Pediatrician - Wall
3350 Highway 138 Building 2 Suite 126
Wall, NJ 07719
732-280-6455

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By contactus@steppingstonepediatrics.com
August 15, 2017
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​The following health and safety tips are from the American Academy of Pediatrics (AAP).

Making the First Day Easier

  • Parents should remember that they need not wait until the first day of class to ask for help. Schools are open to address any concerns a parent or child might have, including the specific needs of a child, over the summer. The best time to get help might be one to two weeks before school opens.

  • Many children become nervous about new situations, including changing to a new school, classroom or teacher. This may occur at any age. If your child seems nervous, it can be helpful to rehearse entry into the new situation. Take them to visit the new school or classroom before the first day of school. Remind them that there are probably a lot of students who are uneasy about the first day of school. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible. If your child seems nervous, ask them what they are worried about and help them problem solve ways to master the new situation.

  • Point out the positive aspects of starting school to create positive anticipation about the first day of class. They will see old friends and meet new ones. Talk with them about positive experiences they may have had in the past at school or with other groups of children.

  • Find another child in the neighborhood with whom your child can walk to school or ride on the bus.

  • If it is a new school for your child, attend any available orientations and take an opportunity to tour the school before the first day. Bring the child to school a few days prior to class to play on the playground and get comfortable in the new environment.

  • If you feel it is needed, drive your child (or walk with her) to school and pick her up on the first day, and get there early on the first day to cut down on unnecessary stress.

  • Make sure to touch base with your child's new teacher at the beginning or end of the day so the teacher knows how much you want to be supportive of your child's school experience.

  • Consider starting your child on their school sleep/wake schedule a week or so ahead of time so that time change is not a factor on their first couple of days at school.

Backpack Safety

  • Choose a backpack with wide, padded shoulder straps and a padded back.

  • Pack light. Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back. The backpack should never weigh more than 10% to 20% of your child's body weight. Go through the pack with your child weekly, and remove unneeded items to keep it light.

  • Remind your child to always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles.

  • Adjust the pack so that the bottom sits at your child's waist.

  • If your school allows, consider a rolling backpack. This type of backpack may be a good choice for students who must tote a heavy load. Remember that rolling backpacks still must be carried up stairs, they may be difficult to roll in snow, and they may not fit in some lockers. And review backpack safety with your child.

Traveling To & From School

Review the basic rules with your student and practice any new routes or modes of transportation:

School Bus

  • Children should always board and exit the bus at locations that provide safe access to the bus or to the school building.

  • Remind your child to wait for the bus to stop before approaching it from the curb.

  • Make sure your child walks where she can see the bus driver (which means the driver will be able to see her, too).

  • Remind your student to look both ways to see that no other traffic is coming before crossing the street, just in case traffic does not stop as required. Encourage your child to actually practice how to cross the street several times prior to the first day of school.

  • Your child should not move around on the bus.

  • If your child's school bus has lap/shoulder seat belts, make sure your child uses one at all times when in the bus. (If your child's school bus does not have lap/shoulder belts, encourage the school system to buy or lease buses with lap/shoulder belts). See Where We Stand: Safety Restraints on the School Bus for more information. 

  • Check on the school's policy regarding food on the bus. Eating on the bus can present a problem for students with allergy and also lead to infestations of insects and vermin on the vehicles.

  • If your child has a chronic condition that could result in an emergency on the bus, make sure you work with the school nurse or other school health personnel to have a bus emergency plan, if possibly, prior to the first day of class

Car

  • All passengers should wear a seat belt or use an age- and size-appropriate car seator booster seat.

  • Your child should ride in a car seat with a harness as long as possible and then ride in a belt-positioning booster seat. Your child is ready for a booster seat when she has reached the top weight or height allowed for her seat, her shoulders are above the top harness slots, or her ears have reached the top of the seat.

  • Your child should ride in a belt-positioning booster seat until the vehicle's seat belt fits properly (usually when the child reaches about 4' 9" in height and is between 8 to 12 years of age). This means that the child is tall enough to sit against the vehicle seat back with her legs bent at the knees and feet hanging down and the shoulder belt lies across the middle of the chest and shoulder, not the neck or throat; the lap belt is low and snug across the thighs, not the stomach.

