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Lexington Clinic is pleased to announce than Dr. Barry Williams, Lexington Clinic Pediatrician, will be joining Lexington Clinic Richmond on Monday, March 8, 2010.

Dr. Williams is board-certified in Pediatrics. He provides primary care for children, childhood immunizations, well-child physicals, and school and sports physicals. Dr. Williams' professional interest is general pediatrics.

Dr. Williams received his medical degree from the University of Kentucky College of Medicine. He completed an internship and residency in pediatrics at the University of Texas. Dr. Williams joined Lexington Clinic in 2004 and has practiced with Lexington Clinic in London and Lexington, Kentucky.

Dr. Williams can be reached at 859.626.0072.

When my youngest daughter was 2, I remember standing in the grocery check out line and my daughter throwing a tantrum—screaming, crying, and trying to escape the grocery cart. I looked behind me and there was a well behaved toddler and her mother (both of whom I knew from work)—I was so embarrassed! I am a pediatrician; I should know how to control my child. HA! HA!

Temper tantrums occur in all children usually between the ages of 1 and 3. Children at this age become frustrated when things do not go their way and do not yet have the verbal skills necessary to express themselves. So they do what comes naturally-scream and cry! After age 3, children can usually express themselves with more words and the tantrums will taper off.

Sometimes as parents we can tell if a tantrum is coming. Our child may seem moody, whiny, or difficult; or the tantrum may come on suddenly for no obvious reason. To help reduce the chances of your child having a tantrum, try the following: encourage your child to use words to express her emotions

• keep a routine, expectable schedule
• avoid long outings with your child
• keep healthy snacks available
• make sure your child is well rested

Another suggestion is to “pick your battles,” avoid getting in the habit of always saying no to your child’s requests. If a request does not compromise your child’s safety and if the request is not too unreasonable, go ahead and say “yes” sometimes.

Sometimes despite all our good intentions aimed at preventing temper tantrums they will occur. A few suggestions for when the dreaded tantrum does occur:

• Parents – stay calm! If we shout and get angry it will only make things worse
• Ignore minor displays of anger such as crying or screaming
• If your child is kicking or hitting or having prolonged screaming, try a “cool-down” period, remove your child from the situation and give her time alone to calm down and regain control

Remember temper tantrums are a normal part of your child’s development and as your child gets older she will outgrow temper tantrums. In the meantime, a calm and loving approach will help both you and your child get through this part of childhood.

Fever is one of the most common reasons for a visit to the doctor’s office. Here are a few things every parent should know about fever.

What is a fever? It is an elevation of body temperature greater than 100.5. Normal body temperature is around 98.6, however it can vary throughout the day and from person to person. In general, our body temperature is lower in the morning and higher in the afternoon and evening. Even though temperatures of 98.7 – 100.4 are “elevated” they are still not considered a true fever.

How do I take my child’s temperature? A digital thermometer can be used orally, rectally or under the arm; this is the type of thermometer I recommend every parent should have. Which method you use depends on the child’s age. For newborns up to the age of three months, the best way to take their temperature is rectally. From age 3 months up to 4 years, you may take the temperature under the arm. For children older than 4 years an oral temperature may be taken.

What about the tympanic (ear) thermometers? I got one as a shower present; can I use it on my newborn? Even though these types of thermometers are very convenient, if not used properly they can give false readings. The American Academy of Pediatrics does not recommend this type of thermometer for young infants and children.

My child has a fever, now what? First, don’t panic. Fever is a natural way for the body to protect itself. Instead of focusing on how high the fever is, pay attention to how your child is acting. If your child is under 2 months of age, notify your pediatrician immediately. For older children, if he/she looks well, you may treat the fever with either Tylenol or Motrin (age appropriate dose) and see what happens. If your child is not acting right, you may want to have them see their doctor.

