This webinar is intended for all parents, with children of various ages (infant – older children), to learn about sleep guidelines, general sleep facts, common sleep issues, and much more! Our panel includes Allied Physician Group pediatricians, Dr. Kerry Fierstein (Pediatric Health Associates, Plainview, NY) and Dr. Janice Montague (Tuxedo Pediatrics, Suffern, NY), as well as Child Sleep Specialists, Seema Bhambri, and Zeenat Hameed-Zaman.
Yesterday there was an article published by Newsday that discussed the challenges of telemedicine and getting patients to click the app.
Allied Physicians Group has been offering telemedicine to our patients since January 2018. We started with one office during the daytime, and then rolled out after-hours telemedicine visits in March 2018 from that same office. Then, at the end of September, we expanded the program to include all of Allied’s offices. These visits are performed by a board-certified Allied pediatrician who has access to the patient’s complete medical records while at the same time doing a visit through out HIPAA compliant platform. Some of our patients even own a device that enables the doctor to do a virtual exam of the ear drum, heart, and lungs.
Just like the article mentions, we too have had a slower than expected adoption of this telemedicine option from our patients. But, with a lot of education about how helpful seeing a trusted pediatrician from the comfort of their living room (or kitchen table, or crib) can be under the right circumstances, our patients are using Telemedicine more and more with each passing week. Our patients have learned what conditions can be diagnosed/treated via telemedicine and which can not. Some of our biggest users at the moment are families with infants at home with issues that can be managed just as well via telemedicine without the possibility of exposure to the cold weather and contagious diseases. All Telemedicine visits are documented right in the patient’s medical record, and the office staff receives a notification of the visit as soon as they log in for the day, which makes any necessary follow up extremely easy.
“Our group offers telemedicine to our patients, so patients truly can have quality care from the comfort of their home. Telemedicine when provided by your child’s pediatric group, offers continuity of care like never before. The consumer should be educated on the difference between a “retail” telemedicine provider and their provider offering telemedicine. There’s quite a difference in the type of quality care that you are receiving. A “retail” telemedicine visit is the equivalent of an urgent care visit at best. A telemedicine visit with your providers office is an extension of the care that you trust.”- Leslie Tarver, VP Patient Experience and Marketing at Adjuvant.Health.
Naomi Zilkha, MD, FAAP
Allied Physician, Division of Telemedicine
By: Lauren Macaluso, MD, FAAP, FABM, IBCLC. Breastfeeding Medicine (New Hyde Park, NY)
Did you know an estimated 15 million babies are born too early every year, equaling more than 1 in 10 babies? These infants face significant health challenges including increased risk of necrotizing enterocolitis, a serious intestinal disease that can be fatal. Human milk provides health benefits for all newborns and is especially important for high risk very low birth weight infants. Human milk has been found to decrease the rate of necrotizing enterocolitis.
Breastfeeding and human milk are the normal standards for infant feeding. The American Academy of Pediatrics Policy Statement on Breastfeeding and the Use of Human Milk states, “The potent benefits of human milk are such that all preterm infants should receive human milk. If mother’s own milk is unavailable despite lactation support, pasteurized donor milk should be used.” Accessibility to donor milk in the U.S. is limited in terms of supply, cost and distribution.
The Allied Foundation is playing an essential role in this process. The Foundation has helped to establish three milk depots for the New York Milk Bank. The New York Milk Bank collects milk from carefully screened donors, pasteurizes it, and distributes it to infants in New York State and the surrounding area. Milk depots are locations where screened mothers can call ahead and drop off milk which is then shipped to the Milk Bank for processing and distribution.
Allied Physicians Group has three milk depot locations. Macaluso Medical in New Hyde Park, Peconic Pediatrics in Riverhead and Kenneth Zatz Pediatrics in Nyack. We are filled with pride as our milk depots have collected a total of 34,579 ounces since inception in February 2016. This equates to roughly 10,479 bottles of 100 ml donor milk going out to hospital NICUs and in need outpatients.
We have found our donors to be filled with pride at drop off and we feel this as well, as we are helping infants to get the best start in life.
On an additional note, congratulations to Allied’s Dr. Lisa Visentin for co-authoring “Breastfeeding: Uncovering Barriers and Offering Solutions”, which was recently published in the journal, Current Opinion in Pediatrics. The Allied Breastfeeding Team is here to help you meet your personal breastfeeding goals.
Button Battery Injuries in Children: A Growing Risk
More than 3,000 button batteries are ingested each year in the United States. It may be as frequent as every three hours that there is a child in the ER somewhere in this country for a battery-related emergency issue.
Small, shiny and appealing to children, button batteries can result in a major injury and even death if ingested.
What Are Button Batteries?
Button batteries are the small round batteries found in small electronics, such as:
- Remote controls
- Games and toys
- Hearing aids
- Bathroom scales
- Key fobs
- Electronic jewelry
- Holiday ornaments
As more homes use these small electronics, the risk of these batteries getting into the hands of curious and crawling infants and young children increases.
What Should Parents Do?