  • All children younger than 13 years of age should ride in the rear seat of vehicles. If you must drive more children than can fit in the rear seat (when carpooling, for example), move the front-seat passenger's seat as far back as possible and have the child ride in a booster seat if the seat belts do not fit properly without it.

  • Remember that many crashes occur while novice teen drivers are going to and from school. You should require seat belt use, limit the number of teen passengers, and do not allow eating, drinking, cell phone conversations even when using hands-free devices or speakerphone, texting or other mobile device use to prevent driver distraction.. Familiarize yourself with your state's graduated driver's license law and consider the use of a parent-teen driver agreement to facilitate the early driving learning process. Click here for a sample parent-teen driver agreement.

Bike

  • Practice the bike route to school before the first day of school to make sure your child can manage it.

  • Always wear a bicycle helmet, no matter how short or long the ride.

  • Ride on the right, in the same direction as auto traffic and ride in bike lanes if they are present.

  • Use appropriate hand signals.

  • Respect traffic lights and stop signs.

  • Wear bright-colored clothing to increase visibility. White or light-colored clothing and reflective gear is especially important after dark.

  • Know the "rules of the road."

Walking to School

  • Children are generally ready to start walking to school at 9 to 11 years of age.

  • Make sure your child's walk to school is a safe route with well-trained adult crossing guards at every intersection.

  • Identify other children in the neighborhood with whom your child can walk to school.  In neighborhoods with higher levels of traffic, consider organizing a "walking school bus," in which an adult accompanies a group of neighborhood children walking to school.

  • Be realistic about your child's pedestrian skills. Because small children are impulsive and less cautious around traffic, carefully consider whether or not your child is ready to walk to school without adult supervision. If the route home requires crossing busier streets than your child can reasonably do safely, have an adult, older friend or sibling escort them home.

  • If your children are young or are walking to a new school, walk with them or have another adult walk with them the first week or until you are sure they know the route and can do it safely. If your child will need to cross a street on the way to school, practice safe street crossing with them before the start of school.

  • Bright-colored clothing or a visibility device, like a vest or armband with reflectors, will make your child more visible to drivers.

Eating During the School Day

  • Studies show that children who eat a nutritious breakfast function better. They do better in school, and have better concentration and more energy. Some schools provide breakfast for children; if yours does not, make sure they eat a breakfast that contains some protein

  • Most schools regularly send schedules of cafeteria menus home and/or have them posted on the school's website. With this advance information, you can plan on packing lunch on the days when the main course is one your child prefers not to eat.

  • Many children qualify for free or reduced price food at school, including breakfast. The forms for these services can be completed at the school office. Hunger will affect a child's performance in class.

  • Many school districts have plans which allow you to pay for meals through an online account. Your child will get a card to "swipe" at the register. This is a convenient way to handle school meal accounts.

  • Look into what is offered inside and outside of the cafeteria, including vending machines, a la carte, school stores, snack carts and fundraisers held during the school day. All foods sold during the school day must meet nutrition standards established by the US Department of Agriculture (USDA). They should stock healthy choices such as fresh fruit, low-fat dairy products, water and 100% fruit juice. Learn about your child's school wellness policy and get involved in school groups to put it into effect. Also, consider nutrition if you child will be bringing food to eat during school.

  • Each 12-ounce soft drink contains approximately 10 teaspoons of sugar and 150 calories. Drinking just one can of soda a day increases a child's risk of obesity by 60%. Choose healthier options (such as water and appropriately sized juice and low-fat dairy products) to send in your child's lunch.

Bullying

Bullying or cyberbullying is when one child picks on another child repeatedly. Bullying can be physical, verbal, or social. It can happen at school, on the playground, on the school bus, in the neighborhood, over the Internet, or through mobile devices like cell phones.

When Your Child Is Bullied

  • Alert school officials to the problems and work with them on solutions.

  • Teach your child to be comfortable with when and how to ask a trusted adult for help. Ask them to identify who they can ask for help.

  • Recognize the serious nature of bullying and acknowledge your child's feelings about being bullied.

  • Help your child learn how to respond by teaching your child how to:
    1. Look the bully in the eye.
    2. Stand tall and stay calm in a difficult situation.
    3. Walk away.

  • Teach your child how to say in a firm voice. 
    1. "I don't like what you are doing."
    2. "Please do NOT talk to me like that."

  • Encourage your child to make friends with other children.

  • Support outside activities that interest your child.

