Southwest Pediatrics Medical Home newsletter

July 2010

Care coordination

Allergies? Really?

Constipation in children

Clinic notes

Library activities

Parent Advisory Committee

Care in the Community

Care Coordination Plan and Office Visit

By Bob Rohloff, MD, pediatrician, Children's Medical Group-Southwest Pediatrics

Southwest Pediatrics is working to improve the coordination of care for our children and youth with special health care needs. Working with parents and families we have begun reviewing charts and creating care plan documents.

The care plan document contains all the information about the child or youth with special needs including his or her diagnosis, medications, specialists, school, community resources and goals. The document is designed for families to use when visiting specialists or physicians not familiar with their child's medical history. It also can be used to help aid communication with schools and community agencies.

To remain accurate, the care plan must be updated on a regular basis. The pediatrician, the patient and his or her family should review the plan to ensure all of the information is correct. It also should be reviewed to ensure all community resources are being accessed and used, and a care coordination office visit is scheduled each year.

The care coordination visit does not replace the annual checkup. Many things are completed during a care coordination visit including:

• Diagnoses are reviewed and updated. 
• Medications are checked for accuracy. 
• Recommendations of specialists are reviewed. 
•  Lab work is reviewed to ensure that any issues are receiving follow-up care.
• Therapies and schedules are evaluated. 
•  Financial concerns are addressed. 

Care coordination visits also include planning for the transition to adult care for adolescent patients and sharing community resources with the patient and family.

If the child with special health care needs is involved in his or her own medical care he or she is included in the visit and encouraged to participate in decision-making. All family members who help with the child's care are encouraged to attend the care coordination visit.

A separate care coordination visit allows the patient, family and medical team to focus on the care plan and coordination of care. Unlike an annual checkup, the care coordination visit does not include a medical exam, shots or detailed discussions of medical problems. Many times, when the two visits are combined it can be an exhausting process for everyone involved.

Southwest Pediatrics already has begun creating care plans with several families in our practice. We will begin scheduling care coordination visits this year.

Any family with a child or youth with special health care needs who is interested in developing a care plan, should call Michelle, Medical Home administrator, at (262) 814-7076.

Allergies? Really?

By Lori Karcher, member of the Parent Advisory Committee

I find it very interesting that I became a part of this Advisory Board because of my daughter who has Cerebral Palsy, but I am writing an article about my son.

When our second child was born, we were so grateful that he did not have to come home on an apnea monitor. We did not have to give him oral caffeine so he wouldn't forget to breathe. He didn't need special, supplemental feedings because he tired out too quickly from nursing. He was a thumb sucker, so we didn't even need a pacifier, and by the time he was 5-weeks-old, he was sleeping through the night. Yeah! I still say it to this day, he was the best baby as far as eatingand sleeping.

And then he turned one.

Everything was going smoothly until we tried to switch him from formula to regular milk. For most of his second year we played a game called "How much dairy is too much dairy?" The odd thing was that he had no problem with yogurt or certain cheeses, and he could tolerate regular formula from the time he was 6-months-old. We didn't have to give him soy formula.

Depending on how much dairy he was given, he would give it right back. Strange. So, we took him off all dairy products. Then, we started introducing them slowly back into his diet based on our doctor's suggestion.

Yogurt...good.
Mac and cheese...good.
Half milk, half formula...good.
Mac and cheese plus yogurt...bad!
Start over.

So, we decided to give him soy milk and avoid dairy products. Problem solved. And then he turned two.

I sat him down to lunch one day for a peanut butter and jelly sandwich. I had avoided giving him peanut butter until he was 2 because that was our doctor's recommendation. He took two bites of the sandwich and his cheeks began to turn red from his chin to his ears. Well, the sandwich went in the garbage, and I watched him as he took his nap that day.

Afterward, our pediatrician recommended having an allergy test done. We found out that our son was allergic to a milk protein and peanuts. It's not the end of the world – so, he can't have a PB&J and a glass of milk – no big deal.

Then, the allergist gave us a list of other foods that we should avoid. Often times people with peanut allergies are allergic to other foods such as tree nuts, shellfish, eggs and more. We needed to be careful when we went out to eat because we couldn't control how the food was prepared. For example, some restaurants use peanut butter as a thickener in their chili.

Neither my husband nor I have any food allergies, and neither did his sister. We needed to learn how to manage this new challenge. We taught him to ask, "Are there nuts in that?" We continued to move through daily life making everyone aware of what he could and could not eat.

And then we sent him to school.

We sent him to a half-day program. We were responsible for sending along a snack with him every day. We thought, "This shouldn't be too bad." We made the teacher and the school aware of his allergies, and they swung into action right away.

I do realize that everything they did was to protect our son. I do appreciate their efforts. However, when I walked into the classroom and saw my son's black and white photo plastered up on the wall with "NO PEANUTS!" written on it, I was reminded of a wanted poster or a no smoking sign with the red circle and the slash through it. Fortunately, my son thought that it was pretty cool and didn't feel singled out.

