Southwest Pediatrics Medical Home newsletter

May 2009

Welcome to our Web site.

Library resources.

1-2-3 Magic.

Summer clinic notes.

A network of support - mums.

A Medical Home is accessible, continuous and culturally effective.

Welcome to our Web site 

BY Chris Schwake, MD, pediatrician, CMG-Southwest Pediatrics

For many of us, the Internet is an invaluable tool to gather information, learn what is going on in our community and network with others who have similar interests or concerns. However, the amazing amount of information available can, at times, be quite overwhelming and confusing, especially when it pertains to medical concerns. To better assist and connect with our families regarding the health issues faced by their children, the Southwest Pediatrics Web site has been redesigned and expanded over the past year.

For those looking for information regarding services for your child, the front page has our current office hours, maps and directions to Southwest Pediatrics, and quick links of how to make your phone calls, medication refill requests and office visits as efficient and helpful as possible. There are additional quick links on the front page for advice regarding common childhood illnesses and concerns as well as how to gain online access to your children's immunization records through the Wisconsin Immunization Registry.

The Spotlight link will direct visitors to answers of frequently asked questions and information on seasonal topics. The Forms link will connect visitors to forms that your children's daycare facilities or schools may require prior to your children being enrolled or allowed to participate in athletic activities. The Forms page also has questionnaires for two common and challenging health issues faced by children, headaches and stomachaches. If your children are faced with such concerns, downloading and completing these questionnaires prior to contacting our office would assist us in providing the most helpful and effective care.

One of the newest areas to the Web site is the Medical Home page where visitors have the opportunity to connect to and read all of the prior issues of our Medical Home Newsletter. There is a link to the Southeast Regional Center for Children and Youth with Special Health Care Needs - an organization dedicated to providing people who care for children with diverse health needs with a wealth of information regarding resources that can be found in our community, online, and in print. Additionally, visitors can connect to the Wisconsin Medical Home Toolkit - an online guide for learning more about and finding resources on topics such as creating care plans for children and preparing for transitions faced by adolescents with special health care needs.

Our Web site is a part of the Medical Home that we are striving to build at Southwest Pediatrics. It is continually growing and changing, so please visit frequently. Like everything else in our Medical Home, our web site will significantly benefit from ideas and suggestions that are made by the children and families in our office. Please provide feedback regarding the current content and content that would make the site more helpful.

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Library resources

BY Melissa Schneider, deputy library director and head of Youth Services at the New Berlin Public Library

Where can you build your baby's brain, grow your child's imagination, find parenting resources and lots of great programs for all ages? The answer is right across the street from Southwest Pediatrics at the New Berlin Public Library.

The New Berlin Public Library's parenting collection includes books and DVDs for parents and is located in the Youth Services area of the library on the first floor. These resources include information on pregnancy, childbirth, newborns, toddlers, preschooler, school-agers, teenagers and how to parent children at all of these stages. Answers to questions on how to teach your baby sign language, how to get colicky babies to sleep, what the best way to toilet train, ideas on discipline and information on children with special needs.

The library not only has books, DVDS, audio-books, playaways, newspapers, magazines, and CDs, we have access to online databases that you cannot access from home. These databases are an important tool for finding accurate information, especially on medical topics.  Librarians are available to assist you in locating materials and accessing online databases.

If you do not find what you are looking for at our library, please ask! We usually can get the material you are looking for from another library. We often purchase the materials you request to add to our library's collection as well. The Youth Services Department wants to be a valuable resource to you and your family and would like to provide the resources you need.  If there is topic you need more information on, please talk to a librarian so we can grow this area of our collection.

Please stop into the library to check out what programs we have going on or check our Web site! All year round we have story times, book clubs, computer classes and informational programs for adults. This summer there are programs going on everyday! The 2009 Summer Reading Program for all ages is "Be Creative @ Your Library."

For your convenience the library has a 24 hour book return on the south end of our building. We also have a drive-up service window. If you call ahead, you can pick up your holds at the window without ever leaving your car! Can't get to the library before we close? You can take advantage of our E-lockers. Give us a call and we will check out your material on your library card and place the item(s) in a locker. You will receive a pin number along with your locker number and can access your items after hours. You have 48 hours to pick up your items at your convenience. And don't forget our Web site is also available 24 hours a day!

Don't have a library card? All you need is a valid ID with your current address. If you have recently moved, simply bring in a piece of mail with your new address along with your ID. If you live in Milwaukee County, library cards are $40 per year. Children are eligible for their own library cards if they are 5 years old and come in with their parent or legal guardian. (Parents and legal guardians need to show valid ID with current address).