  • Make sure an adult who knows about the bullying can watch out for your child's safety and well-being when you cannot be there.

  • Monitor your child's social media or texting interactions so you can identify problems before they get out of hand.

When Your Child Is the Bully

  • Be sure your child knows that bullying is never OK.

  • Set firm and consistent limits on your child's aggressive behavior.

  • Help your child learn empathy for other children by asking them to consider how the other child feels about they way your child treated them.  Ask your child how they would feel if someone bullied them.  

  • Be a positive role mode. Show children they can get what they want without teasing, threatening or hurting someone.

  • Use effective, non-physical discipline, such as loss of privileges.

  • Focus on praising your child when they behave in positive ways such as helping or being kind to other children as opposed to bullying them.

  • Develop practical solutions with the school principal, teachers, school social workers or psychologists, and parents of the children your child has bullied.

When Your Child Is a Bystander

  • Encourage your child to tell a trusted adult about the bullying. Encourage your child to join with others in telling bullies to stop.

  • Help your child support other children who may be bullied. Encourage your child to include these children in activities.

Before & After School Child Care

  • During early and middle childhood, children need supervision. A responsible adult should be available to get them ready and off to school in the morning and supervise them after school until you return home from work.

  • If a family member will care for your child, communicate the need to follow consistent rules set by the parent regarding schedules, discipline and homework.

  • Children approaching adolescence (11- and 12-year-olds) should not come home to an empty house in the afternoon unless they show unusual maturity for their age.

  • If alternate adult supervision is not available, parents should make special efforts to supervise their children from a distance. Children should have a set time when they are expected to arrive at home and should check in with a neighbor or with a parent by telephone.

  • If you choose an after-school program for your child, inquire about the training of the staff. There should be a high staff-to-child ratio, trained persons to address health issues and emergencies, and the rooms and the playground should be safe.

Develop a Sleep Routine

  • Getting enough sleep is critical for a child to be successful in school. Children who do not get enough sleep have difficulty concentrating and learning as well as they can.

  • Set a consistent bedtime for your child and stick with it every night. Having a bedtime routine that is consistent will help your child settle down and fall asleep. Components of a calming pre-bedtime routine may involve a bath/shower, reading with them, and tucking them in and saying good-night to them.

  • Have your child turn off electronic devices well before bedtime.

  • Try to have the home as quiet and calm as possible when younger children are trying to fall asleep.

  • Insufficient sleep is associated with lower academic achievement in middle school, high school and college, as well as higher rates of absenteeism and tardiness. The optimal amount of sleep for most younger children is 10-12 hours per night and for adolescents (13-18 year of age) is in the range of 8-10 hours per night. See Healthy Sleep Habits: How Many Hours Does Your Child Need? for more information. 

Developing Good Homework & Study Habits

  • Create an environment that is conducive to doing homework starting at a young age. Children need a consistent work space in their bedroom or another part of the home that is quiet, without distractions, and promotes study.

  • Schedule ample time for homework; build this time into choices about participation in after school activities.

  • Establish a household rule that the TV and other electronic distractions stay off during homework time.

  • Supervise computer and Internet use.

  • By high school, it's not uncommon for teachers to ask students to submit homework electronically and perform other tasks on a computer. If your child doesn't have access to a computer or the internet at home, work with teachers and school administration to develop appropriate accommodations.

  • Be available to answer questions and offer assistance, but never do a child's homework for her.

  • Take steps to help alleviate eye fatigue, neck fatigue and brain fatigue while studying. It may be helpful to close the books for a few minutes, stretch, and take a break periodically when it will not be too disruptive.

  • If your child is struggling with a particular subject, speak with your child's teacher for recommendations on how you or another person can help your child at home or at school. If you have concerns about the assignments your child is receiving, talk with their teacher. 

  • If your child is having difficulty focusing on or completing homework, discuss this with your child's teacher, school counselor, or health care provider. 

  • For general homework problems that cannot be worked out with the teacher, a tutor may be considered.

  • Some children need extra help organizing their homework. Checklists, timers, and parental supervision can help overcome homework problems.