Parents and caregivers should not assume that every battery-powered product that enters their home is safe for use by children. In many products, for example, the battery is easily accessible or can fall out when the product is dropped. Make sure that the battery compartments of all electronic items are taped shut and loose batteries are always stored out of children’s reach.
A button battery stops powering a device way before it runs out of a charge. So, what we think of as a “dead” battery still has the charge to harm a child should it get caught in their ear, nose, and throat or swallowing passage. The higher the voltage of the battery (3V vs. 1.5V), the faster the injury.
When a child ingests a button battery, their symptoms could be virtually absent or similar to those of a common infection. This makes it challenging for health care professionals who are evaluating the child.
- When a button battery is placed in the nasal cavity or the ear canal, drainage or pain may be noted, which is not unique to button batteries. Non-specific symptoms combined with an unwitnessed placement can lead to a delay in diagnosis and even greater injury. Batteries that are lodged in the nasal cavity can cause nasal mucosal injury, periorbital cellulitis, scar tissue formation and nasal septal perforation. Injuries in the ear canal include hearing loss, tympanic membrane perforation, and facial nerve paralysis.
- When lodged in the body, the electric current in a button battery rapidly increases the pH of the tissue adjacent to the battery, causing significant tissue injury even within two hours. Esophageal button battery injuries can include esophageal perforation, mediastinitis, vocal cord paralysis, tracheoesophageal fistula, esophageal stricture, or death caused by a significant hemorrhage of an aortoesophageal fistula.
Figure 1 (left): Endoscopic view of button battery injury to nasal septum in right nasal cavity of a child.
Figure 2 (right): Rigid esophagoscopy showing button battery injury extending into the muscular layer of esophagus in a child.
If You Suspect Your Child Has Ingested a Button Battery
If a parent or caregiver is suspects their child ingested a button battery, the child needs to be taken immediately to an emergency room.
Healthcare professionals in the primary care, urgent care, and emergency room setting need to consider that any metallic foreign body in the nose, ear canal, or esophagus is a button battery until proven otherwise.
The diagnosis can be confirmed on a two view x-ray, which from a distance can sometimes be mistaken for the more commonly ingested foreign body, a coin. See Figures 3 and 4 below. Note: The button battery has the double ring, or halo sign, as opposed to a single ring of the coin.
Figure 3 (left): Double ring, or halo sign, of a button battery in the esophagus of a child.
Figure 4 (right): Homogenous appearance of a coin in the esophagus of a child.
The treatment for a button battery stuck within the body is urgent removal in order minimize local tissue damage. Both immediate assessment of the area of battery contact and follow-up surveillance for long-term, delayed complications should be performed to identify acute or delayed injuries.
Awareness is Key to Prevention
Parents and caregivers need to be aware of the risk posed by button batteries in their home. Keep loose and spare batteries locked away and store any product that uses button batteries out of reach. A child’s curiosity can be dangerous. Take the necessary precautions to prevent these situations and be sure you are prepared.
No one knows your child like you, and no one can take care of him or her medically like your pediatrician. An Allied doctor is on-call at all times and we want to hear from you. Learn why to call us first and how we can help you.
By: Dr. Lauren G. Macaluso, Breastfeeding Medicine (New Hyde Park, NY)
Happy World Breastfeeding Week! This is the 25th World Breastfeeding Week coordinated by WABA, the World Alliance of Breastfeeding Action. WABA is a global network of individuals and organizations concerned with the protection, prevention and support of breastfeeding worldwide. Each year World Breastfeeding Week has a theme and this year the theme is Sustaining Breastfeeding Together. The focus is about working together, forging partnerships, and addressing breastfeeding at all levels.
Breastfeeding encompasses baby, mother, partner, family, community, healthcare, workplace and government. This is a time for all of us to reflect on what we can do as individuals and together to help protect, promote and support breastfeeding.
We at Allied have come together in the greater New York metropolitan area to support breastfeeding mothers and babies. I am proud to be part of Allied Physicians Group as our mission it to provide the highest quality healthcare emphasizing respect, integrity, compassion, humility and empathy. We are working together at several levels to assist breastfeeding mothers, babies and their families.
We have physicians focused in breastfeeding medicine providing office visits covered by insurance. Lactation consultants providing phone, home and office breastfeeding support. Milk depots providing a place where mothers who make more milk than they need for their own baby/babies can drop off their milk to be shipped to the New York Milk Bank after they have become an approved donor.
We take part in group activities within our communities via the American Academy of Pediatrics, Long Island and New York Lactation Consultant Associations, and La Leche League.
We work with our local hospitals, pediatricians, obstetricians, midwives, lactation consultants, breast surgeons, ENTs, oral surgeons, and feeding, physical and occupational therapists for optimal patient care.
We are so proud of the recognition in our community of the importance of successful breastfeeding. Mothers are wanting to exclusively breastfeed and their partners and families are supportive in this journey. We are providing time and place for women to feed their babies or express their breast milk in the workplace.
The Global Big Latch On takes place this week at locations around the world where women gather together to breastfeed and offer peer support. Friends, family and the community join in to promote and support breastfeeding. It is fun and inspirational to attend, so be on the look out to take part and support breastfeeding.
