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August 01, 2018
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By Dr. Claire Cowley, FAAP, CLC

"Sleep with the fishes", "to sleep per chance to dream", "sleep like a baby", "sleep on it", "beauty sleep".  Sleep is monumental and essential as in this Irish Proverb:  "A good laugh, a long sleep are the best cures in a doctor's book".  Did you know animals would die of sleep deprivation before starvation?  So sleep is important for our looks, our health, both mental and physical; philosophers, writers and most everyone agree.  Thomas Edison wrongfully, we now know, disagreed "sleep is an absurd waste of time".  Americans now sleep about two hours less than they did a century ago with alarming consequences.  Underslept people are more moody, irritable, and irrational.  Sleep deprived suspects held by the police, it's been shown, will confess to anything in exchange for rest.  Lack of sleep in adults is associated with hypertension, obesity, type 2 diabetes, changes in cognitive function, increased heart disease and increased dementia risk.

In children sleep deprivation mimics ADHD (Attention Deficit Hyperactivity Disease) and is associated with depression, bedwetting, behavioral issues and growth disturbance.

How much sleep do children need?  Toddlers and preschoolers need about 11-13 hours, perhaps 11 at night and 2 hours of napping.  The napping may be no more than a quiet time; grade schoolers need 9-12 hours and teens through early adulthood need 8-10 hours.

Parents note sometimes that a child past their bedtime has a hard time settling down and may fight sleep and for those, an earlier bedtime may be appropriate.  Usually a bedtime between 7 and 8pm is appropriate with waking between 6:30 and 7:30am.  Kids that are more tired fight sleep and naps and exhibit some negative behaviors like defiant behavior, being accident prone and excessive talking.  Watch for the earliest signs of sleepiness; rubbing their eyes, lack of focus, yawning or crankiness.  Wait too long and you'll see a child who is wired, jumpy, frantic and a lot harder to get down.

Adolescents are a whole different set of issues:  so many activites and cell phones and other devices practically attached to their bodies.  Overscheduling, jobs, and homework make it difficult to get enough sleep.  During sleep we produce growth hormone which we need in youth to attain full growth and througout our lives to service all of our body systems.

One of the best things we can do as parents in this regard is model good sleep hygiene ourselves, by making good habits a family priority.  Look at the time a child needs to be up in the morning and plan backwards to get the proper amount of sleep.

A wise college student told me this past week that they noticed when they studied prior to a reasonable bedtime and got a good night's sleep they did better on testing than cramming all night. Our waking brain collects information and our sleeping brain consplidates, edits and stores it.  Think of our high achieving, fast track bright adolescents getting 5 and 6 hours of sleep on school nights; they risk depression, obesity, hypertension, ADHD like symptoms and more accidents due to loss of alertness.  In the United States on the Monday after Daylight Savings Time changes, there's a jump in fatal car crashes and heart attacks by 25%.

Melatonin is available over the counter and is suggested even by some physicians to promote good sleep.  Do we really need it?  Our levels surge at about 6 months of age and decline after age 50.  Circadian rhythm is the natural sleep wake cycle set up by light and dark to which the brain responds by releasing melatonin, signalling our brain to sleep.  Healthy humans without organic brain issues, circadian rhythm disturbances (like blindness or jet lag), ADHD or autism shouldn't  require extra melatonin.  Rather, a regular bedtime, a pre-bedtime routine which does not include stimulating activities like TV or rough play, a routine in which the parent is not in the room when the child falls asleep is best.  No caffeinated beverages for 6 hours prior to bedtime and no screen time 1 to 2 hours prior to bedtime.  The routine should be 20-45 minutes and might involve 3-4 soothing activities like bathing, changing to pajamas and reading stories.  The child goes to bed drowsy but awake.  A consistent bedtime helps to reinforce our natural circadian rhythm and fall asleep more easily, security at a very basic level.

Think of the homeless kids in our community trying to get an education while sleeping in cars, shelters and unstable situations.  Think of the attributes of the sleep deprived child; it's no wonder they have issues in school.  In closing, I have included an excellent link with a table to summarize good sleep hygiene.  Sources: The American Academy of Pediatrics, National Geographic, UpToDate and the online resource "Sleep Lady". 



 The prevalence of dental cavities has decreased over the past couple of decades, but continues to account for one of the most common chronic diseases. Many oral health concerns begin in childhood, but the risk of developing dental disease decreases with good preventative care.

Below are some of the most common questions addressed with pediatricians about the health of children’s teeth.

  • When should parents start brushing their child's teeth? 

It is never too early to start going through the motions of brushing your child's teeth. Before your child has teeth, you can simply massage his/her gums. Daily dental cleaning should begin when your child's first tooth appears, which usually happens between 4-15 months of age. If your child does not have his/her first tooth by 18 months, discuss with your pediatrician about a referral to the dentist.

  • How long should children brush their teeth?

It is recommended to brush for 2 minutes. Try to create fun activities to keep your child engaged while brushing his/her teeth such as singing a song, playing music, or setting a timer. 

  • What toothbrush should parents buy?

For infants, it is recommend using a small, soft bristled toothbrush. For younger children, parents should consider buying a toothbrush with a thicker handle so it is easier to hold. Be creative and purchase a toothbrush that has a character or color that your child likes.