Will a high fever (>104) hurt my child? There are a lot of misconceptions about high fevers and brain damage. In general, high fevers are not harmful to the body. Before standard immunizations, high fevers were commonly caused by meningitis, which is an infection in the brain. These children frequently had hearing loss or brain damage because of the meningitis, not the fever. Today, most high fevers are caused by viruses and so even though the temperature may be high, it shouldn’t hurt your child.

If your child is sick and you feel uncomfortable at all about how they are doing, it is always a good idea to contact your pediatrician’s office. Our nurses are excellent about talking with parents about what’s going on and deciding whether or not they should come in to be seen. When in doubt, it’s always better to be safe than sorry.

A baby! This is who you have been waiting for. Without a doubt, parenthood is one of life’s greatest joys…and challenges. Decisions about career and work responsibilities are difficult for new parents. Should we explore part–time work and working from home? Will we be able to manage careers and also be nurturing parents?

I knew from day one that I would be returning to work after maternity leave. This allowed me to make some important preparations for my return to work. First, I had to find quality child care. Finding someone you trust in the care of your infant is very important in successfully returning to work. Next, being a breastfeeding mother, I introduced the bottle a few times prior to returning to work. I also tried formula a few times just in case I was unable to store enough milk once I returned to work. Lastly, a few weeks after delivery, I started going out to the grocery and running a few errands, just to get the baby used to being away from me.

When I returned to work, I started back half–days for a couple of days. This allowed for a better transition for me and the baby. It allowed time for him to adjust to the bottle and his caregiver, and for me to adjust to being away from him.

Having been a pediatrician for 7 years, I have worked with many families and children. Now I have walked in the shoes of those parents who bring their children to see me. I never realized how difficult even a simple thing like coming to the doctor with a baby can be! Organization is key. Small things like preparing bottles the night before help make the mornings go more smoothly. I have to allow a little extra time in the morning since I never know when he will decide he is hungry again right as I am about to walk out the door. While at work, I have to find time to pump breast milk for the next day. Also, a call at noon to check on my baby reduces my anxiety.

The last, and most important aspect of returning to work, is having a strong support system. My husband and I have created a partnership in the care of the baby. With both of our long work hours and my physician’s call, we have to plan our chores and work on them together to keep the household running. Shared responsibility for the baby helps both of us get some much needed rest when we are home. Our network of family and friends give advice, help in child care, and provide emotional support.

Having a career and being a mother are both rewarding. My greatest joy of each day, however, is knowing that there will be a smiling baby reaching for me when I get home—a baby to whom at that moment; I am the only one in the room.

Your new baby will need to see the Pediatrician for a number of “well child” visits in their first two years. These visits are recommended on a schedule that is fairly universal in pediatrics.

The next visits occur at two, four, six, nine, twelve, fifteen, and eighteen months. These well child visits are designed to assess growth, feeding, elimination, development, and social factors, among other things. It is extremely important that you keep these appointments so that the pediatrician may screen for developmental problems, behavioral problems, and physical problems. It is generally okay to do most of these visits a few weeks early or late, if you need to reschedule for illness (however you do need to schedule the twelve month visit after the birthday). Be sure to tell the person who schedules the appointments that you need a well visit, rather than a follow up or recheck, so that enough time may be allowed for the doctor to ask and answer all the questions necessary to do the job right.

One of the most important medical services provided at the well child visits are the vaccinations. Your child will likely receive vaccinations at all of the above visits, except the nine month check. However, this schedule can vary based on parent and pediatrician preference. I strongly urge every child to be vaccinated.

Well child visits can be very enjoyable for you, your child, and your pediatrician. As your baby gets a little older, perhaps starting at the nine month visit, you might consider some role play the day before or the morning of the visit. Describe to your child that they will be weighed and measured. The doctor will listen to their chest, look in their eyes, ears, mouth, and check them all over.

When it’s time to go, gather your child, your list of questions, a few books, a change of clothes and a couple diapers, then go enjoy your time with your pediatrician!

