.  Steve is a native of Whitesburg, KY , a graduate of the University of Kentucky, the University of Louisville School of Medicine and the pediatric residency at Cincinnati Children’s Hospital Medical Center.  After Steve’s chief residency year at Children’s, he worked in the continuity clinic at Children’s and continued to pursue his interests in global health and resident education.  The only drawback that Dr. Hsu could find with him was his rabid devotion to UK basketball. Despite this shortcoming, we are confident you and your kids will love Dr. Steve!
FUN IN THE SUN 

Babies under 6 months:

  • To prevent sunburn the AAP recommends that infants avoid sun exposure, and  are dressed in lightweight long pants, long-sleeved shirts, and brimmed hats that shade the neck to prevent sunburn. However, when adequate clothing and shade are not available, parents can apply a minimal amount of sunscreen with at least 15 SPF (sun protection factor) to small areas, such as the infant's face and the back of the hands. If an infant gets a sunburn, apply cool compresses to the affected area.
For All Other Children:

  • The first, and best, line of defense against harmful ultraviolet radiation (UVR) exposure is avoiding sun exposure by covering up. Stay in the shade whenever possible, and limit sun exposure during the peak intensity hours - between 10 a.m. and 4 p.m.
  • Wear a hat with a three-inch brim or a bill facing forward, sunglasses (look for sunglasses that provide 97% -100% protection against both UVA and UVB rays), and clothing with a tight weave.
  • On both sunny and cloudy days use a sunscreen with an SPF 15 or greater that protects against UVA and UVB rays.
  • Be sure to apply enough sunscreen -- about one ounce per application for a young adult.
  • Reapply sunscreen every two hours, and after swimming or sweating.
  • Use extra caution near water and sand (and even snow!) as they reflect UV rays and may result in sunburn more quickly.
 
HEAT STRESS IN EXERCISING CHILDREN

  • The intensity of activities that last 15 minutes or more should be reduced whenever high heat or humidity reach critical levels.
  • At the beginning of a strenuous exercise program or after traveling to a warmer climate, the intensity and duration of outdoor activities should start low and then gradually increase over 7 to 14 days to acclimate to the heat, particularly if it is very humid.
  • Before outdoor physical activities, children should drink freely and should not feel thirsty. During activities less than one hour, water alone is fine. Kids should always have water or a sports drink available and take a break to drink every 20 minutes while active in the heat.
  • Clothing should be light-colored and lightweight and limited to one layer of absorbent material to facilitate evaporation of sweat. Sweat-saturated shirts should be replaced by dry clothing.
  • Practices and games played in the heat should be shortened and there should be more frequent water/hydration breaks. Children should promptly move to cooler environments if they feel dizzy, lightheaded or nauseated.
 
HEAT STRESS

Infants and small children are not able to regulate their body temperature in the same way that adults do. Every year, children die from heat stroke from being left in a hot car, often unintentionally, with the majority of these deaths occurring in children 3 and under. Here are a few tips for parents when traveling in a car with infants or young children:

  • Always check the back seat to make sure all children are out of the car when you arrive at your destination.
  • Avoid distractions while driving, especially cell phone use.
  • Be especially aware of kids in the car when there is a change from the routine, ie. someone else is driving them in the morning, or you take a different route to work or child care.
  • Have your childcare provider call if your child has not arrived within 10 minutes of the expected arrival time.
  • Place your cell phone, bag or purse in the back seat, so you are reminded to check the back seat when you arrive at your destination.
  • The inside of a car can reach dangerous temperatures quickly, even when the outside temperature is not hot. Never leave a child alone in a car, even if you expect to come back soon. Lock your car when it is parked so children cannot get in without supervision.
 
WATER SAFETY

  • Never leave children alone in or near water, even for a moment; close supervision by a responsible adult is the best way to prevent drowning in children.
  • Less experienced swimmers and children under age 5 in or around water should have an adult – preferably one who knows how to swim and perform CPR – within arm's length, providing "touch supervision."
  • Never swim alone. Even good swimmers need buddies!
  • Designate a “water watcher” when you are in, on or around water.
  • Because drowning can be quick and quiet, the water watcher should pay constant attention, be undistracted, not involved in any other activity such as reading, playing cards, on the phone, while supervising children, even if lifeguards are present. 

