Tick Season/How To Remove A Tick

Summer is tick season. It is important to check your children daily for ticks during this time of year if they play outside in yards and wooded areas. This helpful link discusses the proper method of removal. If you have difficulty removing a tick or have questions, please contact us. Have a wonderful summer! https://www.healthychildren.org/English/health-issues/conditions/from-insects-animals/Pages/How-To-Remove-A-Tick.aspx

Childhood Obesity, BMI, and a Healthy Tidbit

Adult and childhood obesity has been a major health concern for decades and continues to be so in 2016. Overall obesity rates in children have remained stable for the past several years, but are still very high. Approximately 17% of children ages 2-19 years are obese. This represents 12.7 million children nationwide and many millions more are overweight but not obese. Obesity is defined as having a BMI (Body Mass Index) of greater than 95th percentile. Overweight is defined as having a BMI of greater than 85th percentile but less than 95th percentile.

Body Mass Index is calculated by dividing one’s weight in kg by one’s height in meters squared. The formula for calculating BMI is: BMI = weight (in kg)/height2 (in meters). The actual BMI number is not a particularly useful concept in children because they are constantly growing and at certain times in their growth cycle, the height velocity and weight velocity are at different rates. A BMI of 24 in an adult might be a good BMI, but in an 8 year-old child would represent obesity. A more appropriate concept for children is BMI percentile, which compares the BMI in a child of a given age and gender with the BMI of the rest of the population of children of the same age and gender. Thus, a BMI of greater than 95th percentile represents a child whose BMI is greater than 95 percent of children of the same age and sex, and indicates obesity.

The causes of obesity are very complex and multifactorial, and include race, ethnicity, genetics, behavior, education, socioeconomic status, and outside influences such as food availability and advertising by the food industry.

Two of the most important known behavioral risk factors for childhood obesity are: 1) The consumption of high calorie, sugar sweetened drinks such as fruit juices, soda pop, and sports drinks, and 2) the decline in physical activity and outdoor play brought about by an increase in “screen time” which includes television, computers, phones, tablets, and video games. Elimination of sugar sweetened drinks from children’s diets, and limiting screen time to no more than two hours per day (and thus encouraging physical activity) have been shown to help prevent obesity in children as well as provide benefit in treating children who are already overweight or obese.

A very useful and informative website regarding obesity in both children and adults can be found by searching CDC Division of Nutrition, Physical activity, and Obesity, or go to www.cdc.gov/nccdphp/dnpao/index.html

Amber Teething Necklaces Are a Choking Hazard!

Amber necklaces are an extreme strangulation risk for young children. They have become almost common place among children in our practice. I am constantly reminding parents to take them off for fear of their young child choking on one of the beads or strangulating on the necklace itself. There is no proven benefit for the amber working against teething. I have 3 children and I use Tylenol or Motrin for pain relief from teething. Cold teething rings are also beneficial. The remainder of marketed items are, in my opinion, dangerous or ineffective. I found the following informative article in the New York Times. Please read for more information on amber teething necklaces.

Please click here.

Spring Is Here and Allergy Season Came Along for the Ride

Allergy Season: Be Prepared

Spring is here and in East Tennessee that means all of our beautiful trees and flowers are blooming and the pollen counts are starting to climb. As allergy season approaches, it helps to be prepared and to learn about some of the options that your Pediatrician may use to help control symptoms in children. For more information just follow this link to a helpful article.


Drool, Yes. Fever, No

It’s 10 PM, your 8 month old is fussy and not sleeping well, and hasn’t been for the past 3 nights. You recall that she has been drooling more and putting everything into her mouth. As you are comforting her, you look in her mouth and see a glint of white in her bottom gum line. Is that a tooth? Is this what teething looks like?

The average age for a child to get her first tooth is between 6 and 9 months old, though it can occur earlier (3 months old) or later (12 to 15 months old). Teething symptoms are highly variable from one infant or toddler to the next and may include gum irritation, fussiness, and drooling. But fever is not one of them. So if your child has teething symptoms, but has a fever (temperature of 100.4 F/38 C or higher), the fever is not from teething. Why is that important? Because the fever could be a sign of an underlying illness or infection.

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Accidental Poisoning

Accidental poisoning is a common concern in the pediatric population. Unfortunately, accidental poisoning is caused by ingesting many household items. Children swallow harmful substances even though they have a bad taste or smell. Poisoning occurs almost exclusively in kids under the age of six and most often by boys under the age of three. Accidental poisoning usually occurs when something commonly found in the home is out in plain sight, is ready to be used and is unattended. The number one ingested item is medication. Surprisingly, cleaning products are second to medication. Other common items include cosmetics, poisonous plants, batteries, gardening materials, alcohol, cigarettes, (if eaten) Illicit drugs, essential oils, pesticides, and glue.

There can be a wide range of symptoms associated with an ingestion from accidental poisoning. Common symptoms include tummy-ache, nausea or vomiting, unexpected sleepiness, and depending on the substance, complaints of mouth pain due to burns from a causative agent. Other symptoms can include seizures, respiratory or cardiac arrest as well as coma or death. Sometimes a child might just “act funny” after ingesting a poison.

If one suspects accidental ingestion or poisoning, immediately call poison control at 1-800-222-1222 whether or not the child is showing symptoms. It is very important to not induce vomiting as this can sometimes cause more harm. If directed to an emergency facility for further evaluation, make sure to take the ingested substance to that facility. In any life-threatening emergency call 911.
Treatments for accidental poisoning can vary widely depending on the substance involved. Specifically, the hospital might give the child something within an hour of the ingestion that helps absorb whatever was ingested. There are some antidotes available. Oftentimes the best treatment is supportive which can include observation and hospital admission.
Prevention is the key to avoiding accidental poisoning. Always remember to keep medicines and harmful substances put away and out of reach. Childproof containers and child resistant locks on drawers or cabinets are also helpful and should always be used. Last, it is important to store medicines or chemicals in their original containers so that there is no confusion as to what the substance actually is.