Teaching children to use the potty can evoke anxiety and stress among many first time parents. I have been a pediatrician with Lexington Clinic for almost 9 years and have had many discussions about potty training with parents and have received first hand experience with my two daughters, ages 4 and 6.

As a parent I was concerned about training too early and causing my child to develop resistant behaviors versus waiting too long and missing a window of opportunity when my child would be most receptive to toilet training.

Without a doubt potty training is a challenging experience, but by following the tips below potty training can be made easier and ensure that the experience is rewarding for you and your child!

When to start:

• Usually around 18–24 months a child will show readiness. He/she can understand what “pee” and “poop” mean and recognize when he/she is wet or dirty.
• Make sure your child can pull up his/her pants independently. Be careful with clothing containing buttons, elastic pants are the best to pull up and down.

What to do:

• Buy a potty chair that sits on the floor. Create a fun experience and let your child know it is his/her “special chair”. This chair can even be placed in the playroom rather then the bathroom temporarily.
• Praise your child for success! Initially for just sitting on the potty.
• Let your child look at books while on the potty and read toilet learning books to your child.

What NOT to do:

• Never force or pressure your child to sit on the potty.
• Never punish a child for accidents.

For overall potty training success, be supportive and patient. Accidents will happen, expect it. Try to keep the experience fun and upbeat and as always in parenting—keep a sense of humor!

Toddlers love to explore and express their independence. These same charming traits, however, can be a recipe for disaster at mealtimes.

Around age one, children’s appetites may drop off suddenly and you may notice a decreased rate of growth. Many parents are concerned about these changes in eating patterns because they were used to their child eating everything that they were offered. Parents are often also concerned about the decreased rate of growth, which is actually typical for toddlers. (Of course, if your child is losing weight, you should contact your pediatrician.)

During toddlerhood, not only does the growth rate drop, but your child will also strive to become more independent. Instead of readily accepting everything placed in front of them, they will learn the word “no,” especially during meal times! Foods your toddler loved will now be foods they turn down. Your toddler may take two bites one day and eat you out of house and home the next day!

Here are some suggestions for making sure your toddler gets adequate nutrition and that mealtimes are fun:

1. During mealtimes, make sure you offer at least one favorite food you know your child will eat, along with other new foods to try. Children often need to try a new flavor several times before they acquire a taste for it. Exploring and experiencing the colors, smells, textures, and tastes of new foods is fun for toddlers.
2. Offer a variety of foods from all food groups throughout the week. Your child does not need to eat food from every group at every meal, as long foods from each group are offered throughout the week. Your child does not need vitamin supplementation unless he is on a special diet.
3. Avoid getting your child other food if what is on the plate is refused. This can become a game of the wills. Your child will not starve as long as nutritious foods are available at each meal.
4. Do not make mealtime a fussy struggle. Have your toddler sit with the family and decide what and how much to eat. Mealtimes that are relaxed and unhurried, with family members sharing conversation and laughter are fun. If your toddler does not finish her food, save the plate in case she is hungry later. Do not offer snacks in lieu of dinner, rather, warm up her dinner plate and let her eat from that.
5. Do not give your child a lot of juice or sweets. Juice should be limited to 4 ounces daily. Sweets should be given infrequently. The extra sugar will decrease your child’s appetite for nutritious foods. Happy mealtime!

Congratulations! Your baby’s finally here and you’re home from the hospital, now what! First time parents often experience anxiety over their baby’s firsts, especially the first visit to the doctor. As a Lexington Clinic pediatrician I know it’s difficult to know what to expect that first visit. Here are a few tips I recommend to new parents to make the first visit to the pediatrician a good experience for everyone.

