FALL 2012
DID YOU KNOW?

One of the best ways to
prevent getting illnesses,
like the flu, is simply washing your hands.

People who have any type
of flu should stay home
until at least 24 hours after
their fever has gone away
on its own (without medication to reduce fever).

Getting 8½ to 9 hours of
sleep a night during the flu
season can help
strengthen your immune
system, give you more
energy, and make you less
vulnerable to the flu and
stress.
TIPS FOR A SAFE HALLOWEEN
1.
Pumpkin Carving: purchase the kits that are especially made for pumpkin carving.
They include safe instruments (plastic mini-saws and drills). DO NOT USE KNIVES.
Pumpkins are slippery, which can make it easy to cut fingers and tendon injuries are
often a common result.
2.
Try to Trick-or-Treat while it is still light outside. Have a parent or older brother/sister go
Trick-or-Treating with children and try to encourage children to Trick-or-Treat in groups.
If possible, have an adult accompany all groups of children to the front door.
3.
Costumes should be made so they are:
Easy to walk in and get on/off the school bus.
Easily seen (light colors).
Short—to prevent tripping.
Comfortable—well fitting shoes.
4.
Use reflective tape on costumes for added visibility.
5.
Avoid swords, wands, and other props that may jab or poke.
6.
Provide each child with a flashlight or light stick, so they can see and be seen. Do not
use candles.
7.
Why not use make-up instead of a mask? Make sure that any make-up can be removed
with water. Do a patch test before applying the make-up: apply a small amount of make
-up to the inside of the arm and wait one hour. Do not use the product if itching or irritation occurs.
Inside this issue:
BREASTMILK OR
FORMULA?
2
8.
Masks should not go over or around the eyes. They should be taken off while crossing
the street! Cross streets only at corners, not in the middle of the block.
FLU SHOT INFO.
3
9.
Plan your route well ahead of time.
10. Confine visits to daylight or early evening hours. Go to known neighbor’s houses, or the
immediate neighborhood. Use well lit streets.
HOMEWORK
A FAMILY AFFAIR
4
BABY’S SLEEP
PATTERNS
5
12. Instruct children not to eat their candy before they return home. Examine their Halloween “haul” with them.
5-7
13. Why not give out non-food items, examples baseball cards, crayons, stickers and little
books?
BACK TO SCHOOL
KRISTY LUDWIG, PH.D
Hours and
Locations
11. Review pedestrian safety rules with children. Stay together, walk, don’t run, look both
ways before crossing, and cross only at corners.
14. Please do not let young children watch scary or violent Halloween movies!
8
Page 2
Healthy Kids
BREASTMILK OR FORMULA?
Should I feed my baby breast milk or formula?
The American Academy of Pediatrics recommends breast milk exclusively for the first 4-6 months, or iron-fortified cow's milk based formula if
breastfeeding is not possible or adequate for growth.
How much should I feed the baby if I’m breastfeeding?
 Until your milk “comes in” (3-5 days after delivery), feed frequently
(every three hours from start of one feeding to start of next feeding, or
more often if your baby wakes and cries) in order to stimulate more
milk production.
 Try to have your baby nurse from each breast for 15 minutes at each
feeding.
What if my baby won’t latch on or falls asleep soon after I latch him on?
 Undress your baby and keep him warm by holding him close to your body.
 Tickle his cheek or jaw to stimulate his reflex to suck. Try changing his diaper to wake him. If he won’t latch on at
all, try again in 20-30 minutes.
Will feeding sessions always be so frequent or so long?
 By 7-10 days old, your baby is likely to have regained the weight he lost initially. Your pediatrician will tell you if it is
okay to let your baby sleep longer between feedings, or if it is okay to decrease the length of time of your feeding
sessions.
How much does a bottle-fed baby need to eat?
 Typically 1/2 to 1 ounce every 3-4 hours for the first 3-4 days.
 Over about two weeks, feedings will increase to total 16-20 ounces per day.
 Newborns rarely exceed 24 ounces/day in their first month.
How will I know if my baby is eating enough?
 More wet diapers (3/day by 3 days old).
 Meconium changes to yellowish stools.
 Your baby consoles nicely while eating, and stays calm 1-2 hours after feeding.
 Your baby will lose weight for the first 3-4 days of life, but then gain about one ounce per day after that. Your doctor
will check this at the baby’s first visit at 7-14 days old.
What are some warnings that the baby is not getting enough or might need supplemental formula?
 No bowel movements for >24 hours.
 Green or blackish stool persists instead of turning yellow.
 Wet diapers are not heavier or more frequent by 3-4 days old.
 Your baby doesn’t console easily during or after feeding.
 Your newborn loses too much weight in its first 3-4 days of life.
 Your baby develops significant jaundice.
Where can I get help?
 Your pediatrician is a great resource for information about how your baby is doing and whether he needs help with
latching onto the breast, transferring milk from the breast, or getting more calories.
 There are Lactation consultations locally through Evergreen Hospital or Overlake Hospital.
 Log on to www.healthychildren.org for brief articles about breast and bottle-feeding.
www.MyPediatricAssociates.com
Page 3
Healthy Kids
KINDERING AND PEDIATRIC ASSOCIATES
2012 Workshops
Workshops are lead by a Pediatric Associates doctor or a qualified speaker. All workshops are
free of charge and will be held at Kindering, 16120 NE 8th Street in Bellevue from 6:30pm-8:30pm.
Registration is required. Please contact Joe Cunningham at (425)653-4321 or by emailing
[email protected]

