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Posts for category: Well Care

February 28, 2018
Category: Well Care
Tags: ADHD  

So you have an explanation for your child's school and perhaps exasperating home life difficulties and perhaps it makes you look in a new way at yourself, a spouse or other relative who also likely has ADHD.  You may make an appointment to discuss medication with your pediatrician.  What other, non pharmacologic, treatment options might you look at?

Sleep:  A classic study in a landmark sleep text talks about a group of children with obstructive sleep apnea who had snoring, their tonsils and adenoids out.  Amazingly there were some in the group with ADHD and some with bedwetting who stopped having those problems.  What's going on?  Poor or inadequate sleep can cause those and other significant difficulties.  Sleep hygiene is the term for good sleep habits: No caffeine for 6 hours prior to sleep, no screen time for one or two hours prior to bed time, reasonable and similar bed and wake times between school and off school days, good bed time routines like brushing your teeth, shower, read or be read to.  Exercising daily for 30-40 minutes helps to relax us for sleep.  Especially in a child with ADHD, the structure of a good bed time routine is comforting, relaxing and promotes a good night's sleep.

Diet:  Another old study, the Feingold, said dyes and additives caused ADHD and that a diet free of them worked for a high percentage, there is a lot of controversy around this.  There are a small number of individuals in whom red dye causes a marked behavioral disturbance just as some people instead of being made sleepy by Benedryl become wired.  These are inherited genetic variations.  With the Feingold diet, parents had to carefully plan, structure and monitor what their children ate and when they at it.  I never cease to be amazed at how poorly many people eat.  Children with ADHD respond to sturcture and quality in their diet or the lack thereof.  Some newer thinking on diet, research proven, is around essential fatty acids.  A study of the Mediterranean diet in a group of children with ADHD showed that those who followed the diet more closely had fewer ADHD symptoms.  Was it the more fruits and vegetables, more complex carbohydrates, fewer simple sugar?  No, it was felt to be from the Omega 3's found in the fish emphasized in that diet.  That is the basis for one of the medical foods currently being given for ADHD and some other brain issues, like age related cognitive decline.  Diet is important; the Mediterranean diet has been shown to help ADHD and many chronic illnesses.  Feed your children and yourself breakfast.  Find something with adequate protein and calories to sustain them until lunch and if possible make fatty fish like tuna, salmon and other Omega 3:'s a part of your diet.  If you're vegetarian, seek out the plant sources like Flaxseed, chia seeds, brussel sprouts, hemp seeds and walnuts.

Exercise is so remarkble in it's ability to calm us, to help us sleep, to relieve anxiety, to impose our sense of well being, to give us confidence.  And it has been shown to improve school performance.  It is essential for all of us if physically possible and is certainly not limited benefitting ADHD but all of us, find something you and they like to do and do it.

Cognitive Behavior Therapy (CBT) can improve ADHD behaviors by teaching skills for handling life challenges or overcoming negative thoughts.  CBT for children with ADHD seeks to improve their behaviour and functioning via praise and rewards for acceptable outcomes like staying in your seat, being attentive, not interrupting and handing in homework.  Such therapy should come before medication in ADHD children especially the very young.

School can implement IEP's for children with ADHD, individualized educational programs tailored to the result obtained by testing.  In the home, we can implement similar plans like how, where and when homework gets done, rooms tidied, chores done.

So, outside of medication, leading a sturctured, secure life with a good diet, exercise and enough sleep and healthy expectations about behaviors can optomize life outcomes with those special people among us with ADHD.

Good quality, restorative sleep is essential for optimal health and well-being. Insufficient sleep can cause problems with irritability, decreased daytime alertness and poor academic performance, and can contribute to depression, anxiety, ADHD and other mental health issues. Most parents know that sleep is important at all ages, yet in recent years I hear more patients tell me that they often do not sleep well. 

Our society has become increasingly dependent on electronics to function in our daily lives. Most parents and children use computers at work and school, and at home we are texting on our smart phones or keeping up with friends on social media. Our children often study and complete assignments online, but recently, more evidence indicates that an increase in sleep problems may be related to these electronic devices. Light receptors in the retina transmit messages to the brain, and the brain responds with an increase in alertness. The particular type of light associated with i-pads, computers, smart phones, video games, e-readers, and other electronic devices with a lighted screen, seems to be particularly stimulating to the "awake" centers in our brains. Some people are more susceptible to this than others. 

