Rhode Island Child Passenger Safety Law Effective July 1, 2009:

• Children up to their eighth (8th) birthday, unless they are four feet, nine inches (57 inches) tall or 80 pounds in weight, must ride in appropriate child restraints.
• Infants must ride in REAR-facing child restraints to at least one year of age and 20 pounds. (It is best to keep them rear facing up to the maximum weight of the seat as listed by the manufacturer for rear facing use, which may exceed 20 pounds.)
• Once a child has exceeded the maximum weight limit of a child safety seat (FORWARD facing), booster seats must be used for children to their eighth birthday, unless they are four feet, nine inches (57 inches) tall or weigh 80 pounds.
• In Rhode Island, there is a primary law (i.e., vehicle may be stopped without any other violation) if anyone under the age of 18 is not properly restrained. The driver of the vehicle is responsible to ensure that all passengers are properly restrained and for any violations.
• Children under age 8 must be properly restrained in the back seat, unless there is no back seat or the number of children being transported exceeds the number or rear-seating positions. (In such instances, the oldest child should sit in the front with the seat adjusted as far back as possible.) NEVER place a rear-facing child safety seat in a front seating position in front of an active air bag.

Finally 
If you have not signed up for our automatic email notification when a new post is made, follow the link below and do it now. We think it will be a great help to you and your family.

http://www.lincolnpedi.com/resources/email-updates/

Sincerely,

LPA

Burns are among the most common accidental injuries in infants and children, and scalding injuries occur most frequently. Children commonly are burned by hot liquids spilled from a table or stove, but approximately 3,800 injuries and 30 deaths each year are reported to be due to burns from tap water that is too hot. The amount of contact time required to produce a third-degree burn is less than parents may realize.

Water Temperature Time Until Third-degree Burn Occurs:

150ºF 2 seconds

140ºF 6 seconds

130ºF 30 seconds

120ºF 5 minutes

Therefore, the Consumer Product Safety Commission has recommended that all water heaters be set to 120ºF. Parents should call their local electric or gas companies for instructions on adjusting the temperature. Parents who live in apartments should talk with their building managers about having the temperature lowered because the hot water heaters in most apartment buildings are set at higher temperatures to provide hot water to all tenants. In addition to setting hot water heaters to a lower temperature, parents should hand-test water before bathing children and infants, and young children never should be left unsupervised in the bathroom.

Sincerely,

LPA

Since last fall, a number of you have utilized our website and sent us a number of suggestions via our suggestion box. One result of a suggestion we received was the addition of an automated email notification system when our main page is updated (see below). We would like to take this time to respond to some of the other comments we have received. A few sample comments will be listed below.

1. Comment:  I would love to be able to email quick questions to you so I don’t bother you with phone calls. Love the flu vaccine updates on the homepage. I check them every day waiting for a cling for school age children who missed getting their vaccine in Lincoln. Thanks for doing such a great job!

Comment: My suggestion is for the doctors to have email correspondence. Sometimes I have questions and I hate to call and leave a message for the dr to call me back. Not that the questions aren’t important, I mean they are to me obviously but they aren’t emergencies. I would love to see you office take this on. Dr. Hines is so great about giving advice with behavior issues but seeing him once a year for well visits only is tough. Email is the quickest and most painless way to communicate these days and would make the dr. patient (mommy) relationship so much stronger. Anyway, that is my 2 cents. Have a great holiday!!!

Some of the comment had to do with email correspondence with the physicians as noted in the two comments above. We are not quite there yet on this issue. Converting to an Electronic Heath Record has taken a lot of our time and energy. It is a good suggestion, but one that is on hold for now. The phone is still the method of choice to communicate with our patients.

2. Comment: When I first Lincoln Pediatrics for my children’s primary care Dr.’s I used to call in the mornings and a Dr. used to pick up. Now the answering service picks up most of the time and I hardly get to speak to a Dr. directly unless I request a call back which sometimes takes longer. It says in your website and I thought policy was that we could call before hours to speak to a physician directly. Why is this so? I prefer to speak to my child’s Dr. directly when it comes to a medicine that is not agreeing with my child or a particular concern re: my child.