1. Timing – The timing of your first visit to the pediatrician will be determined by several factors: the number of children you have had, the method of feeding you choose, and the health of your baby (i.e. if they are jaundiced). It could vary from one day to two weeks after your discharge from the hospital. Your pediatrician will let you know this date when you leave the hospital with your new baby.
2. Scheduling – Your pediatrician may have a certain time assigned to see newborn visits in the office, but if you have a choice of time, consider mid-morning or early afternoon. It may take you more time than you think to get ready with the baby, so you might not be able to easily get ready for the earliest morning appointment. Try to feed the baby shortly before you leave and allow extra time to get ready, since the baby is likely to have a bowel movement just as you are walking out the door and require an entire outfit change.
3. Extra help – For the first visit, consider taking an extra person with you. That person can go in, register the baby, and obtain any history forms that need to be filled out, while you wait in the car with the baby, avoiding unnecessary exposure to sick children in the waiting room.
4. What to take – Don’t forget the diaper bag with a couple diapers, a couple outfits, wipes, and whatever you may need to feed the baby at least once while you are there. Also take a blanket since doctors are best able to examine the baby if they are dressed only in their diaper. Take a cushion for yourself and a pillow to support your belly when you cough or laugh if you have had a c-section. If you have copies of your hospital records (hearing test, Hepatitis B vaccine, bilirubin levels, birth weight) these are helpful to have along as well.
5. What will happen – The first visit will include weighing the baby, discussing the pregnancy, hospital stay, and what has happened since you have been home. In particular the doctor will want to know how the baby is feeding (how often and how long or how much), urinating, and stooling. The baby may need a blood test to check a bilirubin level (if the baby is jaundiced). If you have questions or concerns, you should write them down (your sleep-deprived mind may not work as it usually does) and give them to the nurse. The nurse may be able to answer some of your questions before the doctor comes in.

Having a newborn baby is exciting and challenging. It’s easy for new parents to feel concerned about their baby. We get many phone calls about newborns daily, to help get new parents through we have included information below about some of the common questions we receive in the first couple months of life:

Cold symptoms
Your infant’s first cold can be a frightening thing. The best treatment is to use saline drops and your nasal bulb syringe to clear the drainage to help with feeding and breathing. Other remedies include a vaporizer or humidifier and elevating the infant’s head to help clear the drainage from the throat. If the infant is struggling to breathe or eat, has a fever greater than 100.5 rectally, or is wheezing, you should contact your physician’s office. Remember, sneezing in infants is common and does not necessarily indicate a cold.

Constipation
Babies may have a bowel movement with every feed or as infrequently as every 4–5 days. As long as the stool is not hard, they do not need treatment. If the infant is uncomfortable, you may try rectal stimulation with a rectal thermometer. You should contact your doctor if the baby does not have a bowel movement within 5 days or if the stool is hard.

Eye drainage
Infants commonly have eye drainage secondary to a blocked tear duct. If you note your infant to have drainage from the eye without redness, you may try warm compresses and massaging the tear duct located in the corner of the eye next to the nose. Your infant should be seen if the eye or skin around the eye has redness.

Rashes
Newborn acne appears as pimples on the face and chest/back of the infant. This develops secondary to passage of maternal hormones to the infant. You should wash the area with warm water and avoid lotions to that area.
Cradle cap appears as thickened, scaly skin on the scalp. The best treatment is to use a fine tooth comb to loosen the scales prior to washing the infant’s hair. You should not apply lotion or oil, as this will cause further scaling.
Erythema toxicum is a normal newborn rash that presents as red blotches that come and go on the body. These areas may have a white center. This rash needs no treatment and will fade away within a few weeks.
Diaper rashes are common in infants. The most common type is a flat, red rash caused by irritation by the diaper environment. A protectant such as A & D or Desitin should help this rash disappear. Frequent stools may also cause a red, flat rash. If your infant has frequent stools and a sunburn–looking rash, using an antacid such as Maalox or Mylanta, followed by a protectant should resolve this rash. The last common rash is a yeast diaper rash. This rash will be thickened and surrounded by small red areas. An antifungal agent such as Lotrimin may be tried or you may contact your doctor for a prescription. Any diaper rash that is worsening with treatment or does not show improvement within 5–7 days, should be seen by your physician.

