Mosquito Borne Illnesses

For those who have seen recent news reports, the thought of mosquito borne diseases can be scary. Typically, in East Tennessee, we see a significant number of mosquito related illnesses in late summer, mainly in late July, August and September. These illnesses have a wide range of severity, from mild upper respiratory symptoms to severe central nervous system infections. The most common mosquito borne illness in our area is Enterovirus infection. Enterovirus infection typically will cause some fever, body aches, sore throat, and in worse cases where the central nervous system is involved, will cause headaches and upset stomach. Routine Enterovirus infections typically run their course in 3-5 days and do not require antibiotics, since they are viruses and not susceptible to antibiotics. Some of the worst of these cases will require brief hospitalizations for patients with severe headache who need pain control, or those who are vomiting and unable to remain hydrated. These illnesses are uniformly short lived and patients make a complete recovery.

The less common but more serious mosquito borne infections come from a family of viruses called the LaCrosse family. These viruses are transmitted by a mosquito bite, exactly the same way enteroviruses are, but they tend to infect the spinal fluid and brain more frequently than enteroviruses. LaCrosse infections are typically more severe than Enterovirus infections and commonly lead to high fever, vomiting, seizures and other symptoms of meningitis. Unfortunately, like all viruses, these infections do not respond to antibiotics, and patients are treated supportively until they recover. A significant number of patients with LaCrosse Encephalitis will be left with long term problems due to their illness.

Obviously, we want to avoid these illnesses as much as possible. Based on expert recommendations, I routinely recommend using an insect repellent with DEET to my patients. Reasonable parents are extremely unlikely to use enough “bug spray” to cause any toxicity to their children and the risk of getting an illness from a mosquito bite in later summer is very real. Always use insect repellents in a well ventilated area, and do not spray them on the face.

For Good Health, Enjoy the Great Outdoors

I recently traveled and hiked in Norway. During my trip I discovered that every kid goes outside every day of the school year, often in rain and snow, frequently exploring in the woods found nearby. This and many other studies have shown that the Norsemen are educationally pretty smart cookies.

It’s Never Too Early!

It may seem a little early to start talking about the flu, but there are recent publications providing important preliminary recommendations for the upcoming flu season.  Notable is the recommendation that live attenuated influenza virus (LAIV) vaccine (i.e. Flumist) NOT be used for the 2017-18 season so prepare your children for injectable flu vaccine only! This is doubtful to change when final guidelines from the CDC come out later this summer. According to the CDC there were 99 pediatric deaths due to influenza this past season. That’s 99 too many in my opinion! KPA is already preparing for the 2017-18 influenza season and will let you know soon when we’ll begin flu shots. Click here to link to an important article from the American Academy of Pediatrics (AAP).

The Best Places for Kids to Bike This Summer

I have a confession to make: I love riding bikes of all types. My husband and I enjoy road cycling, mountain biking and beach cruising. We have cycled in many places including Italy, Colorado and California, but some of the best biking is right here in our area. One of my goals is to get more kids interested in biking, and here are some great ways to get started.

Be a good example: always wear a helmet when cycling, even for short distances. If your child is interested in off road trails (aka mountain biking), elbow and knee pads are a good idea.

Be visible: if you’re going to ride near motorists, choose bright colors and use headlights and tail lights to make yourself standout to drivers.

Choose safe places to ride: Knoxville has an amazing network of greenways (112 miles!) that are a safe haven from motorists. Find the one closest to you here.

In Oak Ridge, the Melton Lake Greenway is a great choice… it has 5.7 miles of paved lakefront greenway trails.  Click here for information.

During the summer months, the Cades Cove Loop road in the Great Smoky Mountains National Park is closed to automobile traffic on Wednesday and Saturday mornings until 10:00.  While not exactly flat, its very doable for kids of all ages, and they’ll likely spot turkey and deer along the way.

If your child is more adventurous, Knoxville also has the Urban Wilderness, a 50 mile network of multi-use trails in wooded areas.  A great starter trail for kids is the Sycamore Loop (1.2 miles) at Baker Creek Preserve that is mostly flat. At Forks of the River, Wyatt’s Way leads to Dozer and the Will Skelton Greenway, which during the month of July features large fields of sunflowers.