Comment: I think you need to improve your phone service. I am a new patient and every time I have had to call to schedule an apt or for the doctor line I only get busy signals. It is really frustrating and I have considered leaving the practice b/c of it. I am sorry if I sound frustrated but I came from Mass General and there was never an unanswered phone call. In addition- one of the benefits you advertise is a 24 hour nurse line but but I cannot even get through to get any help. Thanks

Other comments had to do with our phone service as noted in the two comments above. In midst of the H1N1 crisis, we were inundated with phone calls as was every other physician’s office. We had added an additional phone line installed prior to the flu season (giving us a total of five phone lines), but this proved inadequate. We apologize for any inconvenience or frustration this caused. Most of the year it should not be difficult to get through to our office. We do have our calling time every morning from 7-8 A.M. We try to be faithful to this time, but early morning meetings, vacations, and sickness sometimes interrupt our call-in schedule. You should always be able to reach someone 24-7, including after hours and on weekends through our answering service. We do use a professional nursing service at times in the evenings and through the middle of the night. Please review our after hours recommendations on the patient information section of our website.

Please continue to send your suggestions and comments. We also appreciate the occasional complement as well!

Finally 
If you have not signed up for our automatic email notification when a new post is made, follow the link below and do it now. We think it will be a great help to you and your family.

http://www.lincolnpedi.com/resources/email-updates/

Again, we cannot thank you enough for all your patience and understanding during this busy season!

Sincerely,

LPA

http://www.lincolnpedi.com/wp-content/uploads/2010/01/Vaccine-Philosophy-Statement-Single-Column.pdf

Respiratory Distress
We have also seen a dramatic increase in the number of respiratory infections we are seeing in the office. In younger infants or infants with a history of prematurity this has resulted in several admissions to Hasbro because of breathing problems. The link below summarizes the things that parents should look for in assessing the  respiratory status of an ill infant.

http://www.webmd.com/parenting/baby/your-newborn-babys-breathing-noises

Last Flu Clinic
Our last flu clinic is scheduled for this Saturday, January 30, from 8-10 A.M. This is for children ages 6 months-5 years old who were not able to get the vaccine through the school system who need the second dose of H1N1 vaccine. At the present time, we do not have thimerosal-free H1N1 vaccine available for injection. The H1N1 mist version does not contain thimerosal. We do not believe thimerosal poses any risk, but provide this information as a courtesy for those families who wish to know. We strongly encourage you to make sure your child receives both doses to achieve full protection.

Finally 
If you have not signed for our automatic email notification when a new post is made follow the link below and do it now. We think it will be a great help to our patients and their families.

http://www.lincolnpedi.com/resources/email-updates/

Again, we cannot thank you enough for all your patience and understanding during this busy season!

Sincerely,

LPA

Saturday January 9: School age Massachusetts residents, H1N1 injectable and mist.

Saturday January 16: School age Rhode Island residents who were unable to receive the vaccine in school, H1N1 injectable and mist.

Saturday January 23: Catch-up second dose H1N1 (6 months -5 years old who were not able to get the vaccine through the school system).

Saturday January 30: Catch-up second dose H1N1 (6 months -5 years old who were not able to get the vaccine through the school system).

We strongly encourage you to make sure your child receives both doses to achieve full protection. Thanks for your patience.

Sincerely,

LPA

ADDENDUM: AUTOMATIC EMAIL UPDATES

We are now happy to offer you automatic email notification when a new post is made to our website. This was done in response to a suggestion made from one of our parents through our suggestion box. (We do take your suggestions seriously!) On our website go to resources>email updates and follow the instructions. You will receive a confirmatory email to which you must respond to be signed up. You will at that point be officially signed up to receive automatic updates. Any time a new post is made (for example an update on the flu clinics) you will be automatically notified by email with a link to our website. You may unsubscribe at any time. Your email address is not used for any other purpose. We hope you enjoy this new feature of our website.

ANNOUNCING: WE ARE HAVING THE LAST FLU CLINIC BEFORE THE NEW YEAR THIS SATURDAY, DECEMBER 5, FROM 7 AM UNTIL 10 AM, for children ages 6 months through 5 years of age. We know it’s a little early in the morning, but we are trying to get you in before the regular Saturday schedule begins in the office. We strongly encourage you to have your children vaccinated against the H1N1 and regular flu viruses. We saw cases of the flu all the way into June last spring. Please read the following:

1. We have a good supply of all vaccines, both for the regular flu and for the H1N1 flu. We do not expect to run out of vaccine at the clinic, but we can make no guarantees.