  • Some children may need help remembering their assignments. Work with your child and their teacher to develop an appropriate way to keep track of their assignments – such as an assignment notebook

By contactus@steppingstonepediatrics.com
July 21, 2017
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High Temps Can Make You Sick – Article from NJ Poison Control (NJ PIES)

Today is a hot one around the Garden State. As everyone continues to go about his or her daily routines, it’s important to remember that body temperature can rise to a dangerous level, making you extremely sick. Heat-related illness and deaths are preventable. Know the signs before you become a statistic.

Signs of heat-related illness

·         Heat exhaustion: heavy sweating; weakness; cold, pale, and clammy skin; fast, weak pulse; nausea or vomiting; fainting

What to do: move to a cooler location; lie down and loosen clothing; apply cool, wet cloths to as much of the body as possible; sip water; and seek medical attention if the person vomits and continues vomiting

·         Heat stroke/sun stroke: high body temperature (above 103 degrees Fahrenheit); hot, red skin - dry or moist; rapid and strong pulse; possible unconsciousness

What to do: CALL 911 immediately and follow the operator's directions - this is a medical emergency; move the person to a cooler place; reduce the person's body temperature with cool cloths or a bath; do NOT give liquids

Tips to prevent heat illness:

·         Always check for children and pets when leaving your car. Hot cars can kill. Leaving the windows down does not prevent them from getting heatstroke.

·         Air conditioning is the number one protective factor against heat-related illness and death.

·         Drink extra water (fluids) all day and less tea, coffee, cola and alcoholic beverages. Do NOT wait until you feel thirsty to drink – it may be too late!

·         Reduce or schedule outdoor activity for cooler times of the day, before 10am and after 6pm.

·         During outdoor activities, take frequent breaks and drink plenty of water or other fluids, even if you don’t feel thirsty.

·         Wear lightweight, light-colored, loose-fitting, open-woven clothes.

·         Wear a vented hat in the sun to protect yourself from the sun’s rays. Don’t forget sunscreen!

·         If you have a chronic medical problem, ask your doctor about how to deal with the heat.

 

“It is important to remember that the elderly, the very young, those with chronic illnesses, and pets are at greatest risk for developing such illnesses,” said Bruce Ruck, Pharm.D., NJ Poison Center, Rutgers NJ Medical School. Other factors such as dehydration and medicine usage may also play a role in developing heat-related illness. “Yes, you can get sick from the heat and some medications increase that chance.”

 

Medicines known to increase your risk of heat-related illness (not limited to this list):

·         Some antidepressants

·         Antihistamines (allergy medications)

·         Diuretics (water pills)

·         Antipsychotics

 

“By knowing who is at risk and what prevention measures to take, heat-related injury and death can be prevented,” said Ruck. Call the NJ Poison Experts at 1-800-222-1222 for emergencies as well as for questions or concerns regarding the medicines you take and their effects on increasing the risk of heat-related injury. If someone has collapsed, stopped breathing, or convulsing/seizing call 911 immediately, otherwise call us (NJ Poison Center) at 1-800-222-1222. Calls are free and confidential. Help is available 24/7 in more than 150 languages.

 

Help is Just a Phone Call Away!

 

Written by: Diane P. Calello, MD, Executive and Medical Director

Bruce Ruck, Pharm.D., Director, Drug Information and Professional Education

New Jersey Poison Information and Education System (NJPIES)

 

By contactus@steppingstonepediatrics.com
June 29, 2017
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As summer gets underway, teenagers may be home more often, but that doesn’t necessarily mean you’ll see more of them. If they retreat to their rooms for hours or seem cagey about their plans, don’t take it personally. Following are four truths from the NY Times about teens that may help you and your adolescent coexist.

Read on HERE

By contactus@steppingstonepediatrics.com
April 23, 2017
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Let's face it, flying with children isn't easy. Check out these tips from the American Academy of Pediatrics to assist you in your travels. 

Family Friendly Flying

 

Having a new baby around the house tends to make even the most routine of pre-parenthood tasks require a bit more forethought.

In this age of upward mobility, a large number of new parents find themselves faced with what we consider to be an altogether new form of travel: airplane travel with a baby. With a little knowledge and a positive attitude, you will find that you are very capable through even the most challenging aspects of what lies ahead. In this article, adapted we’ve included insights that apply specifically to flying with your baby. While there isn’t one answer to the question of when it’s easiest to travel, the fact of the matter is that newborns and young babies generally adapt pretty well to changes in sleep and eating schedules. 