By: Dr. Karen Lidoshore- Fuld, Pediatric Health Associates (Plainview, NY)
Many of you have seen or heard about the recent death of an 18 day old baby girl following infection with Herpes Simplex Virus from a kiss. It is important for us to remember that this type of transmission to a newborn and extent of disease is an extremely rare occurrence. It is also important to understand how we as parents can do our best to prevent HSV transmission.
There are 2 types of Herpes Simplex infection; HSV-1 which usually causes cold sores and fever blisters on the mouth and lips, and HSV-2 which causes most cases of genital herpes. According to the World Health Organization close to 70% of people under the age of 50 are infected with HSV-1. Approximately 16% of people age 14-49 test positive for HSV-2.
Herpes affects about 1 in 3,500 babies in the United States each year. Transmission to a newborn can occur either in utero (extremely rare), during labor and birth, or after birth. During labor or birth is the most common way that a newborn can acquire the virus. After birth, a parent or another family member or friend can pass the virus to the newborn as occurred in this case. Unfortunately, most people can shed the virus in their saliva without any symptoms, though sometimes they will have a cold sore on their lips.
Symptoms of HSV-1 in babies (seen 2-12 days after exposure).
- Fever (100.4 or greater –rectally)
- Poor feeding
- Itching and/or burning around the mouth or lips (Does your child pull away and begin crying during breastfeeding, or when the lips or mouth come in contact with an object, or when you touch them?)
- Floppiness (of the body)
- Redness of the gums
- Swollen, tender lymph glands
- Cold sores (on, inside or around the lips and/or mouth; may also occur on the face)
Prevention of transmission of HSV to the newborn is possible in most cases. If you are pregnant and have a history or signs and symptoms of genital HSV-2 infection, tell your doctor as soon as possible. A C-section delivery is recommended if a mother has an HSV-2 outbreak near the time of birth. In terms of HSV-1 transmission, it is essential that you have anyone who will touch the baby wash their hands thoroughly with soap and water. Also, do not kiss your baby or let others kiss your baby on the lips, whether or not there are visible cold sores.
A Roadmap to Improving Support for Breastfeeding Mothers
Washington, DC—Three out of four women in the United States provide their infants with the healthiest start in life by breastfeeding, and today Surgeon General Regina Benjamin called on the entire nation to support the removal of barriers to this important public health behavior. The Surgeon General’s Call to Action to Support Breastfeeding is an unprecedented document from the nation’s highest medical source, calling on health care providers, employers, insurers, policymakers, researchers, and the community at large to take 20 concrete action steps to support mothers in reaching their personal breastfeeding goals.
The United States Breastfeeding Committee (USBC) applauds the Call to Action, which is based on the latest evidence about the health, psychosocial, economic, and environmental effects of breastfeeding. The document includes action steps and implementation strategies for six major sectors of society:
- Mothers and their Families: emphasizes the need to educate and inform families about the importance of breastfeeding, and provide the ongoing support mothers need to continue.
- Communities: calls upon the entire community to support breastfeeding mothers, including the provision of peer counseling support, promotion of breastfeeding through community-based organizations and traditional and new media venues, and the removal of commercial barriers to breastfeeding.
- Health Care: urges the health care system to adopt evidence-based practices as outlined in the Baby-Friendly Hospital Initiative, provide health professional education and training, ensure access to skilled, professional lactation care services, and increase availability of banked donor milk.
- Employment: calls for paid maternity leave and worksite and child care accommodations that support women when they return to work.
- Research and Surveillance: emphasizes the need for additional research, especially regarding the most effective ways to address disparities and measure the economic impact of breastfeeding, and calls for a national monitoring system.
- Public Health Infrastructure: calls for enhanced national leadership, including creation of a federal interagency workgroup, and increasing the capacity of the United States Breastfeeding Committee and affiliated state coalitions.
According to USBC Chair Robin Stanton, “The Surgeon General’s Call to Action to Support Breastfeeding truly paints the landscape of breastfeeding support in the United States, demonstrating a society-wide approach to removing the barriers that make it difficult for many women to succeed. The United States Breastfeeding Committee urges all Americans to be proactive in using these action steps as a springboard to extend support so that mothers throughout the country get the care, help, and encouragement they deserve. USBC looks forward to partnering with both public and private entities on implementation of the action steps.”
For more information on the Call to Action, visit www.surgeongeneral.gov. To receive updates and information from USBC, please consider signing on to support Breastfeeding: A Vision for the Futureat www.usbreastfeeding.org/vision. USBC publications, including an analysis of the barriers to exclusive breastfeeding, can be downloaded from www.usbreastfeeding.org/publications.
USBC is an organization of organizations. Opinions expressed by USBC are not necessarily the position of all member organizations and opinions expressed by USBC member organization representatives are not necessarily the position of USBC.
The United States Breastfeeding Committee (USBC) is an independent nonprofit coalition of more than 40 nationally influential professional, educational, and governmental organizations. Representing over a million concerned professionals and the families they serve, USBC and its member organizations share a common mission to improve the Nation’s health by working collaboratively to protect, promote, and support breastfeeding. For more information about USBC, visit www.usbreastfeeding.org.