October 18th: BETTER BEDTIME: COMMON BEHAVIOR & BIOLOGICAL SLEEP ISSUES
IN CHILDHOOD. This talk will discuss normal sleep patterns and challenges at different ages,
as well as any concerns that you have encountered with your child. Our goal is to give you
several strategies to help you and your child get a good night’s rest! This workshop will be
lead by Jervis Belarmino, MD from Pediatric Associates. Please register by October 12th.

October 24th: AN ALPHABETICAL TOOLBOX FOR PARENTING ZEN. This workshop is a
chance to reflect on the learning we do as parents, with its setbacks and successes and the
role of a parent as a child’s first and most important teacher. This workshop will be lead by
James Chattra, MD from Pediatric Associates. Please register by October 19th.
WHY DO CHILDREN NEED FLU SHOTS!
About 20,000 children in the U.S. are hospitalized yearly with flu complications, with up to 50-150 deaths per year. Vaccination protects children and prevents spread to their family and the community, especially to the very young, the elderly, and those with weak
immune systems.
Who should get a flu shot?



Anyone 6 months or older.
Families and caretakers of young children (especially babies under 6 months old who are too young for the flu vaccine).
Those with chronic health conditions like asthma, diabetes, or heart conditions who are at much higher risk for flu complications.
Why do we need a flu shot every year? Do we still need to worry about H1N1?


The virus strains change every year, so the CDC develops a vaccine each season for the best match.
The 2012-2013 flu vaccine will protect against 3 influenza viruses that research indicates will be most common during the season.
This includes influenza A (H1N1) virus, an influenza A (H3N2) virus and an influenza B virus.
When is the best time to get the flu shot?



Before the flu illness is in the community, because it takes 2 weeks after vaccination for the flu shot protection to start.
It is recommended to get flu shots as soon as they become available.
It is never too early to get the flu vaccine. Immunity lasts for the entire flu season.
Why do some children need two flu shots?

Children under 9 years old who have not received at least 2 seasonal flu shots in the past two years will likely need two flu shots
this season, spaced at least 4 weeks apart.

The first shot “primes” the immune system by showing what the flu looks like, but it is the
second flu shot that makes the antibodies preventing infection.

For these children, getting only one of the two needed doses of flu vaccine might lead to
only partial or no protection from influenza.
Flu vaccine is now available,
call today to schedule your
child's appointment.
Can the flu shot give you the flu?

No. Pediatric Associates provides the injected influenza vaccine, which contains no live virus. It cannot “give you” the flu.
www.MyPediatricAssociates.com
Healthy Kids
Page 4
HOMEWORK...A FAMILY AFFAIR
Kids are more successful in school when parents take an active interest
in their homework. It shows kids that what they do is important. Of
course, helping with homework shouldn't mean spending hours hunched
over a desk. Parents can be supportive by demonstrating study and organization skills, explaining a tricky problem, or just encouraging kids to
take a break. And who knows? Parents might even learn a thing or two!
Here are some tips to guide the way:

Know the teachers and what they're looking for. Attend school
events, such as parent-teacher conferences, to meet your child's
teachers. Ask about their homework policies and how you should be
involved.

Set up a homework-friendly area. Make sure kids have a well-lit
place to complete homework. Keep supplies, paper, pencils, glue, scissors within reach.