  • What toothpaste should parents buy and how much to use?

Toothpaste with fluoride is recommended for children of all ages. For children under 3 years of age, it is recommend using a small smear of toothpaste, about the size of a grain of rice. For children 3-6 years of age, it is recommend using a pea-size amount of toothpaste.

  • When should children have their first dental visit?

The American Academy of Pediatrics (AAP) and American Dental Association (AAPD) recommends to schedule the first dental visit at or near one year of age. Early dental visits and teeth brushing reinforces the importance of oral health. If oral diseases are diagnosed early, the problems can be eliminated or kept from getting worse. If your family does not have a dentist, talk with your pediatrician at the next visit about a pediatric dentist in your area. 

  • In addition to teeth brushing, how can parents help prevent tooth decay?

There are additional steps that parents can take to help prevent tooth decay in their children. Never put your child to bed with a bottle or sippy cup containing formula, milk, or juices. These drinks contain sugar which can cause tooth decay. Also, try to transition from a bottle to a cup at or near 1 year of age.

Limit sugary drinks provided to your child. The AAP recommends no more than 4 ounces of diluted juice daily for children 6-12 months, and no more than 4-6 ounces for children 1-6 years of age. No sugary drinks are recommended for children younger than 6 months. Additionally, limit sweet and sticky foods such as hard candy, gummies, and fruit roll-ups.

December 18, 2017
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by Dr. Kathleen Maurer

Not too many years ago, children got most of their shots before they started kindergarten, and older children only needed an occasional tetanus booster .  Things have changed over the past decade, and several important vaccines are now recommended  for 11-18 year olds. Your pre-teen or teen-ager may be less than enthusiastic about getting vaccines when they come if for a sports physical or yearly exam, but it may help if they are prepared and understand the benefits of being protected from some very serious diseases. 

    1. Hepatitis A - This vaccine protects against a virus that affects the liver and can easily be transmitted person to person. There have also been a number of outbreaks through contaminated food or food handlers. International travel is also a risk factor, but with a more global society, community outbreaks have become more common. About 10-11 years ago, we began routinely giving Hepatitis A vaccine at 15 months and 2 years of age, so most of our younger patients have already had this vaccine, but many over 12 have not had this. Beginning in 2018, Kentucky Schools are requiring this vaccine for all students, so those who have not had it will need to get it. Students will need to have 2 doses of Hepatitis A vaccine at least 6 months apart.  If your child has not had both doses of Hepatitis A vaccine, please call our office to schedule an appointment.

     2. Pertussis (whooping cough) - Although this vaccine is included in the routine baby shots and preschool boosters, immunity tends to wane over time, and community outbreaks have become common. Older children and adults with pertussis may only have a very persistent and annoying cough, but this disease can be very dangerous and even fatal for vulnerable newborns and babies who are too young to be fully vaccinated. Beginning about 6 years ago, the Center for

Disease Control (CDC) and American Academy of Pediatrics (AAP) recommend all 11 year olds receive a dose of pertussis vaccine which is combined with tetanus vaccine (Tdap). This is now required for all Kentucky School children. (also recommended for all women during pregnancy, close contacts of all newborns and infants, childcare workers, and healthcare providers)

     3. Meningitis A vaccine (meningitis A, C, W, Y) -This vaccine protects against several strains of bacteria that can infect the blood, brain and spinal cord and cause serious and life threatening illness. It is most common in teens and young adults, and can spread quickly. The scary thing about this devastating and potentially deadly infection is that it can infect otherwise healthy young people, and its onset tends to be very rapid. A dose of Meningitis A vaccine is required at age 11, with a booster dose at age 16. (Certain high-risk patients may need to get this vaccine before age 11) 

     4. Meningitis B vaccine - This vaccine protects against a serogroup of the meningitis bacteria that is not included in the required Meningitis A vaccine. Within the past 5 years, multiple college campuses have experienced outbreaks of Meningitis B. The symptoms are identical to the other strains of meningitis, causing serious illness or deaths. Two doses of this vaccine are recommended for 16-18 year olds, and especially encouraged for those who will be heading to college. 

      5. HPV - Human Papilloma Virus is very prevalent in the population in general and is the cause of almost all cases of cervical cancer in women and some genital and head and neck cancers in men, as well as genital warts. Although its primary means of transmission is through sexual contact, it is not only careless people who contract this infection. Most people have no symptoms at all from this virus and it eventually clears on its own, but some cases will persist and lead to cancers. The first HPV vaccine, which covered for the most common cancer-causing strains, was approved in 2006.  The current Gardasil 9,  which has expanded protection against more strains of the virus, was approved in 2014. HPV vaccine is recommended for both boys and girls, ages 11 and up (approved down to age 9) Those who receive the first dose of vaccine prior to their 15th birthday only need 2 doses, 6 months apart, while those 15 and older will need 3 doses. 

February 07, 2017
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Welcome to our Blog!  Each month one of our providers will be posting about a topic that covers important information related to children's healthcare.  We invite you to suggest topics that you would like to see covered in our blog.  This page is for you and your kids.  To suggest a topic just call our office and let the Reception desk know you would like to make a suggestion for the Blog.  That suggestion will be relayed to our providers.  Welcome and please let us know next time we see you what you think, we value your feedback!