Making it a habit to turn off electronic devices at least an hour before bedtime can be of great benefit in improving sleep. Some children who are very sensitive may require longer than this, even several hours. Encourage your child to complete their online schoolwork first, so they can read (actual books, not e-readers) and do other non-computer based assignments later in the evenings. Parents should always make sure that their children's access to social media is adequately monitored and developmentally appropriate, but it is also important that electronics not be routinely used late in the evenings and into the night-time hours. Several families have told me that they have instituted a "turn-off, turn-in" policy and at an agreed upon time, their children are to turn their devices off and leave them in a specific location (not in their bedroom, where they may be tempted) 

For children that struggle with sleep issues, having a regular bedtime routine can help them "wind down." Depending on the age of the child, bath or shower, getting schoolwork and lunches ready, story-time or reading a book, listening to soothing music or guided relaxation/meditation may be calming and beneficial. Avoid caffeinated beverages and concentrated sweets, especially late in the day. Most of my patients will tell me that they sleep better and feel better when they are involved in sports or other regular exercise. Over-the-counter and prescription sleep aids are not recommended for most children, and should be used only after consulting with your childs' pediatrician.

Some older children and teens tend to fall into bad sleep habits over the summer, staying up late and sleeping in. They then struggle with getting up early for school. Although it can be difficult, try to maintain a consistent bedtime and avoid napping after school, then staying up late again at night. It may take some time to get back into a good routine. If you suspect that a medical issue such as asthma or sleep apnea might be the cause of your child's sleep problem, please call our office to set up a consult appointment to discuss this with us. If you are concerned that your child is suffering from a mental health issue such as depression or a significant anxiety disorder, or if you suspect a substance abuse issue please call for a referral to a qualified mental health provider. 

Earlier this year my blog discussed various diets, their common characteristics and best current recommendations.  This month, I wanted to begin discussing the individual components and how much we need in our diets.


The first question onmivorous (eat everything) people ask vegetarians is "where do you get your protein?"  Most Hindus would beg to differ.  They are healthy and enjoy a vegetarian diet or a Lacto (milk products) vegetarian diet.  So maybe we don't have to eat meat protein; vegetables, dairy, legumes, eggs, grains and nuts can be rich sources of protein.  Humans need less than half a gram of protein per pound of their healthy weight daily or making it real, a 22 pound toddler needs about 8 grams of protein.  A single egg contains around 6, a piece of bread 2-4 or more, a 4 ounce glass of milk is 4 grams.  So that meal for breakfast would give the child all the protein or a minimum of 12 in that meal alone for the day. Recent studies have shown that children who eat an egg per day in the second year of life are taller generally (similar findings are out there about whole cow's milk vs. plant milks).  How should this information form our habits?  A typical 110 pound woman needs around 40 grams of protein per day.  If we take in about a third of that for breakfast, it will keep us satisfed until lunch compared to a similar breakfast in calories but without enough protein.

Some foods and their protein amounts:  Cooked meats and fish are about 7 grams per ounce, 1 egg is 6 grams, 8 ounce glass of milk is 8 grams, 1/2 ounce nuts is 6 grams, 1 tablespoon of peanut or other nut butter is 7 grams, 1/4 cup of cooked beans, peas or tofu is 7 grams, 1/3 cup of cottage or ricotta cheese is 10 grams, 1 cup of cooked oatmeal is 7 grams, 1 ounce of cheese (the harder tend to be higher) is 4-12 grams, breads or a bagel is 2.5 - 10 grams (variable), cerieals, cold per serving are very variable, pasta is 12.5 grams, Quinoa, teff, amaranth are variable but rich sources of protein.