Schedule a regular study time. Some kids work best in the afternoon, following a snack (see below for
a great recipe idea) and play period. Others may prefer to wait until after dinner.

Help them make a plan. On heavy homework nights or when there's an especially hefty assignment to
tackle, encourage your child to break up the work into manageable chunks. Create a work schedule for
the night if necessary and take time for a 15-minute break every hour, if possible.

Keep distractions to a minimum. This means no TV, loud music, or phone calls. (Occasionally, though,
a phone call to a classmate about an assignment can be helpful.)

Make sure kids do their own work. They won't learn if they don't think for themselves and make their
own mistakes. Parents can make suggestions and help with directions. But it's a kid's job to do the learning.

Be a motivator and monitor. Ask about assignments, quiz 1/4 cup dulce de leche
zes, and tests. Give encouragement, check completed home 4 teaspoons heavy cream
work, and make yourself available for questions and concerns. Directions

Set a good example. Do your kids ever see you diligently balancing your budget or reading a book? Kids are more likely to
follow their parents' examples than their advice.
Remove the rind from the melon and cut into eight
Praise their work and efforts. Post an aced test or art project
on the refrigerator. Mention academic achievements to relatives.
melon on to each skewer, followed by a cube of


Creamy Caramel Dip (Great after school snack)
If there are continuing problems with homework, get help.
Talk about it with your child's teacher. Some kids have trouble
seeing the board and may need glasses. Others might need
an evaluation for a learning problem or attention disorder.
cubes, each approximately 1 inch, or use a melon
baller to make round balls. Cut the mango into
eight similar-sized cubes. Thread one cube of
mango and a strawberry.
Mix together the dulce de leche and cream to
make the dip, and spoon into small bowls. Serve
with the skewers.
Recipe Tip: Lemon Yogurt Dip: For a tasty alternative dip that is easy to prepare, mix 6 tbsp thick
Greek yogurt with 2 tsp milk, 2 tsp confectioner's
sugar and 2 tbsp lemon curd.
www.MyPediatricAssociates.com
Page 5
Healthy Kids
BABY’S SLEEP PATTERNS
At Pediatric Associates, we educate families with
newborns about sleep so their baby may gradually
develop a healthy sleeping pattern. Babies have an
immature nervous system. They easily become overtired which causes them to become fussy. This pattern of fussiness, especially in the evenings, worsens
at around 6 weeks and ends around 12 weeks. As
your baby's brain grows, the fussiness improves and
the sleep will become more organized. You will start
to see a pattern to feedings, naps and night-time
sleep. The following are some tips to develop good
sleep habits for your baby.

Hold your baby a lot (you cannot spoil your infant). Respond sensitively to your baby's signals.
You are not spoiling your baby by picking them up when they cry. Be sure to accept help from
friends and family because the first few months are very tiring for most new parents.

Watch your baby for signs of sleepiness or over-tiredness such as rubbing their eyes, increased fussiness or a shorter attention span. At the first sign of sleepiness, try to coach your
baby to sleep. Follow a daily "nap ritual" and a "bed-time ritual" that lets your baby know that it
is nap time or bed-time. This helps your baby develop a sleep pattern. Babies love routines.

Think of yourself as your baby's "Sleep Coach". Help your baby fall asleep for naps and bedtimes before they are too tired. An over-tired baby is "disorganized" and cannot figure out how
to settle down, taking longer to get to sleep and waking up more often at night. If your baby is
waking up within 1-2 hrs of falling asleep at night, this is often a sign that they are over-tired.

At 4 to 6 weeks old, many infants sleep longer during the first part of the night.

Most infants need to nap after about no more than 2 hours of wakefulness.

By 12 weeks old, many infants nap within 1-2 hours of awakening in the morning. Watch for
signs that your baby has developed this rhythm. If your baby seems ready, gradually place
your baby in a crib "sleepy but awake" so they learn to soothe themselves asleep.

By four to five months of age, most infants shift their bedtime earlier, usually between 6 to 8
pm. Watch for signs of sleepiness earlier and help your baby to fall asleep before they get too
over-tired. Place them "sleepy but awake" in their crib for bedtime. Babies who soothe themselves to sleep at bedtime return to sleep more easily for their night awakenings.