The New Berlin Public Library is open Monday - Thursday 9am-9pm, and Fridays and Saturdays 9am-5pm all year round. The library is open on Sundays 1-4pm during the school year and is closed on Sundays for the summer beginning Memorial Day weekend through Labor Day weekend.

If you have any questions, please stop in to the Library, call us at 262.785.4980, or visit the library's Web site: www.newberlin.lib.wi.us

1-2-3 Magic, written by Thomas W. Phelan

A book review by Chris Keller, MSN, RN, parent and member of the Medical Home Parent Advisory Committee

Dr. Rohloff has been recommending 1-2-3 Magic for about 20 years. The book is now in its 3rd edition. New Berlin library has 1-2-3 Magic available as a book (2 copies), a book-on-tape, and as a video and will soon have a DVD.

1-2-3 Magic is a how-to book that promotes effective discipline for kids 2 to 12. Parents who read the book learn how to stop certain obnoxious, irritating or dangerous behaviors by simply counting: "That's 1" (5 seconds elapse, giving the child time to stop), "That's 2" (5 more seconds, if the child hasn't yet stopped), and "That's 3, take 5," referring to the consequence, a 5-minute time-out for not stopping.

Along with counting to your child, the parent must maintain a poker face (no emotion, as in NO ANGER AND NO FRUSTRATION) and not engage in talking, arguing, rationales or explanations. Only the words "One, two, three" and "Take five" are used.

Topics of interest:

• Treating your child like a miniature adult.
• How to use 1-2-3 Magic for various ages and stages.
• Mealtime and bedtime strife.
• Homework hassles.
• Logical consequences.
• Encouragement.
• The Family Meeting.
• Self-esteem, affection and praise.
• Applications for classroom use.

Sheila says, "I used this technique to enlist her daughter Ali's help in putting away her toys, or to get dressed. I started using it when she was around 2 ½ or 3 years old . . . . as she ventured into the age of autonomy and argument . . ." Sheila adds that consistency in the use of the technique is a large part of the "magic".

Paige's mom explained to Paige that her goal was to help Paige make good decisions. "We told her that we would help her understand how much time she had during transitions and when she chose to not listen when asked to do something, she would have until the count of three to make a better choice. If her choice was still not acceptable, the consequence would be a time-out." Paige is ten now and her mom still uses 1-2-3 Magic.

Tyler is three. Tyler's mother says he is at the age where he is testing her. Tyler tested his mother until she got to "3" only once. After the first time-out, Tyler learned to stop his testing after hearing his mother say,"1".

Another mother, observing the 1-2-3 Magic technique being used in a daycare setting, thought the technique worked best with calm and compliant children, and less well with defiant children or those who had symptoms of ADHD. However, in the book, the author gives assurances that the technique can be adapted and can work with children with behavioral issues and children with cognitive and other disabilities.

Summer clinic notes

Br Rene Petritis, RN, BSN at Southwest Pediatrics and member of the Medical Home Parent Advisory Committee

As warmer weather approaches, the clinic will receive many calls about bug sprays, sunscreens, bug bites, etc. Here are a few helpful tips to help combat some of these issues:

Insect repellents-the American Academy of Pediatrics recommends that repellents should contain no more than 30 percent DEET and not be used in babies under 2 months. Most repellents contain 7-11 percent DEET and are safe for infants 2 months and up. Do not use combination sunscreen and insect repellents, and remember to give your child a bath with soap and water to remove any repellent.

Sunscreen-As a rule, children under 6 months old should be kept out of direct sunlight. When using sunscreen, it is best to use sunscreens made for children. Choose one with both UVB and UVA protection and an SPF of at least  15. Apply sunscreen at least 30 minutes before going outdoors and reapply frequently. Sunburns can be treated by applying cool compresses and avoiding further sun exposure. Remember to replace lost fluids.

Bug bites -Itchy bites can be treated with baking soda paste, menthol aftershave, or hydrocortisone cream. If your child is stung by a bee, wasp or hornet, make sure the stinger is removed by scraping from below with a fingernail or credit card. A cotton ball soaked in meat tenderizer or an ice cube rubbed over the area can be helpful with painful stings/bites. Ticks can be removed by grasping the bug with tweezers. Always wash the wound with soap and water. Monitor bug bites-local redness and swelling can be common for 24-48 hours. Call the office if the redness continues to spread, a red streak develops, yellow crusty drainage is seen or your child has increased tenderness at or near the site of the bite.

Call 911: If your child develops chest or throat tightness, difficulty breathing or swallowing, hoarseness or slurred speech. An anaphylactic reaction usually occurs within 20 minutes after a sting. If your child has a known severe allergy to insect stings and has an Epi-pen, give them an epinephrine injection into the thigh and call 911.

