Traveling Abroad for the Holidays?

ChristmasTeddy.2017The Centers for Disease control has ways to enjoy your stay here.

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Tetanus: Wounds and Shots

TetanusBlogPostI like to walk my dogs at the Bulb in Albany.

If you’ve never been to the Bulb, it’s a former landfill on the San Francisco Bay that’s making the transition to natural, open space.

It’s also a tetanus-prone wound paradise, as you can see from the rusted fitting on this old telephone pole.

Tetanus shots are good for 10 years, however, if you get an injury that’s penetrating, dirty or contaminated, you should get a tetanus shot if it’s been more than 5 years since your last one.

Children get immunized against tetanus at 2, 4 and 6 months. There is a booster for toddlers and kindergarten and again at age 10-11 years old. That’s the Tdap required for 7th grade. I immunize high school seniors so they are protected for wherever life takes them after graduation. After that, tetanus shots are every 10 years.

The technical Guidelines for the management of tetanus-prone wounds is here.

If you think you might be due for a tetanus shot, call the office.

Enjoy your rambling!

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Raising Safe Drivers

Have a rising teen or young adult driver?

Car safety tips for parents as here.

Teen driving agreement is here.

More from the American Academy of Pediatrics:

The Teen Driver


​Teen driving fatalities appear to be on the rise after years of decline, prompting the American Academy of Pediatrics (AAP) to update recommendations for physicians and parents to address risks that include inexperience, speed and distracted driving.

Despite a nearly 50-percent reduction in crash-related teen deaths over the last decade, teen drivers are more likely to be involved in a motor vehicle crash that causes injury or death than any other age group in the United States. Data from 2014-2016 showed an increase in teen driving deaths and crash-related injuries that suggest a need for renewed attention.

In its policy statement, “The Teen Driver,” the AAP observes that while vehicle safety advances, graduated licensing laws, improvements in seat belt use and impaired driving enforcement have helped lower the fatality rate over the long term, much work needs to be done to make driving safer for adolescents and the community.

The policy statement will be published in the October 2018 issue of Pediatrics (published online Sept. 24), and reflect new research on the risks faced by teen drivers. The previous AAP policy statement on teen driving was published in 2006.

“We all know how easy it is to become distracted while driving, particularly in the age of texting and technology,” said Elizabeth M. Alderman, MD, FAAP, FSAHM, member of the AAP Committee on Adolescence and a lead author of the statement. “Parents can set a powerful example with their own driving habits, from using a seatbelt regularly to avoiding cell phone use or speeding.”

In 2015, 1,886 young drivers died in motor vehicle crashes, an increase of 9 percent from 2014. Another 195,000 teen drivers were injured in vehicle crashes in 2015, up 14 percent from the prior year.

Teen drivers with fewer than 18 months of driving experience have four times the risk of a crash or near-crash event, with risk factors that include inexperience, speed, teen passengers, distraction and use of alcohol, drugs or medication.

The crash risks increase for teen drivers who transport young passengers. More than half of children age 8 to 17 who die in vehicle crashes are killed as passengers of drivers younger than age 20.

“Every state has some form of graduated driver’s licensing regulations, which have helped improve safety by limiting the number of passengers or restricting night-time driving, for instance,” said Brian D. Johnston, MD, MPH, FAAP, a lead author of the report and member of the Council on Injury, Violence, and Poison Prevention. “Yet more can be done. One step that could make a difference is for communities to more consistently enforce laws on seat belts and use of cell phones while driving.”

AAP recommends that pediatricians:

  • Counsel teens on seat belt use and the risks of driving while impaired by alcohol, illicit substances and medication.
  • Encourage parents to practice driving with their teenagers in a variety of environments and for more than the state-required minimum of hours.
  • Promote the use of safe alternative routes to school to lessen driving time.
  • Support later school start times to ensure teens have adequate sleep.
  • Study whether the graduated driver’s licensing provisions should be expanded to include novice drivers who are 18 or 19 years old.

The policy statement also notes that adolescents with medical concerns such as attention-deficit/hyperactivity disorder, concussions or sleep apnea may be at higher risk if their driving ability is affected.

“For many teenagers, driving is an important rite of passage,” Dr. Alderman said. “We want to help them navigate this new privilege safely. Families can ask their pediatrician to share in a conversation with their new driver to set expectations and decrease risks.”



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Flu Vaccines 2018-2019

First Aid NeonFlu Vaccines 2018-2019 Season

  • Flu injection for 6 months to 3 years: in stock
  • Flu injection for 3 years and older: in stock.

Flumist is not recommended for this year and we will not be stocking it.

Please call to schedule an appointment. We schedule them throughout the day and ask that you call ahead to make sure you don’t have to wait too long.

We are offering flu shots for healthy parents with PPO and POS insurance.

HMO parents should contact their physician or plan for immunization options.

Sign up for vaccine stock updates @casaverdepeds

Read why to get a flu vaccine HERE

Vaccines for Children Program

Children with Blue Cross through Children’s First Medical Group or Contra Costa Health Plan receive their shots through the Vaccines for Children (VFC) program.