POOL SAFETY

  • Install a fence at least 4 feet high around all four sides of the pool. The fence should not have openings or protrusions that a young child could use to get over, under, or through.
  • Make sure pool gates open out from the pool, and self-close and self-latch at a height children can't reach. Consider alarms on the gate to alert you when someone opens the gate. Consider surface wave or underwater alarms as an added layer of protection.
  • The safest fence is one that surrounds all 4 sides of the pool and completely separates the pool from the house and yard. If the house serves as the fourth side of the fence, install an alarm on the exit door to the yard and the pool. For additional protection, install window guards on windows facing the pool. Drowning victims have also used pet doors to gain access to pools. Keep all of your barriers and alarms in good repair with fresh batteries.
  • Keep rescue equipment (a shepherd's hook ­– a long pole with a hook on the end — and life preserver) and a portable telephone near the pool. Choose a shepherd's hook and other rescue equipment made of fiberglass or other materials that do not conduct electricity.
  • Avoid inflatable swimming aids such as "floaties." They are not a substitute for approved life jackets and can give children and parents a false sense of security.
  • Children over age 1 may be at a lower risk of drowning if they have had some formal swimming instruction. However, there is no evidence that swimming lessons or water survival skills courses can prevent drowning in babies younger than 1 year of age.
  • The decision to enroll a child over age one in swimming lessons should be made by the parent based on the child's developmental readiness and exposure to water, but swim programs should never be seen as "drown proofing" a child of any age.
  • Avoid entrapment: Suction from pool and spa drains can trap a swimmer underwater. Do not use a pool or spa if there are broken or missing drain covers.  Ask your pool operator if your pool or spa's drains are compliant with the Pool and Spa Safety Act. If you have a swimming pool or spa, ask your pool service representative to update your drains and other suction fittings with anti-entrapment drain covers and other devices or systems. See PoolSafely.gov for more information on the Virginia Graeme Baker Pool and Spa Safety Act.
  • Large, inflatable, above-ground pools have become increasingly popular for backyard use. Children may fall in if they lean against the soft side of an inflatable pool. Although such pools are often exempt from local pool fencing requirements, it is essential that they be surrounded by an appropriate fence just as a permanent pool would be so that children cannot gain unsupervised access.
  • If a child is missing, look for him or her in the pool or spa first.
  • Share safety instructions with family, friends and neighbors. 

BOATING SAFETY

  • Children should wear life jackets at all times when on boats, docks or near bodies of water. Adults should wear life jackets for their own protection, and to set a good example.
  • Make sure the life jacket is the right size for your child. The jacket should not be loose and should always be worn as instructed with all straps belted.
  • Blow-up water wings, toys, rafts and air mattresses should not be used as life jackets or personal flotation devices.
  • Adolescents and adults should be warned of the dangers of boating even as a passenger when under the influence of alcohol, drugs, and even some prescription medications.
 
OPEN WATER SWIMMING

  • A lifeguard (or another adult who knows about water rescue) needs to be watching children whenever they are in or near the water. Younger children should be closely supervised while in or near the water – use "touch supervision," keeping no more than an arm's length away. 
  • Make sure your child knows never to dive into water except when permitted by an adult who knows the depth of the water and who has checked for underwater objects.
  • Never let your child swim in canals or any fast moving water.
  • Ocean swimming should only be allowed when a lifeguard is on duty.
  • Teach children about rip currents. If you are caught in a rip current, swim parallel to shore until you escape the current, and then swim back to shore.
 
For more tips on sun and water safety, visit www.healthychildren.org
 

Copyright © 2017 American Academy of Pediatrics. Please feel free to use tips in any print or broadcast story with appropriate attribution of source.
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Pediatric Associates PSC - Crestview Hills | 2865 Chancellor Drive | Suites 225 (Upstairs) and 120 (Down Under) | Crestview Hills, KY 41017 | Phone: 859-341-5400 | Fax: 859-578-3172
Pediatric Associates PSC - Mt. Zion Road | 9920 Berberich Drive | Florence, KY 41042 | Phone: 859-341-5400 | Fax: 859-578-3172
Pediatric Associates PSC - Cold Spring | 175 French Street | Cold Spring, KY 41076 | Phone: 859-341-5400 | Fax: 859-578-3172
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