Find maps here: Forks of the RiverBaker Creek

For older kids looking for more mountain biking, the TVA managed Loyston Point Recreation Area has  12.7 miles of multi-use trails that are suitable for kids.

For more information on biking in and around Knoxville check out and


7 Happiness Tips for New Parents

I will be expecting my first child in a few short weeks.  I am of course beyond excited to meet my baby!  But, as the due date is approaching, I have fears that have been popping up, too.  Will I be a good parent?   Will I be able to breastfeed?  Did I get the right car seat?  Do I have enough clothes?  Do I need a wipe warmer?  And, the list goes on and on…  Yes, I am a pediatrician, so I do know a thing or two about caring for babies, but there are a lot of things you do not learn in medical school.  I did not get any training on how to be a parent (does anyone?).  So, I can fully empathize with expecting parents!

Throughout the course of my pregnancy I have gotten a lot of advice.  I appreciate experienced families sharing with me tidbits about being a parent.  I find those that have already gone through being “new parents” are a great resource.  I will also say that it can be difficult at times to sift through all the advice in books, blogs, and even from friends and family.  I came across this short little piece that shares a few tips to being a happy parent, written by a pediatrician.  Most seem like common sense.  I am sure that at some point when I am sleep deprived and doing a 3 AM feeding, I will want to remind myself of these tips.   I feel some of the advice may also still hold true for seasoned parents.  I hope you find them helpful!  We all want to be good parents.

  1. Trust Yourself.

Some new parents get emotional whiplash flipping between feeling like you’ve got the job nailed…and feeling like a rookie.  But, you know what?  You are the newest, shiniest link in an unbroken chain of successful parents that stretches back to the beginning of time!   Things may actually get much stickier later on (fears, unfair friends, teen traumas, etc.).   But, for now, you will be a total success if you just keep to the basics:  love, touch, singing, milk and patience.

  1. Be Kind…to Yourself.

If you’re like many new parents, you’ve barely ever maybe even touched a newborn – before you had your own – yet you think you should automatically be a baby care pro.  Please, ask that “judge” in your head to take a hike.  Be as supportive to yourself as you would be to your best friend or significant other.  That’s a sure path to great satisfaction and happiness.

  1. Accept All the Help you Can Get.

Never before in history have moms and dads been expected to care for their newborns…all alone.  When parents are working, you may even be more pressed.  So don’t hesitate to ask or pay for help if you are able.  Lean on family and friends for support and most people genuinely want to help.  Who doesn’t love babies?  You’ll get more sleep and enjoy your beautiful growing family more fully

  1. Be Flexible.

You will naturally find that some parenting philosophies will make more sense than others.  It is great to have ideas and plans, but our children are here to challenge all of our preconceived expectations.  Stay flexible, especially when things aren’t going as planned (as that will happen!).  You may be surprised how “just rolling with it” can keep your mood going.

  1. Keep Your Sense of Humor Handy.

Remember, perfection is only found in the dictionary.  So, forget dignity, forget organization, be gentle with yourself, and laugh, laugh, laugh!  Laughter raises your spirits and lowers your stress!

  1. Take Care of Each Other. And Do Some Fun Stuff!

Caring for your baby is only half your job; the other is giving your significant other some TLC.

New AAP Policy on Fruit Juice

The American Academy of Pediatrics will soon publish new guidelines on fruit juice intake for infants and children in the June issue of Pediatrics. The AAP released a policy statement originally in 2001 (and revised in 2006) that recommended no juice for infants less than 6 months of age, 4-6 ounces daily for children ages 1-6 and 8-12 ounces for children 7  years and older. However, with the rise in childhood obesity and dental caries, these amounts will be decreased considerably.

The new recommendations are:

– Infants under age 1 should not have any juice in their diet unless needed in the management of constipation.
– Toddlers between age 1-3 should be limited to 4 ounces of juice daily.
– Children ages 4-6 should be limited to 4-6 ounces of juice daily.
– Children ages 7-18 should be limited to 8 ounces of juice daily.