VFC Flu Vaccines 2018-2019 Season

  • Flu injection for 6 months and older: Expected in September-October
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Flu Shots 2018-2019

IMG_7705From the American Academy of Pediatrics:
All children should receive the flu shot as soon as it is available.
This season, the AAP recommends that pediatricians offer the injectable form of the vaccine to all children 6 months and older as soon as it becomes available, preferably by the end of October. The AAP recommends the injectable flu vaccine as the primary choice for children because it has provided the most consistent protection against all strains of the flu virus in recent years.
The AAP and CDC also support the use of the nasal spray vaccine – or live attenuated influenza vaccine (LAIV4) – for the 2018-2019 season with the aim of adequate vaccination coverage and optimal protection in children of all ages.
Since the nasal spray did not work as well against influenza A/H1N1 strain during the 2013-2014 and 2015-2016 flu seasons, it was not recommended in the U.S. for the past two flu seasons. Vaccine effectiveness can vary from one flu season to the next. The effectiveness of the latest nasal spray vaccine for this upcoming season is more of an unknown against the influenza A/H1N1 strain.
Therefore, AAP recommends the flu shot as the first choice for children.
“The flu virus is common – and unpredictable. It can cause serious complications even in healthy children,” said Flor M. Munoz, MD, FAAP, member of the AAP Committee on Infectious Diseases. “Being immunized reduces the risk of a child being hospitalized due to flu.”
The 2017-2018 flu season became one of the most severe seasons on record, excluding pandemics, according to the U.S. Centers for Disease Control and Prevention.
As of Aug. 18, 2018, a total of 179 children died of influenza-associated deaths, and thousands more were hospitalized. About 80 percent of the children who died had not received a flu vaccination, according to the CDC.
“Staying healthy is the goal for all of us. As a pediatrician and mom, I see too often how quickly the flu spreads,” said Wendy Sue Swanson, MD, MBA, FAAP, a pediatrician in Seattle and an AAP spokesperson. “Unfortunately, you can spread influenza without realizing it because some infected people begin to spread the virus a day or two before they have symptoms. Get the shot. It just makes sense.”
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Insect Repellents and Kids

mosquito-clip-art-AT-1-300x215Good article from Consumer Reports (and I helped).

More info here.

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Eating In, Snacks and Picky Eaters

Apple PearBreakfast, lunch and dinner pretty much covers it, but if you offer snacks, make them healthy and not so large to discourage kids from eating the healthy things offered at meals.

Up your game with the quiz and planner here.

Want info on cooking for the family? Check out Choose My Plate.

“Picky” or just waiting to see if you’ll cave and offer food with high fat, salt and sugar? Coping strategies here.


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Urgent Care

First Aid NeonWith the rise of urgent care centers and after hours clinics, it can seem like an easy decision to get your baby, child or young adult seen any time they are sick, even when we aren’t open.

Those types of clinics are best reserved for the times that your child needs urgent or emergency care and not just because it is convenient.


The emergency room is for emergencies–a life-threatening illness or injury that can’t wait for a trip to the doctor’s office. But what about walk-in clinics popping up inside drug stores and shopping centers and big box stores? Is it ever acceptable to go to a walk-in for relatively minor health complaints like earaches and sore throats?


Certainly, these clinics can be helpful, especially if you are away from home or an illness occurs after hours. But just like the ER, they don’t meet the definition of a medical home, and for the health of your child, you should think twice about using them routinely. In the long run, you may not save time seeing someone who doesn’t really know your child and isn’t a pediatrician.


Remember that you can always call our office for after hours advice.


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Disaster Preparedness for Families

First Aid Badge

No one can be completely prepared for a disaster, but planning helps.

Our local chapter of the American Academy of Pediatrics offers the following resources:

How to Talk with Kids

Talking about Natural Disasters with Children audio link.

Family Readiness Kit

Helping Children Cope



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Sleep on It


sleepdogThe American Academy of Pediatrics (AAP) has issued a Statement of Endorsement supporting the American Academy of Sleep Medicine (AASM) guidelines outlining recommended sleep duration for children from infants to teens. The guidelines, “Recommended Amount of Sleep for Pediatric Populations” was published June 13, 2016 in the Journal of Clinical Sleep Medicine. The AAP endorses the guidelines and encourages pediatricians to discuss these recommendations and healthy sleep habits with parents and teens during clinical visits.

The consensus group recommends the following sleep hours:

  • Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
  • Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health.
  • Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health.
  • Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health.
  • Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health.

The group found that adequate sleep duration for age on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Not getting enough sleep each night is associated with an increase in injuries, hypertension, obesity and depression, especially for teens who may experience increased risk of self-harm or suicidal thoughts.

In addition to these recommendations, the AAP suggests that all screens be turned off 30 minutes before bedtime and that TV, computers and other screens not be allowed in children’s bedrooms. For infants and young children, establishing a bedtime routine is important to ensuring children get adequate sleep each night. The AAP program, “Brush, Book, Bed,” is available here:

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