I wrote about the toddler's breakfast; how about for grown ups?  If we try to get a quarter or a third of our protein for breakfast, how about a peanut butter sandwich on whole grain bread, an egg cheese and veggie omelet, greek yogurt with fruit, nuts or a quality granola topping, a breakfast burrito?  Cereals can be a good breakfast but many are short on protein.  Where are these gram amounts shown? On all food labels it's listed.  On another blog, I will discuss fats, carbohydrates, fiber and some of the micro nuturients we should get in a varied, balanced diet.  Remembering the 5-2-1-0 plan recommended for children (and adults) 5 servings of fruits and bvegetables per day, 2 hours max of screen time (except for school work), 1 hour of exercise and 0 sugared drinks, but getting a good breakfast with enough protein is an excellent start and enough protein the rest of the day is essential.

By Jenny Oberst, APRN, CLC
May 26, 2017
Category: Well Care
Tags: Physicals  

I have been a Family Nurse Practitioner for almost seventeen years.  I worked at Kosair Hospital (now known as Norton Children's Hospital) for six years, prior to that as an Onocology/Renal/Transplant nurse.  I also worked at Norton Hospital while attending nursing school at the University of Louisville.  I have spent all of my professional years working with children and families.  I cannot imagine doing anything else.  But the face of healthcare and insurance and its cost has changed dramatically in my years of practice.

The ever changing dilemma of health insurance coverage for ourselves and our family affects us all.  As a mother and wife keeping up with what is covered in my plan, annual deductibles, pharmacy benefits, co-pays and in and out of network providers is a huge undertaking.  Once you think you have it down a new enrollment period is upon you and it changes again.  One thing that I am certain of is you need to understand your plan and be an advocate for yourself.  Take advantage of the programs your insurance company has in place to keep costs down, ask questions, be friendly with your health insurance representatives and ASK QUESTIONS.  With the passage of "Obamacare" a few years back one of the most beneficial components is wellness benefits for all at no or minimal cost.  This is especially important for our children as they grow.  They need to be seen at each recommended and scheduled time for Well Baby-Child/Adolescent/College Age student visits.  The importance of seeing a trusted and well informed Pediatrician/Osteopath/Nurse Practitioner/Physician Assistant is imperative for health guidance and illness prevention in our next generation of adults.  The rise in healthcare costs and a US population that seems to get less fit each year should be a concern for us all.  Our children truly are our future and how we raise them and teach them will impact who they are as adults.  I believe healthcare is a basic right but the idea that it should come without financial responsibility and accountability is a reality we likely will not see again in our lifetime.  So plan and prepare, realize that health insurance is part of a famly budget.  Here are some websites to help you begin to get informed.  A healthy mind and body is essential for us all.




http://www. kyvoicesforhealth.org




By Dr. Kathleen Maurer

It's time to schedule physicals!!!

Did you now that the Academy of Pediatrics recommends a yearly physical for all school aged children? Those who sign up to play sports or register for summer camps are required to have a physical before they can participate. When time is short and schedules are busy, it might seem convenient to stop in at the local retail clinic at your grocery store or pharmacy.  When children seem healthy, parents may wonder if it is really necessary that they schedule a yearly visit at their pediatrician's office, but there are some very good reasons why this is important:

-Your child's pediatrician or nurse practitioner is familiar with your child and has access to their medical records, including their complete medical history, immunizations, growth charts, allergies, medication, and other important information

-A yearly exam may pick up on health issues that are not always obvious, such as high blood pressure, scoliosis, a new heart murmur, a concerning skin lesion, abnormalities of growth or abnormal pubertal development

-If an abnormality is found at the yearly exam, your pediatrician is able to order labs or imaging, make referrals and arrange appropriate follow up 

 -Guidelines for yearly exams include important screenings for health problems, and age-specific discussions about topics such as nutrition, safety, body changes, risky behaviors, etc 

-Yearly exams provide an opportunity for your child to become comfortable with their physician, and less likely to be overly anxious about doctor visits in the future 

-If your child is due for immunizations these can be provided at the yearly exam

-You may have heard the term "Medical Home" which has become an important concept within this past few years. It is widely recognized that patients are likely to receive better care if they have one primary physician or group where all of their records are in one place and all of their health care is co-ordinated. 

So call early to get your children in for their physicals and get the jump on sports season!  Some families schedule their yearly physicals around the time of their child's  birthday, and others come in during the spring and summer so they will be ready for camp or conditioning for team sports. We have forms available at our office for school physicals and sports physicals. If your child needs a camp physical or if their school has their own form, please bring them in when you come. 

We look forward to seeing you!