Spitting up
All newborns will spit up at some time or another. This can be caused by swallowing air during feeding and a loose muscle entering the stomach. Some things to try at home for frequent spitting is to elevate the infant’s head and to keep the infant upright for at least 20 to 30 minutes after feeding. If your infant continues to spit frequently, is very fussy with spitting or has projectile vomiting, you should contact your physician for further treatment.

Thrush
Thrush is caused by a yeast infection in the mouth. It appears as white patches on the tongue and cheeks that cannot be wiped away. Your physician can prescribe a medication for treatment. You should boil your pacifiers and bottle nipples between feedings in order to not reinfect the infant.

**You should contact your doctor immediately for the following**

Fever greater than 100.5 rectally

Lethargy

Inconsolable crying

Increased work of breathing

Inability to feed

It is easy in our fast paced world to get caught up in work and activities that nutrition can take the back seat and all too often our meals are obtained thru a fast food window.

I certainly can relate, many days my husband and I come home from work after picking up our kids and afterwards stop to eat on the way home. There is little nutrition and a lot of fat in the grilled cheese, fried chicken nuggets and french fries my daughters love to eat.No wonder 1 out of every 3 children in the United States is considered obese or overweight.The incidence of obesity in American children has tripled since the eighties.This is really sad, as an obese child is at greater risk of developing diabetes, high blood pressure, and premature death from early heart disease or stroke.

Many children are obese because of changes in the typical American family’s lifestyle: Unhealthy eating habits and a decrease in exercise. Our children today are more sedentary with so much time in front of a computer or television screen.To prevent obesity in children we should take the following steps:

• Monitor food portion size and try to get 5 fruits/veggies in a day, meal planning in advance will help achieve this goal
• Make sure your child eats breakfast daily and limit the sugary sodas and juices
• Get your child to exercise- a goal should be 1 hour a day. Playing in the backyard, riding a bike, playing soccer—just get moving!
• Limit TV, video games, and computer time to less than 2 hours a day, and please do not have a computer or TV in your child’s bedroom.
• Lastly, as parents we should be role models for our children.If we are overweight, our children are more likely to be overweight.Although sometimes it is difficult to do, we should exercise regularly and demonstrate good nutrition for the benefit of ourselves and our children.

As a pediatrician, I know the value of vaccines. There are a very important part of routine well child care and preventative medicine. Unfortunately, thanks to a lot of bad press, more and more parents are starting to question the need for vaccination. I am afraid that misinformation will cause some parents to make a bad decision regarding immunizations.

If you are one of many parents with questions about vaccines, you have no doubt consulted the internet. There are some really great resources on the web, and then there are some that are not so great. I have found two websites that I particularly like and will often recommend to parents with questions about immunizations. The links are at the end of this post—feel free to check them out. Of course, no resource can be a substitute for your pediatrician, who you should also consult before making any decisions.

Many people claim that organizations who endorse vaccines use scare tactics to convince people to comply. The bottom line is that the diseases we are immunizing against are devastating illnesses and have the potential to kill. Even though I am a young pediatrician, I have seen healthy kids become deathly ill and even die from diseases that we can prevent with vaccines. It is not a scare tactic—it is a reality.

We have been hugely successful in this country with vaccines and we have greatly reduced the incidence of these illnesses. While this is a great achievement, it has had the negative effect of convincing many parents that their children don’t need to get vaccines because their children will never be exposed to the disease. Don’t be fooled; these diseases are still out there—and they are closer than you think.

It is important to continue to have high immunization rates so that we can keep these diseases at bay and continue to ensure our children a healthy future.

www.cdc.gov/vaccines/spec-grps/parents.htm

www.vaccine.chop.edu/