Reminder to parents-check the expiration date on your child's Epi-pen. If it has expired or will expire soon, call your pediatrician's office for a refill. If your old Epi-pen has expired, practice giving an injection into an orange or grapefruit so you can review how to do this in case there is an emergency.

Call your pediatrician's office if you have any other questions or concerns. You can also find much more helpful information by going to our Web site at www.southwest-pediatrics.com (under the For Parents) icon.

A network of support - Mums   

By Kimberly Gunn, parent, member of the Medical Home Parent Advisory Committee

Supporting one another is what MUMS International is all about. It's an incredible national network of mothers, fathers and care providers who are matched up with one another according to their child's disability, disorder, chromosomal abnormality or health condition. Their network database of members spans over 56 countries, and includes over 22,000 families, covering over 3,500 disorders, syndromes or conditions. Parent can exchange a multitude of information from medical records and resources to doctors and research programs.

Wondering how all this got started? It all started with a mom, named Julie Gordon from Green Bay, Wisconsin. She was pregnant in 1973 along with many of her good friends, all of them looking forward to enjoying their new babies. Due to a loss of blood during delivery her daughter, Jessica, was born in shock. When Jessica was 4 years old she was diagnosed with severe Cerebral Palsy. Julie endured the death of her second child at birth, and then was blessed with healthy twin girls. Through all of this her marriage ended and she needed the support of others. With a little coaxing from a therapist, and names of 3 other mothers who had children with Cerebral Palsy, MUMS was born in her living room. They also met other mothers of children with special needs who did not have a place to turn, and welcomed them. Every mother had so much in common with one another, including the lost dream of having a perfectly healthy child.  Mothers gathered and shared their feelings of being alone and frustrated. The group began to share medical information, services and doctors. But most importantly, they bonded with an understanding friendship that only mothers of special needs children can share. They began to advocate for one another at schools and hospitals along with writing to legislation. MUMS soon realized there was power in numbers. Not long after the MATCHMAKER, MUMS National Parent-to-parent Network Newsletter was in print.

Thankful for the support of her fellow MUMS Members, Michelle Scott stated, "I thank you from the bottom of my heart. Since the birth of our son and everything that my husband and I have been through, I have had the pleasure of meeting the BEST people ever! Everyone that I speak to has a story and that story is what drives me ahead. They are the people that take on the biggest odds and the tallest mountains but always shine though." At the end of the day there is nothing like the feeling of connecting with others, who share your same concerns and desires. To learn more about MUMS and be matched with other supportive members contact:

MUMS: National Parent to Parent Network
Julie J. Gordon
1-877-336-5333 (Parents only please)
E-mail: mums@netnet.net  or  http://www.netnet.net/mums    

A Medical Home is accessible, continuous and culturally effective      

By Bob Rohloff, MD, pediatrician at CMG-Southwest Pediatrics

Southwest Pediatrics is building a Medical Home. A Medical Home is not a building but a way of practicing pediatrics that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. This is the second article in a three part series aimed at explaining what each of these characteristics means and how they apply to our pediatric practice. In the last article (see the March 2009 issue) the terms "family-centered" and "coordinated" were discussed.  In this issue the terms "accessible", "continuous" and "culturally effective" will be described.

Accessible

Care is provided in the child or youth's community. We are very fortunate to be affiliated with Children's Hospital and the fine pediatric specialists available there. Because of this, your child's primary pediatric care as well as all referrals to specialists can be provided in the community in which you live. Our practice accepts nearly all insurances including some Medicaid and state health plans, making Southwest Pediatrics financially accessible. Our physicians are accessible 24 hours a day every day of the year.

Continuous

A Medical Home provides continuous care from the time a child is born until they are ready to transition their care to adult medical physicians (see "Transitions" in the August, 2008 newsletter). In the Medical Home the physicians and staff are ready and able to assist fully in the many transitions that occur in the pediatric age group including: nursery to home, preschool to school age, school age to adolescents and adolescents to adulthood. In this way the pediatrician is continuously involved in your child's care. The pediatrician is also involved to the fullest extent possible in care and discharge planning when a child is hospitalized or medical care is provided by another physician or health care provider. It is sometimes not possible for a pediatrician to be involved if care is provided at facilities such as "quick care" clinics located in malls and drug stores that do not communicate with primary care providers.  Because this lack of communication is not consistent with the medical home model of care, the physicians at Southwest Pediatrics do not recommend "quick care" clinics for your child's illnesses.

Culturally Effective

Every effort is made to respect cultural differences when providing medical care. Cultural backgrounds are valued and respected and, whenever possible, incorporated into medical care plans. As part of Children's Hospital and Health System, Southwest Pediatrics has access to interpreters in many languages. Every effort will be made to provide written instructions in the family's primary language if necessary.