A note went home to all of his classmates' parents to let them know that they weren't to send in treats with peanuts for birthdays because a classmate had a allergy. Students were taught not to share food with each other. I had to meet with the school nurse to write up an emergency plan. I also had to get him an allergy bracelet and an EpiPen®.

Last year, our son was in school all-day and eating the school lunch. I was assured they never serve food that contains any form of peanuts, peanut oil or other nuts. However, since other students bring their lunches and may have PB&J or peanut butter crackers, my son had to sit at a peanut-free table in the lunchroom away from everyone else. Other kids could join him there as long as they didn't have any peanut contraband.

I know that these two allergies that we've had to deal with are probably minor compared to what other parents of children with allergies live with. However, I believe that if we build more awareness, starting with the child, it will be easier for our children to adapt to living with food allergies.

Constipation in children

By Christopher Schwake, MD, Children's Medical Group-Southwest Pediatrics

Constipation is one of the most challenging conditions faced by children, parents and pediatricians. It's seen often in children with and without special health care needs.

When children with special health care needs have constipation, it's often difficult to treat due to many other factors. If left untreated, severe constipation can lead to issues such as significant stomach pain. Children also might have frequent accidents. These accidents can impact a child's self-esteem and confidence.   

Constipation is different for each child. Some won't go to the bathroom often. Others will have small, hard stools. Others will have pain as they try to pass large, firm stools. Children with these symptoms also may have stooling accidents.

Constipation can happen for many reasons. When infants and toddlers move to solid diets, constipation often occurs when children don't receive enough fiber or fluids. Toddlers and young children require about 20 grams of fiber per day. Their fluid intake is based on weight. For example, a child who weighs 22 pounds needs 32 ounces of fluid, or four, 8-ounce glasses each day. A child who weighs 44 pounds needs 50 ounces of fluid, or almost six, 8-ounce glasses. Drinking too much milk (more than 32 ounces per day) slows down the movement of waste through a child's body. This decreases a child's interest in eating or drinking fiber-filled items such as fruit and vegetables that encourage soft stools.

Children who are of toilet training age often have poor diets that put them at risk for constipation. Many children also avoid going to the bathroom because it's difficult to pass hard, painful stools. Adult-sized toilets also don't provide enough foot support so a child is comfortable enough to pass hard stools. These behaviors, if left unnoticed, can make the constipation worse.

School-aged children often don't give you enough information about their bathroom habits. This leaves parents unaware of any constipation concerns. Many children also avoid going to the bathroom at school because they feel embarrassed or rushed. Children at this age and in these situations can benefit from regularly scheduled and unhurried toilet time after meals.

Children with special health care needs are at risk for constipation for any of the reasons above but also from other existing medical concerns. Constipation can be a symptom of certain conditions such as hypothyroidism, cerebral palsy and cystic fibrosis. Many medicines can cause constipation or make it worse. Children who are fed by a method other than by mouth, such as a gastrostomy tube (G-tube), are at a higher risk for constipation. Many times, formulas don't have enough fiber for kids. Children who are unable to be as physically active as other children their own age also can have problems going to the bathroom.     

One of the most important things to know about constipation is that it may be an ongoing health issue that requires continued attention over time. Try to talk with child, especially school-aged kids, about their bathroom habits. Ask these questions:

• How often do you go to the bathroom?
• Are you comfortable going to the bathroom at school?
• How much water and other fluids such as juice do you drink?
• Do you know how to pick out foods that are high in fiber?

Make a partnership with your child and set specific toileting times after meals. Be consistent with these times and you will find that any problems with constipation will improve.

Changing a child's behavior and lifestyle may not be enough to control constipation. For children with special health care needs, you might not be able to use all of the methods listed above because of other health conditions. If this is the case, it's important to talk to your doctor as soon as possible. Discuss ways you can use medication to lower the issues of constipation. If your child needs medication for constipation, it's necessary to talk to your doctor often so you can best manage your child's constipation problems.  

Clinic notes

By Rene Petritis, RN, Children's Medical Group-Southwest Pediatrics

Prevnar 13 vaccine
Southwest Pediatrics began giving the Pneumococcal Conjugate Vaccine, also known as PCV13 or Prevnar 13, in May 2010. Based on recommendations from the Centers for Disease Control, this vaccine replaces the PCV 7, or Prevnar 7, which has been given since 2000.

Prevnar 13 is given to young children to protect them from potentially serious diseases. These diseases, caused by pneumococcal bacteria, can include ear infections, pneumonia, blood infections and meningitis.

We are using Prevnar 13 for all children 6 weeks old to 59 months. We also use the vaccine for children with existing medical conditions that may increase their risk for pneumococcal disease or complications who are between 60 months and 71 months old.

If your child is in one of the above age groups, your doctor will talk to you about this new vaccine at your next well child visit. You also can learn more about Prevnar 13 at www.cdc.gov/vaccines.