Infant sleep can be very FRUSTRATING. Some babies develop predictable sleep patterns
while some babies have a lot of difficulty with sleep. Call or make an appointment with Pediatric Associates if you are having any concerns about your baby's sleep.
www.MyPediatricAssociates.com
Page 6
Healthy Kids
BACK TO SCHOOL: Avoid the Parenting Pitfalls of Anxiety
Kristy Ludwig, Ph.D.
As we enter the fall and the return of a new school year, children are transitioning back into their school schedule and a new class and, for some, a new
school and a new schedule. Anxiety during times of change and transition
are common. However, a parent’s response to their child’s anxiety, particularly when the parent is also anxious about the upcoming changes, can significantly impact the child’s experience and anxiety. Permitting your child to
escape and avoid will result in more avoidance and increased anxiety and
dependence. This article provides a brief description of common parental
pitfalls and helpful strategies to more effectively reduce anxiety and prevent
avoidance.
1) Excessive Reassurance: It is important to provide reassurance within
reason, but if you constantly have to reassure, use excessive physical affection or closeness, tell the child “everything will be all right” and “there is nothing to be afraid of”, you may be creating a vicious cycle of excessive reassurance. Anxious children are often
not able to rely on themselves and will ask for reassurance far more than other children. Reassurance is a
form of attention and every time your child is anxious and you reassure him, you are rewarding his anxiety.
This attention may give your child another reason for acting anxiously and can teach him that he needs you to
handle difficult situations.
TO DO: Hold off on excessive reassurance and help your child understand that they can learn to do things
on their own. A general rule is to answer a question or provide reassurance once, and then resist the urge to
repeatedly answer the same question and provide the same information. Instead, distract your child to focus
on something else, ignore the excessive questioning or reassurance seeking behavior, and provide attention
and encouragement for brave and non-anxious behavior.
2) Being Too Directive or Taking Over: When a child is having difficulty, parents will often try to take over and
direct the child. They may tell the child exactly what to do, how to behave and what to say in anxietyprovoking situations, or they may take over and do it for them (e.g., helping a child put their coat on when the
child is trying to do it on their own, ask other children on the playground if their child can play with them). Parents usually take over after repeatedly watching their child struggle. In short term, this reduces anxiety, but in
the long-term it is a form of avoidance. It does not allow the child to face the feared situation and gives the
unintended message that the child cannot handle the situation on their own.
TO DO: Let the child do things on their own; help child identify the easiest steps of a difficult task first and
then gradually have them progress with more independence. Let your child make mistakes. They learn best
from making their own mistakes and can learn that situations are not as dangerous as they think when they
are forced to experience the situation.
3) Over Accommodating, Enabling, or Rescuing: It can be difficult for parents to continuously nag their child
so they might prefer to give in and let their child avoid (i.e. not leaving the child at home with a babysitter
when the child is crying for them not to leave, not taking your child back to soccer because they cry and don’t
want to go, staying at school for several hours because your child is having difficulty with drop-off).
TO DO: Don’t let your child avoid situations and separation because they are afraid. If needed have them sit
on the sidelines or watch, but do not remove them from the situation. In separating, do not drag it out or try to
reduce the anxiety by prolonging the separation.
www.MyPediatricAssociates.com
Healthy Kids
Page 7
4) Becoming Critical, Impatient, or Frustrated: Often it may feel like a child could do it if they only tried harder.
Becoming frustrated or angry will only make an anxious child who is clingy, difficult, or demanding more anxious. Often kids internalize the message from their parents frustration or impatience that they are not capable
or a disappointment. Being angry and frustrated can lead to critical statements such as -- “other kids can do it,
why can’t you,” “what’s wrong with you”, “you are just being difficult, there is nothing to be afraid of”.