The new policy also stresses the importance of whole fresh fruit in children’s diets since whole fruits add much-needed fiber to combat constipation. Toddlers should also not be given juice in bottles or cups that can be carried around all day as this promotes dental caries. Fruit juice should not be given at bedtime or used to calm an upset child. Although some fruits juices may contain vitamin C, calcium and Vitamin D, there is minimal nutritional value to fruit juice in a child’s diet. Juice lacks fiber and protein that are critical for the optimal growth in children. Water and low-fat or non-fat cow’s milk are more than sufficient as
fluid sources for children after weaning from breastmilk or formula.

More information

Tick Tock, Ticks!

It’s tick time. Summertime is the time of the year to enjoy the outdoors. It’s also the time when the habitats of children and ticks overlap. Whether you enjoy hiking or camping in the Great Smoky Mountains like my kids and I do or playing in the backyard with your kids and pets, you may be exposed to ticks. Ticks can transmit disease and depending where you live or visit in the USA, different diseases can be spread by tick bites.

Here in the Appalachian Mountains, the most common is Rocky Mountain Spotted Fever transmitted by the dog tick, which is about 1/2 inch in size. Over towards Nashville and the Cumberland Plateau, Ehrlichiosis is more commonly spread by a variety of ticks. In the Northeast and Upper Midwest, Lyme disease is the most commonly transmitted tick borne disease. It’s spread by the small tick called Ixodes scapularis which is about the size of a pinhead. All over the Southeast, there is a newer illness called STARI which is the Southern Tick Associated Rash Illness spread by the Lone Star tick – also about ½ inch in size.

                                                                              Once a tick is attached and feeds on you for at least 72 hours, the little buggers can transmit these diseases. Most symptoms that you will encounter are fever, headache, nausea, muscle or joint pain and rash.  Think of it as summertime flu symptoms. Most symptoms start anywhere from 2 to 14 days after the bite.

How can you help prevent tick bites? Be aware of the areas where ticks live. Most ticks prefer dense woods with thick growth of shrubs and small trees as well as along the edges of woods where the woods abut lawns. Ticks require humidity to survive, and drier areas usually are less infested. When outdoors your child should wear long-sleeved shirts tucked into his or her pants. The pants should be tucked into socks or boots. Use an insect repellent containing permethrin on clothing to repel ticks and other insects but don’t apply this to skin. DEET containing products from 5-30% helps prevent both ticks and mosquito but don’t use it on babies under 2 months of age. During a hike or camping, do tick checks using a buddy system every 4 hours. After a full day do a bare skin check and shower to remove any ticks that are not firmly attached.

Tick bites are painless and don’t itch.  Favorite hiding places for ticks are in the hair, so check the scalp, neck, armpit and groin. To remove a tick, get a tweezer and apply pressure right behind the head and lift straight up after it releases. If any part of the tick is still there, scrape it off and then wash with soap and water. Also check your pets, especially dogs for ticks daily. You can save the tick for inspection later by keeping it in a glass jar.  More on tick removal from the AAP.

Remember, if you develop any of these symptoms such as fever, rash or headache after a tick bite, please call your pediatrician’s office. How to treat tick bites.


The Science of Rudeness

Pediatricians, like most folks, are human. We can have our feelings hurt just like anyone else. At KPA, our staff, including doctors, nurses and ancillary team members, are reminded at every opportunity to be kind and courteous to our patients and their parents. We also realize that parents are frequently frightened and anxious about their child’s illness. The following link is to a paper written by Perri Klass, MD,  that lends credence to the notion that you win with honey, not vinegar. So we urge you discuss any disagreements, communication problems, staff rudeness, etc. in a gentle spirit. We, like you, respond much better to niceness than to vitriol. And, if you accept the science, your child’s care will be better as well. The science of rudeness…

Camp, Nature’s Way of Feeding Mosquitos

It’s that time of year when parents start to make plans for the summer.  Summer is such an important time for families to be together, to take special trips, and for children to recharge from the busy school year. Summer is also a great time to try out new activities at a summer camp. Summer camps offer a valuable opportunity for learning that can’t be done in a classroom setting and can benefit your child for the rest of the year.