Hypothermia and Frostbite

As I was walking through the neighborhood tonight, I realized that winter has finally come to east Tennessee. No longer do we have the wet and balmy weather as we did over the holidays. The clear, starry sky appears beautiful until I realize my cheeks sting. And though we live south of the Mason-Dixon line, we can still be struck by such winter hazards as hypothermia and frostbite. Whether playing in the backyard, hiking the local trails, or fishing in the nearby streams and lakes, the cold weather can cause our body temperature to drop from 98.6 degrees to 95 degrees or less. This temperature change can cause shivering, clumsiness, and poor hand coordination. In addition, cognitive functioning slips with confusion, memory loss, slurred speech, and exhaustion. This state of lower body temperature with some or all of these symptoms is called hypothermia.Frostbite is a localized injury to the body where the tissue starts to freeze. The signs start with redness and pain to skin which then can become numb, white and firm. See the following articles, “Winter Weather Frequently Asked Question” and “Cold Weather Injuries” for further information on hypothermia and frostbite including prevention and management:


Two other factors besides temperature increase the risk for hypothermia and frostbite: wind and water. Wind can make the ambient temperature drop significantly – causing exposed skin to develop frostbite and core body temperature to drop to 95 degrees (hypothermia). For example, a 40 degree day with 30 mph winds generates a windchill temperature of 28 degrees; a 15 degree day with 20 mph winds generates a windchill temperature of -2 degrees. Wind can make a day much colder than the thermometer indicates. Be sure to take wind into account when planning outdoor excursions. Have clothing to block the wind, and avoid exposed skin on very cold and windy days. See the following National Weather Service Windchill Chart:


Water can also hasten temperature loss and increase the risk for hypothermia. Whether drenched by rain, by snow, or by accidental immersion in a stream or pond, our wet bodies will drop their temperature much more quickly than when they remain dry. Cold and water are not a good mixture. When outdoors during cold and wet weather, avoid cotton (as it absorbs moisture and loses its insulatory properties). Rather, dress in layers with a wicking base layer, an insulating middle layer of fleece or synthetic material, and a windproof, waterproof outer layer. Furthermore, even during a warm day, an unfortunate plunge or fall in very cold water like the Little River or Chilhowee Lake can lead to hypothermia. Review the following article, “”Hypothermia Prevention: Survival in Cold Water” for further information on hypothermia and water exposure:


Winter is a wonderful time of year to explore the outdoors at home and afield, but remember to practice these safety tips.

Family Resolutions for a Healthier 2016

It’s a new year!  Why not get the entire family involved in living a healthier lifestyle?  This can be done using the 0-5 easy steps listed below: 

0:  Eliminate sugary beverages to zero (none) in your family’s diet.

1:  Incorporate one hour of physical activity per day into everyone’s daily routine.

2:  Limit screen time for you and your children to less than two hours per day.  This includes televisions,     computers, and cell phones.

3.  Eat three servings of low-fat milk products daily.  Skim milk, yogurt, and cheese are examples.

4.  Drink four servings of water every day.  A serving size is 4-6 ounces for young children and 10-12 ounces     for older children and adults.

5.  Eat five servings of fruits and / or vegetables each day.

To make these lifestyle changes easier to become habits for your family, try to introduce 1 or 2 each month.   Becoming physically active as a family can be a simple as playing ball, hiking local trails, riding bikes, roller skating, dancing, or walking the dog.  It may be more practical to “get moving” in short 15-20 minute segments.  Keep food portions the size of the individual’s fist.  Only fruits or vegetables should be offered for second helpings. 

http://www.choosemyplate.gov provides practical information to individuals to help build healthier diets with resources and tools for dietary assessment, nutrition education, and other user-friendly nutrition information. The online resources can empower parents and guardians to make healthier food choices for themselves and their children.

Here’s to a healthier 2016!  Good luck!


Ski Season, Head Protection and How to Avoid Injury

I’ve been thinking a lot about head protection lately. My Mom knocked her head pretty hard a couple of years ago and although some people might argue that she always was a little forgetful before she hit her head, she sure has some memory problems now. My friend’s father had a garage door fall on his head. He developed a head bleed and subsequent dementia. Dr Robert Atkins, the creator of the Atkins Diet, slipped on the ice in New York City and hit his head. He died a week later from his head injury. It makes me think that we should all be wearing helmets. On my 65th birthday (which isn’t too far away) I plan to wear a helmet to work. When people ask who your pediatrician is, you can tell them it’s that weird guy that’s always wearing a helmet!

Being a pediatrician, of course, I’m more interested in protecting children’s heads. With ski season upon us, I would like to urge skiers to wear a helmet. The National Ski Areas Association (NSAA) reported that in 2003 only 25% of skiers wore helmets, their data shows that in 2012:

91% of children 9 years old or younger wore ski/snowboard helmets

81% of children 10 to 14 wore helmets

53% of adults 18 to 24 wore helmets

78% of adults over the age of 65 wore helmets

According to Dr Jasper Shealy, Professor Emeritus of the Rochester Institute of Technology in Rochester, NY, the use of a helmet while skiing or snowboarding reduces the chance of head injury by 30 to 50%.  The best way to avoid any injury however is to follow the steps of Your Responsibility Code including:  stay in control, stop in a safe place for you and others and when starting downhill or merging, look uphill and yield. It is also important to obey signs designating slow zones and intersecting areas. It is recommended that all skiers and snowboarders share the slopes and always show respect for others-which we should do all the time anyway.