2. We are still encouraged by the health department to give children only the first dose of the H1N1 vaccine at this time. We can start giving the second dose after January 1, 2010. This is to assure that all children receive at least one dose of the vaccine before the new year. This Saturday will again be for those children who have not received the first dose of the H1N1 vaccine.

3. We will follow the same guidelines as before for children ages 6 months through 5 years of age. School age children will still be receiving the vaccine through their individual schools. Children who are 2 years and older who are otherwise healthy will be offered the intranasal H1N1 vaccine only. Children ages 6 months through 35 months will receive the injectable preservative free H1N1 vaccine if they do not qualify for the intranasal vaccine. Children ages 3-5 years old will be offered the injectable H1N1 vaccine (again if they do not qualify for the intranasal version). This vaccine does have a small amount of preservative in it and it is not considered a health risk.

4. No appointment is necessary, so please do not call our office regarding the clinic. The vaccine will be given on a first come first serve basis.

5. We encourage you to utilize the clinic, so that we have more scheduled time for sick visits during the week.

6. We have not yet had the green light from the health department to provide the H1N1 vaccine for those children who were unable to receive it in school.

The regular flu season has yet to come upon us. We do not have any indication how severe the regular flu will be. The H1N1 flu has been moderate in its severity. If your child has recently become ill, use common sense in initiating treatment. If it is a common cold or even the start of the flu, we will only tell you to do the obvious: treat the fever, increase fluids, rest, etc. We ask that unless there is a compelling reason for your child to be seen, to give it a few days first and see how your child does. We are trying to conserve appointment slots for the children who are most sick and in need of being seen. We do have to triage phone calls at times to accomplish this, so we ask for your patience and cooperation. As an office, Tamiflu is only prescribed for good reason. We do not give it to otherwise healthy children who have the flu with no other complications.

Thanks again for all your help.

LPA

High risk children who are unable to receive the intranasal vaccine include:

•Children less than 2 years of age;
•Children with a medical condition that places them at higher risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease; children with medical conditions such as diabetes or kidney failure; or children with illnesses that weaken the immune system, or who take medications that can weaken the immune system;
•Children younger than 5 years old with a history of recurrent wheezing;
•Children receiving aspirin therapy;
•Children who have had Guillain-Barré syndrome (GBS), a rare disorder of the nervous system, within 6 weeks of getting a flu vaccine,
•Children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components.

Children who are severely allergic to eggs may need to receive the vaccine through their allergist.

Let us also clear up some misconceptions, misunderstandings, etc.

1. We are in contact with the health department almost daily. The supply of vaccine is what it is.

2. We are administering the vaccine according to a strict protocol given by the health department. We don’t make the rules, but we need to abide by them.

3. We are discouraged by the DOH to administer the second H1N1 dose to children less than 10 years old until after January 1, 2010. This is to assure that all children can get at least one dose of the vaccine before the start of the new year. The good news is that first dose appears to be more effective than originally thought.

4. People who live in Massachusetts and come to our practice are eligible to receive the H1N1 vaccine according to the same guidelines we use for residents of Rhode Island. We cannot give it to school age children who are scheduled to receive it through the school system. Massachusetts is slowly starting to offer it through the schools, but on a much slower pace than Rhode Island. However, RI will be offering a special vaccination clinic for RI residents who attend Massachusetts’s schools for children K-12 on Saturday, December 12, 2009. You must preregister at www.health.ri.gov by 4 PM on Wednesday, December 2, to attend this clinic.

5. At the present time, we can only offer the flu vaccine through our Lincoln office.

AS A REMINDER, PLEASE READ THE FOLLOWING:

With the onset of H1N1, our office (as well as other physician offices) has been inundated with calls and appointments.  We are seeing over 100 children a day in the office, approximately 1/3 of which are add-ons. Judy, our nurse, is answering in the range of 50-75 phone messages a day (and that is a conservative estimate). Our front office staff have been extremely busy in answering calls and with moving patients in and out. Our physicians are busy as well returning phone calls, seeing patients, and handling emergencies. This does not take into account that every family being seen in the office has additional questions about the flu, which lengthens each office visit. In order to provide timely care in the most efficient manner, we ask your cooperation in reading and complying with the following reminders and suggestions:

1. When leaving a phone message, leave one phone number that we can reach you at. We will make one attempt to call you back. It is helpful if you can be brief and to the point in your concerns and questions because of the volume of calls we are receiving.