TO DO: Identify and validate a child’s emotions by empathetically describing the child’s emotions and reactions. Be aware of your own emotions and model effective emotion regulation. Encourage and reward brave
and non-anxious behavior.
Rapee, R., Wingnall, A., Spence, S., Lyneham, H. & Cobham, V. (2008). Helping Your
Anxious Child: A Step-by-Step Guide for Parents. CA: New Harbinger Publications, Inc.
The following books and websites may be helpful for parents:
http://www.amazon.com/Helping-Anxious-Child-Step---Step/dp/1572245751/
http://www.amazon.com/Freeing-Your-Child-Anxiety-Practical/dp/0767914929/
http://www.anxietybc.com/parent/index.php
http://circleofsecurity.net/
Dr. Kristy Ludwig is a Licensed Psychologist experienced in treating anxiety disorders and helping parents
more effectively parent their anxious children. She is available to meet with children and parents at Eastside
Psychological Associates in Issaquah, and may also be conducting groups for parents of anxious children in
the fall.
PARENT SUPPORT GROUPS
Parents of children with various health concerns can help each other by sharing what they have learned. The following Parent Support
groups are available and could be a useful forum of information regarding the care, treatment and ways of dealing with the impact of
the condition on the child and family.
CHD (Congenital Heart Defects) Heart to Heart Support Group
http://groups.yahoo.com/group/seattlechd
Josephine Young, MD, parent, 425-827-4600
Children's Hydrocephalus Support group
http://www.hydrosupport.org/
Lori Poliski, parent, 425-482-0479
Diabetes Support Groups
Infant-toddler: Zuraya Aziz, parent, 425-985-9199
School age-Teens: Kathy Bolopue, parent, 425-643-0592
Feeding Issues
Tiffany English, MSW 206-499-6919
Grief Support
Jackie Kite, MSW, LICSW 206-987-2062
Sibshops (for siblings of patients)
Cathy Harrison, CCLS 206-987-3285
Seattle Children’s Hospital sponsors and hosts a variety of support
groups/networks for families. The website is www.seattlechildrens.org.
Click on Patients & Families, proceed to Support Groups.
www.MyPediatricAssociates.com
PEDIATRIC ASSOCIATES
Serving the Eastside since 1967.
Winter Phone Hours
Bellevue Office
Monday—Thurs: 7:30 AM—6:00 PM
Friday: 7:30 AM— 5:30 PM
Saturday: 8:00 AM—4.30 PM
(urgent care only)
Sunday & Holidays: 8:00 AM—4:00 PM
(urgent care only)
Factoria Office
Redmond Office
Pine Lake Office
Monday—Thurs : 7:30 AM—6:00 PM
Friday 7:30 AM—5:30 PM
Saturday: Closed
Sunday & Holidays: Closed
Monday—Thursday : 7:30 AM—6:00 PM
Friday 7:30 AM—5:30 PM
Saturday: Closed
Sunday & Holidays: Closed
Monday—Thursday : 7 :30 AM—6:00 PM
Friday 7:30 AM—5:30 PM
Saturday: Closed
Sunday & Holidays: Closed
Totem Lake Office
Redmond Ridge Office
Sammamish Office
Monday—Thursday : 7:30 AM—6:00 PM
Friday 7:30 AM—5:30 PM
Saturday: Closed
Sunday & Holidays: Closed
Monday—Thursday : 7:30 AM—6:00 PM
Friday 7:30 AM—5:30 PM
Saturday: Closed
Sunday & Holidays: Closed
Monday—Thursday : 7 :30 AM—6:00 PM
Friday 7:30 AM—5:30 PM
Saturday: Closed
Sunday & Holidays: Closed
Please note these are phone hours and not appointment times.
Pediatric Associates was established in 1967 to offer excellent healthcare to infants, children and adolescents throughout
the greater Eastside. Over the years, we have grown to seven locations in order to provide our patients unparalleled accessibility. We continue to develop our clinics as we are determined to offer unbeatable service. All of our physicians are
board certified/board eligible. In addition to regular office hours, our providers see newborns at Overlake Medical Center, Evergreen Hospital, Swedish Issaquah and children of all ages at Seattle Children’s. Our goal as healthcare professionals is to provide our patients with accessible, high quality care.
Reference for the “TIPS FOR A SAFE HALLOWEEN” article on page 1 includes
information from www.mypediatricassociates.com.
Reference for the “BREASTMILK OR FORMULA?” article on page 2 includes information from www.mypediatricassociates.com
Reference for the “WHY DO CHILDREN NEED FLU SHOT” article on page 3 includes information from www.mypediatricassociates.com
Reference for the “HOMEWORK...A FAMILY AFFAIR” article on page 4 includes
information from www.parenting.com and www.kidshealth.org
Reference for the “BABY’S SLEEP PATTERNS ” article on page 5 includes information
from www.pediatric associates.com
Reference from BACK TO SCHOOL: Avoid the Parenting Pitfalls of Anxiety
(page 6-7) was submitted by Kristy Ludwig, Ph.D.
We’re on the web! www.MyPediatricAssociates.com
Newsletter Staff
Editor-in-Chief
Teri Hailstone
Director of Human Resources
Content Editors
Stuart Minkin, M.D.
Medical Director
Katherine Nikirk, RN
Director of Staff Development/Medical
Services
Managing Editor
Jeanine Bracco
Copywriter & Design
Jeanine Bracco