We have found that babies tend to sleep more reliably at nighttime than they do during naptime travel after the first few weeks. If you and your baby can sleep on the plane, a late-night flight may be the way to go.

Ticket to ride

The Federal Aviation Administration (FAA) does not require the purchase of an airline ticket for any child younger than 2 years. However, because turbulence is the most common cause of nonfatal injury among passengers and flight attendants, according to the FAA, adults, coffeepots, and tray tables all need to be restrained during flight — and we believe infants should be no exception. Also, many babies who would otherwise be content to sit in their car seats and entertain themselves or sleep tend to have much greater expectations about playtime when they are held.

FAA recommendations:

  • A child weighing less than 20 pounds should use a rear-facing child restraint system (CRS).
  • A forward facing child safety seat should be used for children weighing between 20 and 40 pounds.
  • The FAA has also approved one harness-type device for children weighing between 22 to 44 pounds.

When purchasing airline tickets:

  • Contact the air carrier to see if there are any discounts available for children since buying a ticket for a child is the only way to guarantee that a child safety seat can be used during flight.

Before flying:

  • Check to make sure that their CRS is approved for use on an aircraft. This approval should be printed on the system’s information label or on the device itself.

Tips for traveling with an infant on your lap:

The safest place for a child under two on an airplane is in a car seat, not on a parent’s lap. However, if you still find yourself looking for tips about traveling with an infant on your lap, we have some useful ones to offer:

 

  • Choose your seat wisely.  A window seat is out of the way but with less easy access to the aisle. In an aisle seat, you’ll have to pay attention to a second set of body parts to make sure that heads, feet, and limbs don’t get bumped by service carts or passers-by. Book the aisle and window seats. Chances are better that the middle seat will remain unoccupied.
  • Consider the perks. As for the choices you do have when it comes to seat assignments, many parents vie for the opportunity to sit in the bulkhead rows located at the front of each section of the aircraft. These seats typically offer more space than is allotted between the rest of the rows.
  • Play the odds. When you check in at the gate, ask the ticketing agent if there are any seats still available. If there are, chances are good that they will be middle seats, and you may be allowed to secure your infant’s car seat in the window seat you had reserved for yourself.

 

At the airport

Figuring out how to get everyone and everything checked in and to the gate requires some forethought. Many airlines now require that infants without a paid ticket receive a boarding pass. And, as inconvenient as it may seem, safety regulations now require that you lift your baby out of her car seat—even if your baby is sleeping contentedly.

Time saving strategies to consider:

  • Avoid the prospect of parking and get dropped off whenever possible.
  • If you do end up driving yourselves, the divide and conquer approach leaves one adult free to park while the other checks in (assuming you are not traveling solo). Be sure to set a clearly defined meeting place before parting ways.
  • Make the most of modern-day conveniences, such as rolling luggage, Smarte Cartes, and your baby stroller or carrier.
  • Check baby gear at the gate so you’ll have one less item to lug on board.

 

Dressing for flight

We highly recommend dressing yourself and your child in easy-on, easy-off layers so that you are prepared for whatever in-flight conditions you may find. In making your selections, remember that easy access and comfort are key.

Simply put, elastic-waist pants, zip-up outfits, or easy-snap crotches are far easier than tights and lace-up or button-up-the-back Onesies when it comes to diaper changing — especially when faced with doing it in cramped quarters. 

If everything you choose to bring along fits easily in your carry on bags, it will significantly decrease the likelihood that you will leave a trail of belongings in your wake.

Supplies to carry on:

  • Diapering supplies
  • Change of clothing
  • Favorite blanket or stuffed animal
  • Tissues or paper towels

 

Easing baby's ears

Fortunately for all involved, many young babies actually do travel well in flight. As for ear pain caused by the change in cabin pressure, a great many babies never show the slightest sign of discomfort. It’s useful to know that there is a practical and realistic alternative to gum chewing that works very well for babies when it comes to relieving ear pressure.

Offer a breast, pacifier, or bottle during takeoff and initial descent. If you must get resourceful in soothing your child, take comfort in knowing that the drone of the engines usually limits how far a crying baby can be heard. Airplane cabin noise hovers around 100 decibels, and is even louder during takeoff. Using cotton balls or small earplugs may help to decrease the decibel level your baby is exposed to, and as a result make it easier for her to sleep or relax.

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3350 Highway 138 Building 2 Suite 126,
Wall, NJ 07719