Although it might seem like it's too early to think about the upcoming flu season, check back in early August for our upcoming flu clinic schedule. We will post the dates at www.southwest-pediatrics.com and on our phone system when they are available.  

Make a splash at the library this summer

By Melissa Schneider, deputy library director, New Berlin Public Library

This summer we have a reading program for the whole family.

Children younger than 12, who can read on their own or who are read to, can sign up for the Youth Summer Reading Program in the Youth Services Department. The Teen Reading Program is for ages 13 to 17. Sign up in the Youth Services Department and pick up your reading record. Get some reading done and receive great prizes. Readers in the youth or teen program also can complete a Challenge Sheet after they finish the first Reading Record, participate in weekly trivia and complete the Super Challenge for more prizes. The reading program ends Thursday, Aug. 5, but, you can take part in the August Challenge until school starts.

For adults, sign up for the Adult Reading Program at the Adult Reference Desk or e-mail nbinfo@wcfls.lib.wi.us. The adult program ends Aug. 5.

If you don't want to take part in the reading programs, we have other fun activities all summer long. For younger children, the library offers the following story times and play groups:

Toddler Time for 2-year-olds
Tuesdays through July 27. Registration required.

Lap-sit Storytime for children younger than 2
Wednesdays through July 28. Registration is not required.

Preschool Storytime for 3 to 6-year-olds
1:30 p.m. Wednesday, 9:30 a.m. and 10:30 a.m. Thursdays through July 29. Registration is required. The sessions at 1:30 p.m. and 9:30 a.m. are for children not with caregivers.

Bedtime Stories
7 p.m. second Wednesday and fourth Thursday of each month. Registration is not required. Stories are for children ages 2 to 6.

Play group
9:30 a.m. to 10:30 a.m. Fridays. Registration is not required. The play group is a social opportunity for parents and grandparents of toddlers and preschoolers to meet other parents with children of the same age. Adults and children socialize, play and read together.

Activities for school-aged children:

Lego Club
10 a.m. to 11 a.m. Mondays through Aug. 2. For children ages 7 to 12. Registration is required. Space is limited.

Knit and Crochet Club
1 p.m. to 2 p.m. Mondays through Aug. 2. For children older than 6. Beginning and experienced knitters and crocheters are welcome. Registration is required. Formal instruction will not be available some weeks.

Craft Club
3 p.m. to 4 p.m. Mondays through Aug. 2. For children in grades 1 through 6. Registration is required. The club meets in the Youth Services Program Room. Space is limited.

Chess Club
5 p.m. to 6:30 p.m. and 7 p.m. to 8:30 p.m. Wednesdays through Aug. 11. For children in grades 1 through 8. Register at the Youth Services Reference Desk. The club meets in the Community Room.

Tuesday Family Movie Afternoons
1 p.m. Tuesdays through Aug. 3. All movies are G or PG. For a list of movies, see a member of the Youth Services staff. Children younger than 9 must be with an adult. Children between 10 and 12 must have an adult in the building. No registration required.

Thursday afternoon programs
1 p.m. Thursdays through Aug. 5. Join us for family fun in the afternoon including Wednesday, July 21 (note the change of day), magician LaVerne Bakkom; July 29, David Stokes; and Aug. 5, End of the Summer Party. All ages are welcome. Join in games, ice cream and fun. No registration is needed.

For more information about these programs, call the New Berlin Public Library at (262) 785-4980 or visit www.newberlin.lib.wi.us. You do not need to be a New Berlin resident to join these programs. You also can become a fan of the library on Facebook.

The New Berlin Public Library is located at 15105 Library Lane in New Berlin, Wis.

Southwest Pediatrics' Parent Advisory Committee

Our parent advisory committee meets on Tuesday nights every six weeks. We discuss current health topics, ideas for articles for our Medical Home newsletter, topics for future parent resource meetings and issues parents of children with special needs face. The meetings are held in our office from 6:30 p.m. to 7:30 p.m. If you are interested in becoming a member, e-mail Michelle at MRodriguez@chw.org for more information.

Care in the Community

By Meg Steimle, outreach specialist, Southeast Regional Center for Children and Youth with Special Health Care Needs

The Southeast Regional Center for Children and Youth with Special Health Care Needs sponsors its annual conference Wednesday, Sept. 22. "Care in the Community: Building Bridges, Creating Options and Making Positive Connections" will be held from 8 a.m. to 4 p.m. at the Radisson Hotel, Milwaukee West, in Wauwatosa, Wis.

The conference will give families and providers the information and tools they need to work together in providing coordinated, community-based care. The conference features topics such as mental health of children, health literacy, transition to adulthood, supplemental security income and more. There are nine sessions you can choose from.

The keynote speaker is Rick Guidotti, co-founder and director, Positive Exposure, a non-profit organization that works to end the stigma of genetic differences. See Rick's work at www.positiveexposure.org.

Continuing education credits are available for social workers. The cost for parents is $15 and $25 for professionals. If you would like clock hours, the cost is $50. For more information, visit www.maxishare.com/conferences.