2. Have your caller ID turned off. We use our back lines to return phone calls. We leave our other phone lines open for new patient phone calls. If your caller ID is on, it will greatly delay our ability to call you back as we reserve the right to keep our back-lines private.

3. Evening and weekend phone calls are for emergencies only. If you have questions about H1N1, please call Monday-Friday during the day.

4. Please do not call on nights and weekends for prescription refills. Our policy states that we also require a 2-3 day notification for refills in general.

5. Referrals are not able to be done on Mondays. Our policy states that we need a one week notification for referrals, so please plan accordingly.

6. If your child has recently become ill, use common sense in initiating treatment. If it is a common cold or even the start of the flu, we will only tell you to do the obvious: treat the fever, increase fluids, rest, etc. We ask that unless there is a compelling reason for your child to be seen, to give it a few days first and see how your child does. We are trying to conserve appointment slots for the children who are most sick and in need of being seen. We do have to triage phone calls at times to accomplish this, so we ask for your patience and cooperation.

7. As an office, Tamiflu is only prescribed for good reason. We do not give it to otherwise healthy children who have the flu with no other complications.

We will continue to update the website in a timely fashion as we get new information and vaccine supplies. We again thank you for your patience and cooperation.

LPA

Contraindications to giving the intranasal vaccine (seasonal or H1N1) include:

• Children less than 2 years of age;
• Children with a medical condition that places them at higher risk for complications from influenza, including those with chronic heart or lung disease, such as asthma or reactive airways disease;  children with medical conditions such as diabetes or kidney failure; or children with illnesses that weaken the immune system, or who take medications that can weaken the immune system;
• Children younger than 5 years old with a history of recurrent wheezing;
• Children receiving aspirin therapy;
• Children who have had Guillain-Barré syndrome (GBS), a rare disorder of the nervous system, within 6 weeks of getting a prior flu vaccine,
• Children who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components.

AS A REMINDER, PLEASE READ THE FOLLOWING:

With the onset of H1N1, our office (as well as other physician offices) has been inundated with calls and appointments.  We are seeing over 100 children a day in the office, approximately 1/3 of which are add-ons. Judy, our nurse, is answering in the range of 50-75 phone messages a day (and that is a conservative estimate). Our front office staff have been extremely busy in answering calls and with moving patients in and out. Our physicians are busy as well returning phone calls, seeing patients, and handling emergencies. This does not take into account that every family being seen in the office has additional questions about the flu, which lengthens each office visit. In order to provide timely care in the most efficient manner, we ask your cooperation in reading and complying with the following reminders and suggestions:

1. When leaving a phone message, leave one phone number that we can reach you at. We will make one attempt to call you back. It is helpful if you can be brief and to the point in your concerns and questions because of the volume of calls we are receiving.

2. Have your caller ID turned off. We use our back lines to return phone calls. We leave our other phone lines open for new patient phone calls. If your caller ID is on, it will greatly delay our ability to call you back as we reserve the right to keep our back-lines private.

3. Evening and weekend phone calls are for emergencies only. If you have questions about H1N1, please call Monday-Friday during the day.

4. Please do not call on nights and weekends for prescription refills. Our policy states that we also require a 2-3 day notification for refills in general.

5. Referrals are not able to be done on Mondays. Our policy states that we need a one week notification for referrals, so please plan accordingly.

6. If your child has recently become ill, use common sense in initiating treatment. If it is a common cold or even the start of the flu, we will only tell you to do the obvious: treat the fever, increase fluids, rest, etc. We ask that unless there is a compelling reason for your child to be seen, to give it a few days first and see how your child does. We are trying to conserve appointment slots for the children who are most sick and in need of being seen. We do have to triage phone calls at times to accomplish this, so we ask for your patience and cooperation.