I spent summers as a child going to Girl Scout camp and have many happy memories of learning to swim in a lake, canoeing, backpacking and singing around the campfire.  I wanted my children to have that experience as well and they both attended day and overnight camps. Honestly, I can say they didn’t love every camp experience! My daughter didn’t like any one day camp because “the counselors were mean” and when I pressed her for details she said “They never smiled!” My son attended scout camp where he had an awful time, hated the food, the cabins and experienced bullying. Needless to say they didn’t return to those camps! However, we did find a wonderful traditional camp in the mountains of North Carolina that they both loved and looked forward to all year long. They returned every summer and when they got home we used the expression “camp sick” to describe how much they missed it! This summer will be my teenage son’s last to attend as a camper and when I asked him what camp has meant to him, he had difficulty putting it into words.  There is a “camp magic” of treasured traditions, activities and an experience that seems to exist in a separate space and time. I think I can say for him that those are the things that he looks forward to and what makes camp so special.  Most of the year he is connected to his cell phone and computer.  At camp, it is a time of digital detox-no cellphone, computer or TV.  It is a time to interact face to face and live in community.  He has made friends that live in other cities and countries and he looks forward to seeing them each summer. He also looks forward to seeing the counselors each year and looks up to them as role models.

Camp gives children a chance to connect with nature and try new activities that they wouldn’t otherwise get to experience, and build self-confidence.  It is a safe place to take risks, face challenges and build their self-esteem in a safe, supervised and supportive environment.  It is a place to have the freedom to be yourself and have a sense of belonging in a community.  It is a chance to develop resilience and independence.  Camp gives children a chance to develop the skills that will enable them to live on their own as adults. It is a place to develop their “emotional intelligence,” an ability to manage emotions and work together with others cooperatively.  Camp is good for parents too!  In this day and age of “helicopter parents” it’s hard for some parents to allow their children to be away for an extended time.  A good part of parenting is finding the balance between protecting your child, keeping them safe and providing opportunities for growth.  Successful parenting is a process of preparing your child for adulthood and a good camp can teach those skills. Parents might find that letting go just a little bit helps to strengthen their relationship. If your child is comfortable spending the night away from you with friends and family, they might be ready for overnight camp as young as seven years of age.  Many overnight camps have shorter sessions for the youngest campers. My children attended a camp where siblings could attend at the same time but the girls and boys camps were separate.  My son who wasn’t as outgoing as his sister and felt ready for camp after visiting several years in a row when we dropped off his sister and he saw how much she enjoyed it. He felt better being away overnight since she was there at the same time.  Now nine years later he is happy to go for a month long session.

There are about 5,000 summer camps in the U.S.  How do you choose the right one?  There are traditional camps, specialty camps- like sports, special needs, religious, day and overnight camps.  Here are a few ideas specifically when considering an overnight camp.

1. Involve your child in the decision making process, consider their interests, look at websites, watch camp videos, and visit open houses if available.

2. Look at the camp’s history, how long has it been in operation? Do former campers send their children there? How experienced are the camp directors? Try to speak directly with the directors to learn about the camp. Ask for references.

3. What is the camp’s philosophy? Is it structured? Is the camp to have fun or foster growth? Does it share your family values?

4. Look at the camp counselors, how many are former campers? How many return each year? What does the director look for in their hiring? How extensive are they interviewed, are background checks done? How are they trained in safety? What is the average age of counselors? What is the ratio of campers to counselors?

5. What is a typical day’s schedule? Does the camper have choice in their schedule? How long are the sessions? What is a typical menu? What are the sleeping arrangements, bathrooms/showers?

6. What is the cost? Are there scholarships available?

7. Is the camp accredited by the American Camping Association? ACA membership verifies that the camp complies with up to 300 individual standards

For more information contact the American Camping Association

The doctors of KPA hope you all have a wonderful summer!  Don’t forget to schedule that camp physical!

(My son and daughter and camp)