7. As an office, Tamiflu is only prescribed for good reason. We do not give it to otherwise healthy children who have the flu with no other complications.

We will continue to update the website in a timely fashion as we get new information and vaccine supplies. We again thank you for your patience and cooperation.

LPA

PLEASE DO NOT CALL OUR OFFICE REGARDING THIS CURRENT POST.

This Wednesday from 2 PM-4 PM we will be giving the H1N1 preservative-free injectable immunization for children ages 6 months thru 35 months of age. PLEASE ENTER AND EXIT THROUGH THE SIDE DOOR FOR THE IMMUNIZATION. We do have a limited amount of the vaccine and it will be given on a first come basis.  As our vaccine supply replenishes, we will continue to make it available  by providing additional times for flu vaccination in our office. We are trying to work around an already busy schedule. We greatly appreciate your patience and understanding as we try to provide the best care possible for your family. Please continue to check our website for updates.

We also appreciate the suggestions and comments we are receiving through the website. Though we do not have the time at present to respond to them individually, we hope to address some of them in a future post.

With the onset of H1N1, our office (as well as other physician offices) has been inundated with calls and appointments.  We are seeing over 100 children a day in the office, approximately 1/3 of which are add-ons. Judy, our nurse, is answering in the range of 50-75 phone messages a day (and that is a conservative estimate). Our front office staff have been extremely busy in answering calls and with moving patients in and out. Our physicians are busy as well returning phone calls, seeing patients, and handling emergencies. This does not take into account that every family being seen in the office has additional questions about the flu, which lengthens each office visit. In order to provide timely care in the most efficient manner, we ask your cooperation in reading and complying with the following reminders and suggestions:

1. When leaving a phone message, leave one phone number that we can reach you at. We will make one attempt to call you back. It is helpful if you can be brief and to the point in your concerns and questions because of the volume of calls we are receiving.

2. Have your caller ID turned off. We use our back lines to return phone calls. We leave our other phone lines open for new patient phone calls. If your caller ID is on, it will greatly delay our ability to call you back as we reserve the right to keep our back-lines private.

3. Evening and weekend phone calls are for emergencies only. If you have questions about H1N1, please call Monday-Friday during the day.

4. Please do not call on nights and weekends for prescription refills. Our policy states that we also require a 2-3 day notification for refills in general.

5. Referrals are not able to be done on Mondays. Our policy states that we need a one week notification for referrals, so please plan accordingly.

6. If your child has recently become ill, use common sense in initiating treatment. If it is a common cold or even the start of the flu, we will only tell you to do the obvious: treat the fever, increase fluids, rest, etc. We ask that unless there is a compelling reason for your child to be seen, to give it a few days first and see how your child does. We are trying to conserve appointment slots for the children who are most sick and in need of being seen. We do have to triage phone calls at times to accomplish this, so we ask for your patience and cooperation.

7. As an office, Tamiflu is only prescribed for good reason. We do not give it to otherwise healthy children who have the flu with no other complications.

We have begun to receive a limited supply of the H1N1 injectable vaccine in the office for children ages 6 months to 5 years of age. We are attempting to contact and vaccinate our patients who are at highest risk for complications from H1N1 (diabetes, congenital heart diease, cystic fibrosis, etc.) until our supply of the vaccine improves. DO NOT CALL OUR OFFICE UNLESS YOUR CHILD HAS A SERIOUS MEDICAL PROBLEM SUCH AS LISTED ABOVE. We still have the intranasal vaccine for children 2-5 years of age. (See Flu Update 10-21-2009 for who can get the intranasal vaccine) School age children will still be receiving the H1N1 vaccine through the schools. Because of high demand, we are beginning to schedule appointments for the intranasal H1N1 vaccine on Tuesdays, Wednesdays, and Thursdays between 5:30-6:30 PM.   We can vaccinate only so many additional children during the week because of the business of the office. We may have additional flu clinics, but this is partly dependent on vaccine supply.

We are doing our best in a difficult situation. We realize the media does not help. We realize the messages are sometimes confusing and contradictory. Please continue to check the Website for updates and information. We also suggest checking the RI Department of Health as well as the CDC websites for updated information on H1N1. We truly need your cooperation and understanding. We will try to do our best. We ask for your best as well.